About Breast Cancer

Breast cancer is the second most common cancer seen in women. Once thought a disease of the developed countries, the incidence of breast cancer is on the rise in India as well. Breasts are designed to produce milk for the newborn baby after delivery. Breast is made up of milk glands and supporting breast tissue. Milk glands contain milk sacs, where milk is produced and milk ducts carry the milk to the nipples from where it is discharged. The breast tissue extends up to the collarbone on top and the armpits on the side. Traditionally the shape and size of the breasts are associated with femininity and any disease affecting the breasts are psychologically traumatic.

What is Breast Cancer?

Breast cancer is a tumor (a mass of abnormal tissue) within the breast. The majority of breast cancers begin in the milk ducts, however a small number start in the milk sacs or the lobes. Like other cancers, breast cancer if unchecked also has the ability to spread to different areas. The spread occurs mainly via the lymph ducts.

Who is at risk?

Breast cancer is far more common in women than in men. Some women are at a particularly higher risk.

  • Age-risk of breast cancer increases with age.
  • Family history of breast cancer i.e. women whose mother, grandmothers, aunts or sisters have developed breast cancer, are at an increased risk.
  • Women, who previously had breast cancer, have a slightly higher chance of having breast cancer in the other breast.
    Women who started their periods (menarche) at an earlier age (before 12 years).
  • Delayed childbearing, women who did not breast-feed their infants, or those who never had children.
  • Late menopause (after 50 years)
  • Obesity
  • Diet rich in animal fat.

It is important to mention here that even if several risk factors are present, if does not necessarily mean that cancer will develop in these cases. It is equally important to mention that 75% of women who develop breast cancer have no known risk factors.

What are the signs and symptoms of Breast Cancer?

In a majority of women breast cancer is first noticed as a lump in the breast. There are other important signs and symptoms.

  • Discharge from the nipple, particularly if blood stained.
  • Change in shape or size of breast.
  • Change in appearance of skin in a part of the breast.
  • Rash on the nipples or surrounding areas.
    A lump or thickening inside the breast tissue.
    Inversion or turning in of the nipple.
  • Swelling on the upper arm
  • Swelling in the armpit

How can Breast Cancer be diagnosed?

Being in an area, which is easily accessible, the importance of early detection and diagnosis of breast cancer cannot be over-emphasized. Early detection and treatment can provide an almost 100% cure.

  • Breast Self Examination (BSE) is important as it helps the patient to detect any changes occurring in her breast by herself. All women should be taught how to do a breast self-examination. However it is reassuring to note that all lumps in the breast are not cancerous, though one must check out with the doctor, when a lump is suspected.
  • A Mammogram is an X-ray of the breast using a specially designed machine and is very useful in early diagnosis.
  • Besides BSE every woman over 40 years must have Physical Examination of the breast done by a doctor, as part of the annual check up program.
  • Following a clinical examination a Biopsy is the only definite way of confirming or ruling out breast cancer in suspected cases. A piece of breast tissue is taken for testing; this can be done by inserting a needle into the Breast (FNAC-fine needle aspiration cytology), or by an operation under local or general anesthesia. A pathologist then examines the breast tissue under the microscope to check for cancer cells.

What are the treatment options for Breast Cancer?

Surgery, chemotherapy and radiotherapy are the three options available for treating breast cancer. Often the treatment given may be a combination of 2 modalities, such as surgery followed by radiotherapy; or chemotherapy followed by surgery. Selection of the appropriate therapeutic approach depends on the location and size of the tumor, breast size, appearance on the mammogram, the extent of change in the tissues, and the preference of the patient and treating doctor.

  • Surgery is the commonest modality of cancer treatment wherein the surgeon removes the affected tissues mostly a localized tumor. The types of surgery may vary. Mastectomy means total removal of breast tissue.
  • Radiotherapy involves subjecting the tumor-bearing region either in part or whole to ionizing radiation using a variety of delivering systems.
  • Chemotherapy using cytotoxic drugs capable of arresting fast growth of cancer cells.

Life after mastectomy (surgery done to remove the breast)

Because of the traditional thinking that femininity is associated with presence of breasts, the surgical removal of a breast can be traumatic and requires rehabilitation measures. Detachable External Prosthesis, Silicone prosthesis and reconstructive surgery provide hope to these patients. Breast prosthesis are now available, to help patients feel as feminine as before and nobody can notice the difference.

The fitting of breast prosthesis should occur approximately 6-8 weeks following mastectomy. Careful measurements help in getting a well-fitted prosthesis. When fitted correctly, the prosthesis is comfortable and looks as natural as the healthy breast. Check for the following:

  • Does the prosthesis fill out the cup of the bra both top and bottom.
  • Check for similarity. Place the flats of your hands on top of both your natural breast and the prosthesis and compare size and softness.
  • Check that there is not too much fullness in the underarm extension of your breast prosthesis. You can do this by feeling with the hand, then by swinging your arms back and forth. If fullness is greater than on your other side, then try a shape with less thickness in this area.
  • Stand upright and look in the mirror to check shape and symmetry. The form should be completely covered by the bra.
  • To check final result put on a soft blouse or T-shirt. No difference should be noticed in either breasts.
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