Breast Cancer
Breast cancer
Breast cancer occurs when cells in the breast grow out of control and form a growth or
tumor. Tumors may be cancerous (malignant) or not cancerous (benign). The risk of
getting breast cancer has shown an increase over the years.
Current statistics put breast cancer as the number 1 cancer in females with it
constituting 15% of all new cases of cancer. According to estimates 12-13% of females
will have breast cancer in their lifetime.
Risk Factors of getting Breast Cancer
1. Older age is the main risk factor for most cancers.Breast cancer similarly is
found mostly in middle age and old age females. Although males can also get
breast cancers, the risk is quite low.
2. A personal history of invasive breast cancer , ductal carcinoma in situ (DCIS), or
lobular carcinoma in situ (LCIS).
3. A family history of breast cancer in a first-degree relative (mother, daughter, or
sister).
4. Inherited changes in the BRCA1 or BRCA2 genes or in other genes that increase
the risk of breast cancer.
5. Breast tissue that is dense on a mammogram.
6. Exposure of breast tissue to estrogen made by the body. This may be caused by:
a. Menstruating at an early age.
b. Older age at first birth or never having given birth.
c. Starting menopause at a later age.
7. Taking hormones such as estrogen combined with progestin for symptoms of
menopause.
8. Treatment with radiation therapy to the breast/chest.
9. Drinking alcohol.
10. Obesity .
Signs of Breast Cancer
- A lump or thickening in or near the breast or in the underarm area which is increasing in size.
- A change in the size or shape of the breast.
- A dimple or puckering in the skin of the breast.
- A nipple turned inward into the breast.
- Fluid, other than breast milk, from the nipple, especially if it's bloody.
- Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple).
- Dimples in the breast that look like the skin of an orange, called peau d’orange .
Diagnosing breast Cancer
1. History taking and Medical examination including a Clinical Breast exam that will
be done by a doctor.
2. Mammogram: This is an Xray of the breast to look for the suspicious lesion.
3. Ultrasonography: This is also to look for the lesion. It also helps to localize the
lesion and to take biopsy from it.
4. MRI: An MRI of the breast can also be advised by your oncologist in certain
indications.
5. Biopsy: A procedure in which tissue is taken from the lump to confirm that it is
cancerous. After confirmation, certain tests will be run on it like Estrogen &
Progesterone receptor ( ER/PR) test, Her2Neu Test, and other multigene panels.
6. PET CT scan: It is a whole body scan and is usually advised in higher stages of
cancer to look for the spread of the disease.
Breast Cancer Prevention
Cancer prevention is action taken to lower the chance of getting cancer. Some risk
factors for cancer can be avoided, but many cannot. Some preventive measures to
reduce the occurrence of breast cancer include:
1. Decreasing exposure of estrogen to breast tissue: Younger age of pregnancy has
been found to be protective against breast cancer in a study. Also, Women who
breastfed have a lower risk of breast cancer than women who have had children
but did not breastfeed.
2. Risk-reducing or prophylactic mastectomy-Some women who have a high risk of
breast cancer may choose to have a risk-reducing or prophylactic mastectomy
(the removal of one or both breasts when there are no signs of cancer). After
surgery, the risk of breast cancer becomes much lower in these women.
However, it is very important to have a cancer risk assessment and counseling
about the different ways to prevent breast cancer before making any decision
about surgery.
3. Ovarian Ablation: The ovaries make most of the estrogen that is made by the
body. Treatments that stop or lower the amount of estrogen made by the ovaries
include surgery to remove the ovaries, radiation therapy, or taking certain drugs.
This is called ovarian ablation .
4. Women who take part in physical exercise have a lower risk of breast cancer.
Breast Cancer Screening
Screening is looking for signs of disease, such as breast cancer , before a person has
symptoms . The goal of screening tests is to find cancer at an early stage when it can be
treated and may be cured .Screening tests are done when you have no cancer
symptoms. Women who have a strong family history or a personal history of cancer or
other risk factors may also be offered genetic testing .
Various methods which are offered are:
1. Mammography is the most common screening test for breast cancer.
International guidelines suggest that women after the age of 50 should undergo
once yearly mammograms to detect any asymptomatic breast cancers.
2. Women with risk factors for breast cancer, such as certain changes in the BRCA1
or BRCA2 gene or certain genetic syndromes may be screened at a younger age
and more often.
3. MRI may be used as a screening test for women who have a high risk of breast
cancer.
4. Breast examination: Breast self-exams may be done by women or men to check
their breasts for lumps or other changes. If you feel any lumps or notice any other
changes in your breasts, talk to your doctor.
Treatment of Breast Cancer
Treatment of breast cancer is multidisciplinary and requires help of Breast/Onco
surgeon, Medical oncologist, Radiation Oncologist, Geneticist, Radiologists, etc.
The following types of treatment are used:
1. Surgery
2. Radiation therapy
3. Chemotherapy
4. Hormone therapy
5. Targeted therapy
6. Immunotherapy
Radiation Therapy for Breast Cancer
Radiation Therapy in Breast cancer is mostly utilised in a postoperative setting. This is
given to the postoperative breast or chest wall along with draining nodal regions. The
aim of the treatment is to prevent local recurrences. The various protocols for
administering radiation to breast are:
1. Conventional fractionation: The standard dose of 1.8-2Gy is delivered daily and
the entire treatment duration is around 5-6 weeks.
2. Hypofractionation : Slightly higher doses than the conventional method are
delivered daily. The advantage of this is the reduced overall treatment time of 3-4
weeks. This is the standard treatment protocol across institutes now.
3. Extremely Hypofractionated ( Fast Forward Approach)- Newer trials have studied
the delivery of treatment in 1-2 weeks by giving high doses per day. These
studies in international centers have delivered equivalent results with respect to
tumor control rates and adverse event profile. However the protocol has limited
indications and needs to be discussed with the treating radiation oncologist
before starting treatment.
4. Accelerated Partial Breast Irradiation (APBI) – In cases where the tumor size is
upto 2-3 cms and no nodal burden only the tumor bed can be given radiation
instead of the whole breast. This treatment protocol is finished in 1-2 weeks and
can be done in indicated cases after discussing with your radiation oncologist.