Early Detection of Breast Cancer

A Preview of Breast Cancer 

Breast cancer is diagnosed in 1 out of 4 cancer cases. Every 4 mins, one woman in India gets diagnosed with breast Cancer. By the year 2030, breast cancer will kill more women. It is also the most common cancer globally. Despite numerous medical advances in cancer cure and prevention, the numbers are rising. Therefore, it is essential that we know more about this silent killer and identify it in its early stages. It all begins with the awareness of Breast Cancer that will lead to early detection. This is the only way to tackle this growing cause of death among women of all ages.  

 

Why the emphasis on early detection for better cure

 

There are many cases where there is no family history of Breast Cancer. Many with healthy lifestyles, too, have developed breast cancer. Patients often have not exhibited any symptoms until the cancer has advanced. These are significant reasons for early screening and testing among the affected age group. 

Some of the other reasons why early detection is important

• Early detection enables successful treatment at a lower cost.
• It increases the chances of survival.
• Decreases the complications associated with therapy since cancer hasn’t spread to other organs 

 

Statistics on effective breast Cancer treatment Leading to better survival rates

The fact remains that the survival rates in India are low compared to Western countries, mainly because early detection is much lower.

In India, 60% of women report to a doctor when their cancer has reached stage 3 or 4, while 15% to 20% visit a doctor when breast cancer is in the later stage. Only 66% of women in India survive breast cancer. 

According to ICMR, less than 5% of women in Indian undergo breast screening. 

But there is hope and light at the end of the tunnel because statistics, according to the World Cancer Report 2020, state that the survival rate is high as 99% when detected early.

When Breast Cancer is detected before it has spread, the success rate of treatment is the highest. Along with early diagnosis, accurate diagnosis is also essential. 

 

Defining Breast Cancer

 

The breast has ducts and lobules, which have glandular tissue, and breast cancer forms in the lining of the epithelial tissues in these two parts. In stage 0, cancer remains within these two parts of the breast and exhibits no symptoms, as well as has the least potential of spreading, also known as metastasis. At this stage, breast cancer can be cured most successfully, enabling a patient to lead a normal life and complete their life span. 

In Stage 2, the cancer spreads to the surrounding tissues and lymph nodes, also called regional metastasis. Cancer then progresses to higher stages called distant metastasis, wherein other body organs are affected. Women usually die when breast cancer spreads to other parts of the body. 

Breast Cancer can affect women of any age after puberty, but older women are more susceptible to developing breast cancer. 

 

Factors that lead to Breast Cancer 

 

Several factors in different combinations lead to breast cancer. It isn’t easy to pinpoint the most precise reason in general. Each individual is unique, and the causes of cancer also remain subjective to individual cases. 

• Being older than age 50 years (need not be in all cases) 
• Inherited genetic mutation BRCA1 and BRCA2 individuals are at higher risk. 
• Early menstruation and later menopause expose women to hormones for a longer duration which can make them more prone to developing breast cancer. 
• Women with dense breasts are more likely to develop breast cancer because of the excessive connecting tissues. It also makes it difficult to detect tumors through mammography. 
• Women previously diagnosed with non-cancerous breast diseases like hyperplasia or lobular carcinoma in situ are at a higher risk of developing breast cancer. Women previously diagnosed with breast cancer also have the possibility of breast cancer reoccurring. 
• Family history of breast cancer or ovarian cancer 
• Women who have undergone radiation that covers the chest or breast, like Hodgkin’s lymphoma and before the age of 30 are at a higher risk of developing breast cancer. 
• Exposure to certain drugs may also lead to breast cancer developing. 

 

Who are at risk of developing breast cancer

 

• Those who are physically inactive 
• Obesity, overweight, weight gain after menopause 
• Undergone any hormonal treatment 
• Excessive consumption of alcohol 
• Smoking 
• Never breastfed, never had a full-term pregnancy, pregnancy at a later age.

These broad factors make one more prone to developing cancer, but they need not always develop into cancer. 

 

Symptoms of Breast Cancer 

 

Different people develop different symptoms, and there is no chronological symptom timeline. The significant warning signs are: -

• Pain in the breast or any part of the breast 
• Lump under the arm or in the breast
• Redness, soreness, dimpling, or rash on anyone of the breast 
• Inverted nipples, pain, liquid, or blood oozing from any nipple
• A constant fever 
• Change in shape & size of the breast 
• Discolouration, change in skin texture
• Any other change occurring should be reported to a doctor 

 

Significant Stages of Breast Cancer 

 

Stage 0

Normal cells turn abnormal within lobules of the breast, known as lobular carcinoma in situ (LCIS). This isn’t considered cancer yet but is categorized under stage 0.                          

Where cancer is found inside the milk ducts but hasn’t spread to neighbouring tissues within the breast. It is known as ductal carcinoma in situ (DCIS)

Stage 1

Cancer is small but hasn’t spread to surrounding lymph nodes, or the tumour can’t be located, but lymph nodes have cancer cells. 

Stage 2

Cancer turns invasive with some combinations. No tumour has grown, but cancer has attacked the lymph nodes. There is a tumour growing, and lymph nodes are affected too, or there is a tumour, but your lymph nodes aren’t affected yet. 

Stage 3

This is an advanced invasive stage of cancer. But in stage 3, it hasn’t spread to other organs. Cancer may spread in the underarms or breastbone. 

Lymph nodes under or near your collarbone may also get affected in this stage. In stage 3, more than ten lymph nodes get affected. 

Stage 4

In stage 4, cancer spreads to other organs in the body, like the brain, lungs, liver, and kidney. 

There are various ways through which cancer spreads. One is the cancer cells take root in surrounding tissues or organ tissues and begin to grow. 

Cancer also spreads through the lymph circulatory system, where cancer cells travel through the lymph nodes and attack other body parts. 

 

Triple Negative Breast Cancer (TNBC) 

 

A type of Breast Cancer that is aggressive and prevalent among younger women. India has seen a large number of Triple Negative Breast Cancer Cases. TNBC does not have any of the receptors found in other breast cancers. This leaves doctors with very few options to treat TNBC. , But Chemotherapy and mastectomy are widely used to treat TNBC. Many new drugs have been developed to treat TNBC. 

 

Tests to Detect Breast Cancer 

 

Breast Cancer screening cannot prevent breast cancer, but it can detect it and ensure timely treatment is provided to save a life. Discuss all your symptoms, family history, and lifestyle with your doctor for the best recommendation for screening tests.

A combination of lab tests, imaging tests, and biopsy will reveal the actual extent of cancer in your body.

The most common screening test is 

• Self-Examination:

Check your breast’s size, shape and skin appearance. Be familiar with all dimensions so you can easily spot any changes.  

• Clinical Breast Examinations:

A doctor examines your breast to see if there are any lumps or abnormalities.

• Ultrasound: 

Ultrasound of the breast is used to reveal abnormalities 

• X-ray:

 Gives a picture of what is inside your breast. 

• Mammography:

 

An breast X-ray is the safest and best way to identify cancer at an early stage. Women who regularly get mammography done are less likely to die of breast cancer. 

• Breast Magnetic Resonance Imaging (MRI): 

Radio waves and magnets take images of the breast. Today there is advanced diagnostic equipment that provides 3D imaging for accurate diagnosis. 

• MRI-guided breast biopsy:

This advanced imaging technique uses PET and computed tomography (CT) in one machine. It shows the structure of cells and tissues in a single image. A tracer, a radioactive substance, is injected into the patient’s body, and wherever it settles is where the cancer is likely to be. The PET scan shows where precisely the tracer is concentrated. 

• Digital breast tomosynthesis:

Similar to mammography, this test provides multiple views from various angles within seconds. 

• Biopsy: -

Here, fluids or tissues are removed from the breast and examined minutely to detect any cancer cells or mutations existing. This is often the most reliable way to confirm if cancer is prevalent.  

 

Recommended diagnostic tests for Breast Cancer 

Other than the above test, your doctor may order a lab test. The most common lab tests are the hormone receptor and HER2/neu tests. The test results provide the best diagnosis, and oncologists can decide your course of treatment. Other than these, complete blood count(CBC) Blood chemistry tests, Tumor markers, MSI and MMR testing, Tumor mutational burden (TMB), NTRK fusion genes, ESR1 gene mutations, PIK3CA gene mutation, BRCA1 and BRCA2 mutations and some other lab test may also be ordered by the doctor till a complete diagnosis is made.

Lab reports and readings

No one test can help a doctor diagnose breast cancer. A series of blood tests, imaging, and biopsy will help an oncologist accurately diagnose the stage of breast cancer. 

A positive lab test often does not indicate the presence of cancer but rather inflammation in the cells. Some lab test also shows the pre-cancerous stage 

 

Various treatments for breast cancer

 

There is no one standard treatment for Breast Cancer. Breast cancer treatment is carried out depending on the stage of cancer, where it has spread and its effects on the general health of the patient.

Various clinical trials are being carried out to treat breast cancer more effectively and save more lives. While this is happening, some tested and established treatments are:- 

Opting for Surgery 

When the cancer tumour needs to be removed from the body, surgery is prescribed. 

Effective radiation therapy 

The cancer cells are killed through high radiation. 

Using Chemotherapy to treat breast Cancer

Drugs are used to shrink or kill the cancer cells. These are administered through pills or IV drip. 

Hormone therapy as a treatment for Breast Cancer

The hormones that facilitate the growth of cancer cells are blocked so that cancer does not grow. 

Targeted Therapy to Treat Breast Cancer

Medication that targets the proteins that grow on breast cells. This stops the growth of cancerous cells. A promising treatment that can help millions of women regain their lost vigour for life. 

Immunotherapy

Boosts the immune response to fight cancer cells using various drugs. 

The treatment of breast cancer has evolved tremendously over the last ten years. 

New treatment like CDK4/6 Inhibitors used to treat hormone-positive Metastatic Breast Cancer is effective. More than 60% of patients in India are diagnosed with this cancer. 

New methods like cryosurgery, where extreme cold in liquid nitrogen is used to freeze breast tumours or cancer cells, effectively treat breast cancer. It doesn’t involve any significant surgery.  

Various Drugs like anti-angiogenesis that can treat advanced cancer patients by stopping the formation of new blood vessels that enable tumours to grow are being rolled out for widespread use.

Similarly, many other drugs and older effective drugs that need new ways of being administered are under clinical trials. 

 

Mastectomy and coping with it.

 

Mastectomy is done by surgically removing all parts of the breast. This surgery is done in both or single breasts, depending on the cancer stage. Different types of Mastectomies involve the removal of various tissues and lymph nodes depending on your stage of cancer, hormone receptor status, and the lymph nodes involved. Total, radical, preventive, and partial mastectomy are some types.

Breast reconstruction after mastectomy 

Breast reconstruction surgery involves rebuilding the removed breast in an appropriate shape. This helps women regain their confidence and feel beautiful again. It is one of the most tremendous advances in cancer care. 

The breast can be reconstructed with implants, autologous tissue taken from other parts of the body, or a combination of both. 

Breast reconstruction does not affect post-cancer check-ups like mammography, nor does it lead to the recurrence of cancer cells. 

Taking care of your mental health once you are diagnosed with breast cancer. 

Being diagnosed with any disease is a significant jolt. A breast cancer diagnosis can lead to anxiety, depression, and decreased self-esteem. Fear of losing one’s body image does occur. Rejecting any emotion that arises or brushing them under the carpet can adversely affect successful treatment. 

Research has proven that patients with positive outlooks and emotions see better outcomes from their treatment than those with sorrow and pain in their hearts and minds. 

Dealing with mental problems after being diagnosed with breast cancer. 

There are various ways to deal with negative emotions and overcome them. 

• Seek help immediately. The more your feelings are suppressed, the possibility of overcoming them diminishes. 
• Do not hide your fear. Articulate them and speak to your doctor, family, and friends. Many women worry about things like their fertility and body image. Voice out all these concerns; you will feel much better when a professional guides you.
• Instead of sulking, tell yourself you will fight this disease and succeed. 
• Build a coping mechanism for day-to-day functioning. Like additional house help. Someone to cook or a vehicle to take you to and back from the hospital etc. Do not hesitate to ask for help. 
• Take the spiritual path. 
• Work on your overall health by changing your lifestyle and habits.
• Ensure corrected nutrition and exercise by taking the services of a health coach.
• Visit a psychiatrist if you cannot control your thoughts and have difficulty being positive. 

 

Commonly asked Questions on Breast Cancer

 

The most appropriate age to undergo Breast Cancer Screening

Women between the age of 50 to 74 are at risk of developing breast cancer and, therefore, should undergo regular screening for breast cancer. Women between the age of 40 to 50 years should speak to their doctor and discuss the right time to experience a breast cancer screening test and mammography. The earlier, the better. Since the only way to beat cancer is to catch it early.  

Self-examination should begin at the age of 18 years. On the 7th day of the menstrual cycle, self-examination should be done. In postmenopausal women, self-examination can be done on any given day. Pregnant women should not ignore breast examination since breast cancer can develop in pregnant women too. 

A doctor should immediately check any lump, unusual feeling, inverted nipple, or pain. 

Is a man also prone to developing Breast Cancer? 

Statistics show that men’s breast cancer cases are relatively less than women’s. But men also develop breast cancer. The symptoms are similar to the signs in women. Other than those, men with the below condition pose the risk of developing breast cancer.  

• Men with Klinefelter syndrome who have an extra X chromosome 
• Injury, swelling, or surgery to remove testicles 
• Liver disease 

Decreasing Breast Cancer in India  

India sees a lot of late diagnoses of breast cancer cases, mainly in the 3rd or 4th stage. This is primarily because of unawareness of breast cancer and its symptoms. 

There are a lot of social stigmas. Women in rural India find it difficult to report a problem related to private parts of their bodies, especially to a male doctor. Contrary, breast cancer remains primarily in urban areas because of unhealthy lifestyle trends. 

In rural India, a lack of medical facilities and diagnostics leads to late diagnosis, which increases the mortality rate.

World Health Organization states that certain factors can decrease the possibility of developing breast cancer.

How to avoid getting breast cancer 

• Prolonged breastfeeding 
• Maintaining a healthy weight
• Occasional consumption of alcohol 
• Non-consumption of tobacco and harmful drugs. 
• Living a non-sedentary lifestyle.

 

Looking Ahead: Prioritizing Early Detection of Breast Cancer 

Breast Cancer can be easily cured and prevented when diagnosed at stage 0. Prevention is difficult because the exact cause is still known. While one can follow many steps to prevent breast cancer, there is no assurity. Therefore early diagnosis is the only way forward. Early diagnosis can be achieved by regular screening. This way, the overall burden of cancer in our country can decrease and mortality rates too.