Prevention of Breast cancer

Dr Deepak Bharti
Breast cancer is the most dreaded disease which has spread its roots among women of all ages and has become a major problem both in developed and developing countries.It is found mostly in women, but men can get breast cancer, too. 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.
DETECTION: Breast cancer detection involves clinical examination by Doctor, breast self examination (BSE) and by using Mammogram.
Clinical examination should be performed by doctor or trained nurse practitioner annually for women over 40 years, after three years for women between 20 and 40 years 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 then 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.
Breast self-examination involves checking your breasts for lumps or other changes. Many breast problems are first discovered by women themselves, often by chance. Breast lumps can be non-cancerous (benign) or cancerous (malignant).
The best time to examine your breasts is usually 1 week after your menstrual period starts, when your breasts are least likely to be swollen or tender. Examining your breasts at other times in your menstrual cycle may make it hard to compare results of one examination with another.If menstrual cycle is irregular, or if menstruation stopped due to menopause or by the removal of uterus (hysterectomy), do your examination on a day of the month that’s easy to remember.
Breast self-examination normally doesn’t cause any discomfort. If your breasts are tender because your menstrual period is about to begin, you may feel slight discomfort when you press on your breasts.
To do Breast self-examination:
* Remove all your clothes above the waist. Lie down and spread your breasts evenly over your chest and makes it easier to feel lumps or changes. Check your entire breast by feeling all of the tissue from the collarbone to the bottom of the bra line and from the armpit to the breastbone.
* Use the pads of your three middle fingers – not your fingertips. Use the middle fingers of your left hand to check your right breast. Use the middle fingers of your right hand to check your left breast. You can use an up-and-down pattern or a spiral pattern. Move your fingers slowly in small coin-sized circles.
* Use three different levels of pressure to feel all of your breast tissue. Light pressure is needed to feel the tissue close to the skin surface. Medium pressure is used to feel a little deeper, and firm pressure is used to feel your tissue close to your breastbone and ribs. Avoid lifting your fingers away from the skin as you feel for lumps, unusual thicknesses, or changes of any kind.
When in doubt about a particular lump, check your other breast. If you find the same kind of lump in the same area on the other breast, both breasts are probably normal.
In addition to examining your breasts while lying down, you may also check them while in the shower. Soapy fingers slide easily across the breast and may make it easier to feel changes. While standing in a shower, place one arm over your head and lightly soap your breast on that side. Use the flat surface of your fingers (not the fingertips) – gently move your hand over your breast, feeling carefully for any lumps or thickened areas.
It takes practice to perform breast self-examination. Having fibrocystic lumps also may make breast self-examination difficult, because lumps occur throughout the breast. Ask your doctor for tips that can help you to do it correctly.
When should you see a doctor?
After you know what your breasts normally look and feel like, any changes should be checked by a doctor. Changes may include:
* Any new lump – whether painless or painful to touch.
* Unusual thick areas.
* Sticky or bloody discharge from your nipples.
* Any changes in the skin of your breasts or nipples, such as puckering or dimpling.
* An unusual increase in the size of one breast.
* One breast unusually lower than the other.
Remember that most breast problems or changes are caused by something other than cancer.
*Even if you choose to do breast self-examination, talk to your doctor about having regular mammograms as well as regular breast checkups.
THEME 2021: This year’s BCAM theme focuses on buddying up with one another because no one should fight cancer alone. We hope that both men and women can partake and ‘buddy’ with their loved ones to protect themselves by going for regular mammograms and practice breast self-examination for early breast cancer detection.
Current strategies to decrease a woman’s risk of developing breast cancer include primary prevention, such as avoiding tobacco/alcohol use, exogenous hormone use (OCPs/HRT) and excess exposure to ionizing radiation, breastfeeding,exercise regularly, eating a healthy balanced diet and maintaining a normal weight. Chemoprevention medications are available for those at high risk, though they are underutilized in eligible women. Mastectomy and/or bilateral oophorectomy are reasonable strategies for women who have deleterious mutations in genes that dramatically increase the risk of developing cancer in either breast. Increase the use of chemo preventive agents with proven efficacysuch as tamoxifen and raloxifene in the prevention of breast cancer.
To summarize,a healthy stress free lifestyle, timely pregnancy, adequate lactation, avoid overuse of OCPs and abstinence from tobacco and alcohol are certain measures which can definitely reduce the incidence of breast cancer.
Awareness about breast self examination, beginning from 20 years of age and regular screening from physician/surgeon so that it can be detected early and treated successfully.
“Early detection is the key to prevention”
(The author is Medical Oncologist)