Dr. Rakesh Kumar Panjaliya
Cancer, the uncontrolled growth of abnormal cells is the major health issue worldwide. There are many different types of cancers but most types of cancer cells eventually form a lump or mass called a tumor. Not all tumors are cancerous. Tumors that aren’t cancer are called benign. These tumors are almost never life threatening. Breast cancer is a malignant (cancer) tumor that originates in the breast tissue; made up of glands that can make breast milk (lobules), small tubes that carry milk from the lobules to the nipple (ducts), fatty and connective tissue, blood vessels and lymph vessels. The burden of breast cancer is increasing both in developed and developing countries. The peak occurrence of breast cancer in developed countries is above the age of 50 whereas in India it is above the age of 40. About 90% of all breast cancers originate in the ducts or lobes of the breast but they can also start in the cells of the other tissues of the breast. It is found mostly in women, but men can get breast cancer, too. Breast cancer is the most common diagnosed malignancy in women worldwide (22%) and in India (18.5%) it ranks second to cervical cancer. It is the second most common cause of cancer related mortality. It affects 1 in 8 women and one third of the women having breast cancer die from it. Cancer that has not spread is called in situ, meaning “in place” which involves intraductal (DCIS) and intralobular. Cancer that has spread is called invasive or infiltrating (infiltrating ductal carcinoma, tubular carcinoma, mucinous carcinoma and medullar carcinoma). Most breast lumps are not cancer – they are benign. But some benign breast lumps can increase a woman’s risk of getting breast cancer. The American Joint committee on cancer has designated staging of breast cancer by T (Tumor size) N (Lymph Node development) M (Metastasis).
Stage O breast cancer: Known as “cancer in situ,” meaning the cancer has not spread past the ducts or lobules of the breast.
Stage 1: the tumor is small and has not spread to the lymph nodes.
Stage 2: Tumor > 2.0 < 5 cm with no metastases.
Stage 3: Tumor > 5 cm (T3) breast cancer has spread to the chest wall, or caused swelling or ulceration of the breast, or is diagnosed as inflammatory breast cancer.
Stage 4: breast cancer can be of any size and has spread to distant sites in the body, usually the bones, lungs or liver, or chest wall
DETECTION: Breast cancer detection involves methods of clinical examination by MD or nurse, mammography and breast self examination (BSE). Clinical examination should be performed by doctor or trained nurse practitioner annually for women over 40, after three years for women between 20 and 40 and more frequent examination for higher risk patients. Mammography involves the X-ray of the breast.
BREAST SELF EXAMINATION: It involves the monthly examination of the breasts and under arm area to discover any changes at the early stage. It should begin at the age of 20 and the continued thereafter. In case of menstruating women it should be done 5-7 days after the beginning of the period, whereas in case of menopausal and pregnant women at the same date during each month and it takes about 20 minutes. However most of the women don’t do BSE due to fear, embarrassment, lack of knowledge, too busy and forgetfulness.
FIVE STEPS OF A BREAST SELF-EXAM:
Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips
Here’s what you should look for:
* Breasts that are their usual size, shape, and color
* Breasts that are evenly shaped without visible distortion or swelling
If you see any of the following changes, bring them to your doctor’s attention:
* Dimpling, puckering, or bulging of the skin
* A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)
* Redness, soreness, rash, or swelling
Step 2: Now, raise your arms and look for the same changes.
Step 3: While you’re at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).
Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.
RISK FACTORS: Researchers have found a number of factors that increase chance of getting breast cancer. These are called risk factors. Risk factors do not cause breast cancer, but can increase the chances of getting breast cancer.
* Lifestyle: Breast cancer risk increases with increased consumption of alcohol, tobacco, cigarette/bidi smoking, intake of large amount of dietary fats, poor diet, less intake of fruits and vegetables, decreased physical activity and obesity.
* Menstruation: Early menses before the age of 12yrs increases the risk of breast cancer and late menopause after the age of 55yrs also increases the risk of breast cancer.
* Estrogen: This hormone is essential for normal sexual development, functioning of female reproductive organs, maintaining menstrual cycle and for normal development of breast. If its level increases in the body it adds up to the risk of having breast cancer in women’s lifetime.
* BRCA mutations
* Body weight: obesity or adult weight gain especially just before and after menopause increases the risk of breast cancer. Overweight adolescent girls are more likely to experience early onset of menstruation which in turn increases the susceptibility for breast cancer.
* Birth control pills: Prolonged use of oral contraceptives may increase breast cancer risk.
* Breastfeeding: women avoiding breastfeed enhances the chance of getting breast cancer in later stages of their life.
Apart from the above said risk factors nulliparity (having no child), late pregnancy (after the age of 30), use of hormonal replacement therapy (more than five years), family history of breast and ovarian cancer and low levels of vitamin D are thought to promote breast cancer.
(The author is Principal Investigator, “Molecular Genetic Study of Breast Cancer in J&K State” Human Genetics Research cum Counselling Centre, University of Jammu)
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