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Breast Cancer
2018-03-07 16:45:19
Breast Cancer

Breast Cancer

Breast Cancer

Breast cancer is a cancer that forms in the cells of the breasts. Breast cancer can occur in both men and women, but it's far more common in women. It is most common type of cancer effecting women all over the world. Substantial support for breast cancer awareness and research funding has helped create advances in the diagnosis and treatment of breast cancer. Breast cancer survival rates have increased, and the number of deaths associated with this disease is steadily declining, largely due to factors such as earlier detection, a new personalized approach to treatment and a better understanding of the disease. But in India awareness among women are far low than the developed countries.

Types of Breast Cancer

  1. Angiosarcoma
  2. Ductal carcinoma in situ (DCIS)
  3. Inflammatory breast cancer
  4. Invasive lobular carcinoma
  5. Male breast cancer
  6. Paget's disease of the breast

Symptoms

Nipple changes

Signs and symptoms of breast cancer may include:

A breast lump or thickening that feels different from the surrounding tissue

  • Change in the size, shape or appearance of a breast
  • Changes to the skin over the breast, such as dimpling
  • A newly inverted nipple
  • Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
  • Redness or pitting of the skin over your breast, like the skin of an orange

When to see a doctor

If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor for prompt evaluation.

Awareness is the key

As we can see that awareness among women is the key reason behind increased rate of survival in the US and other developed European countries. In India if we want to get the desired result the focus should be on awareness among women. 

 

Every person should know the symptoms and signs of breast cancer, and any time an abnormality is discovered, it should be investigated by a healthcare professional.

 

Most people who have breast cancer symptoms and signs will initially notice only one or two, and the presence of these symptoms and signs do not automatically mean that you have breast cancer.

 

By performing monthly breast self-exams, you will be able to more easily identify any changes in your breast.  Be sure to talk to your healthcare professional if you notice anything unusual.

Symptoms and Signs

Many breast cancer symptoms are invisible and not noticeable without a professional screening, but some symptoms can be caught early just by being proactive about your breast health. Keep your breast health in check with the 

 

Every person should know the symptoms and signs of breast cancer, and any time an abnormality is discovered, it should be investigated by a healthcare professional.

 

Most people who have breast cancer symptoms and signs will initially notice only one or two, and the presence of these symptoms and signs do not automatically mean that you have breast cancer.

 

By performing monthly breast self-exams, you will be able to more easily identify any changes in your breast.  Be sure to talk to your healthcare professional if you notice anything unusual.

A Change In How The Breast Or Nipple Feels

  • Nipple tenderness or a lump or thickening in or near the breast or underarm area
  • A change in the skin texture or an enlargement of pores in the skin of the breast  (some describe this as similar to an orange peel’s texture)
  • A lump in the breast (It’s important to remember that all lumps should be investigated by a healthcare professional, but not all lumps are cancerous.)

A Change In The Breast Or Nipple Appearance

  • Any unexplained change in the size or shape of the breast
  • Dimpling anywhere on the breast
  • Unexplained swelling of the breast (especially if on one side only)
  •  Unexplained shrinkage of the breast (especially if on one side only)
  • Recent asymmetry of the breasts (Although it is common for women to have one breast that is slightly larger than the other, if the onset of asymmetry is recent, it should be checked.)
  • Nipple that is turned slightly inward or inverted
  • Skin of the breast, areola, or nipple that becomes scaly, red, or swollen or may have ridges or pitting resembling the skin of an orange

Early detection is the key:

Breast cancer can't be prevented, but you can take three important steps to help detect it earlier. The 

Self-Examination

Adult women of all ages are encouraged to perform breast self-exams at least once a month.  Johns Hopkins Medical centre states,

“Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important.”

 

While mammograms can help you to detect cancer before you can feel a lump, breast self-exams help you to be familiar with how your breasts look and feel so you can alert your healthcare professional if there are any changes.

How Should A Breast Self-Exam Be Performed?

1.In the Shower

Using the pads of your fingers, move around your entire breast in a circular pattern moving from the outside to the center, checking the entire breast and armpit area. Check both breasts each month feeling for any lump, thickening, or hardened knot. Notice any changes and get lumps evaluated by your healthcare provider.

2.In Front of a Mirror 

   Visually inspect your breasts with your arms at your sides. Next, raise your arms high overhead.

 

Look for any changes in the contour, any swelling, or dimpling of the skin, or changes in the nipples. Next, rest your palms on your hips and press firmly to flex your chest muscles. Left and right breasts will not exactly match—few women's breasts do, so look for any dimpling, puckering, or changes, particularly on one side.

3.Lying Down

 When lying down, the breast tissue spreads out evenly along the chest wall. Place a pillow under your right shoulder and your right arm behind your head. Using your left hand, move the pads of your fingers around your right breast gently in small circular motions covering the entire breast area and armpit.

Use light, medium, and firm pressure. Squeeze the nipple; check for discharge and lumps. Repeat these steps for your left breast.

Any Nipple Discharge—Particularly Clear Discharge Or Bloody Discharge

It is also important to note that a milky discharge that is present when a woman is not breastfeeding should be checked by her doctor, although it is not linked with breast cancer.

Frequently asked Questions

If I have some symptoms, is it likely to be cancer?

 

Most often, these symptoms are not due to cancer, but any breast cancer symptom you notice should be investigated as soon as it is discovered. If you have any of these symptoms, you should tell your healthcare provider so that the problem can be diagnosed and treated.

If I have no symptoms, should I assume I do not have cancer?

Although there’s no need to worry, regular screenings are always important.  Your doctor can check for breast cancer before you have any noticeable symptoms. During your office visit, your doctor will ask about your personal and family medical history and perform a physical examination. In addition, your doctor may order one or more imaging tests, such as a mammogram.

Trend of breast cancer in India?

  Rising incidence of breast cancer in India

 

Breast cancer is now the most common cancer in most cities in India, and 2nd most common in the rural areas. Please have a look at the following bar graph about percentage distribution of top ten cancers in females in Mumbai. 

 

The complete details of cancers in various cities like Mumbai, Delhi, Bengaluru, Bhopal, Kolkata, Chennai, Ahmedabad etc. can be found on the PBCR (Population Based Cancer Registry) Website. After going through all the graphs, the point worth noting is that, breast cancer accounts for 25% to 32% of all female cancers in all these cities. This implies, practically, one fourth (or even approaching one thirds) of all female cancer cases are breast cancers.

Increasing incidence of BC in younger age groups (30's and 40's)

In India, we are now witnessing more and more numbers of patients being diagnosed with breast cancer to be in the younger age groups (in their thirties and forties). Please consider the adjoining graph (This is only a rough representation of the data):

 

The horizontal line lower down represents the age groups: 20 to 30 years, 30 to 40 yrs and so on. And the vertical line represents the percentage of cases. The blue colour represents the incidence 25 years back, and maroon colour represents the situation today. 25 years back, out of every 100 breast cancer patients, 2% were in 20 to 30 years age group, 7% were in 30 to 40 and so on. 69% of the patients were above 50 years of age. Presently, 4% are in 20 to 30 yrs age group, 16% are in 30 to 40, 28% are in 40 to 50 age group. So, almost 48% patients are below 50. An increasing numbers of patients are in the 25 to 40 years of age, and this definitely is a very disturbing trend.

Of course, one particular reason for higher numbers of younger patients is our population pyramid, which is broad at the base and middle and narrow at top, which means that we have a huge population in the younger age group and much lesser in older age group.

Late presentation and decreased survival

Consider the adjoining image. This was published byASCO (American Society of Clinical Oncology) in 2009, and shows the improvements in the overall five year survival for various cancers in the United States.

 

The details of ASCO article cited above, can be foundHERE . If you see, the over all5 year survival for breast cancer has increased from 75% in 1970's to almost 89% presently. This means that, out of every 100 women with breast cancer in the US, 89 women are likely to survive for atleast 5 years. There are barely any similar statistics for India available, but a rough estimate from the PBCR and HBCCR reports is that, this figure is not even more than 60%. The most important reason being lack of awareness about breast cancer and screening of the same; more than 50% patients of breast cancer present in stages 3 and 4, and outcome is not as good as earlier stages, however aggressive the treatment may be. The western nations have achieved a steadily improving and good survival mainly because of screening of breast cancer.

Lack of awareness of breast cancer, lack of screening

Breast cancer is a non existent entity for a majority of population till a near and dear one suffers from it. Healthcare is low on priority and even in major cities, screening is also an 'alien' word for most people. So naturally, this results in most people presenting only when symptomatic, and on an average, most 'symtomatic' cancers are stage 2B and beyond (significant numbers in stages 3 and 4). So the breast cancer patients do not tend to survive for a longer time, as their western counterparts.

 

In the West, majority of breast cancers (read more than 75%) present in stages 1 and 2, resulting in good survival; and there is an ever increasing numbers of patients presenting wih mammography detected cancer, with no symptoms. India needs to reach this achievement, and it is only with aggressive promotion of screening and awareness and proper treatment that India will achieve this; and will take atleast a few decades to reproduce similar results.

Aggressive cancers in the youngCancers in the young, tend to be more aggressive (Most, but not all). Many of these cancers are HER2 positive and ER/PR negative, or HER2/ER/PR all three negative, and they have a worse prognosis than those who have ER/PR positive tumours. Since chances of long survival decrease fast with increasing stage of these tumours, so all the more reason to catch these cancers early.

Moral of the story

If you have read all the above points, they are all pointing to one necessity - 'Breast Awareness'. Since the numbers of cases are rising, younger women are getting affected, most are presenting only after symptoms develop (so usually stage 2B and beyond, rarely earlier stage) and we cannot prevent this cancer, all we can do is to detect this cancer early. BREAST AWARENESS is the way to go.

Bibliography: 

Visit these links to read more:

 

 http://www.nationalbreastcancer.org/early-detection-of-breast-cancer

 

http://www.nationalbreastcancer.org/breast-cancer-symptoms-and-signs

 

http://www.nationalbreastcancer.org/early-detection-of-breast-cancer

 

Mayo clinic website

 

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