Breast Cancer

You must have heard about the pink October! It’s the month for breast cancer awareness. Breast cancer is the most common cancer among women, with favorable outcomes if detected early. This demands the utmost importance of spreading awareness and knowledge about breast cancer. When the breast cells enlarge or multiply uncontrollably, they form a mass or tumor that results in breast cancer. It is a common dilemma In females, but it can occur in males as well. It is not very frequent before the age of 50 years in women. It can be benign or malignant. The malignant tumors can grow, invade, and spread to adjoining areas of the breast. They can travel through the blood and form new growths in different locations, resulting in active metastasis.It is better to know more about the signs, symptoms, and risk factors of breast cancer so that you can evaluate yourself and get help at the first signs! Treatment depends upon the type of cancer, the stage at which it is presented, the patient’s age and preferences, and some other factors. It usually involves surgery, radiation therapy, chemotherapy, hormonal therapy, etc.  

Get yourself aware of the following risk factors for breast cancer;

• Increasing age
• Weight gain
• Family history
• Genetic factors (BRCA1 and BRCA2 mutations)
• Personal history 
• Certain dietary habits
• Alcohol consumption
• Failure to breastfeeding
• Breast implants
• Hormone replacement therapy
• Birth control pill
• Increase breast tissue density
• Radiation exposure
• Exposure to diethylstilbestrol
• Reproductive history (Age at menarche, age at menopause, no children, first pregnancy later in her 30s)
• Nulliparity (means never had a baby)
• Previous cancer

Breast cancer is the second most common cancer. It is a common cancer among US women estimating 268600 cases every year. 42000 women die due to breast cancer every year. The incident increases dramatically with age and is highest at menopause. It is more common in the left breast than in the right breast.

You may have one or more of the following signs and symptoms for breast cancer;

• Lump in the breast
• Skin changes
• Lump in the armpit
• Swelling of the breast
• Nipple retraction
• Inflammation of the breast
• Swollen or red nipples
• Discharge
• Change in size of the breast
• Breast pain
• Change in shape of the breast

Most breast cancers are a type of carcinomas described as adenocarcinoma. They are:

• Ductal carcinomas

Cancers arising in the epithelium of mammary ducts are called ductal carcinoma. There are two types of ductal carcinomas.

• Ductal carcinoma in situ (early, benign )
• Invasive ductal carcinoma ( metastatic )

There are many Subdivisions of invasive ductal carcinoma.

1. Medullary carcinoma

2. Mucinous carcinoma

3. Tubular carcinoma

4. Papillary carcinoma

5. Cribriform carcinoma

• Lobular carcinoma.

It is characterized by spreading into lymph nodes and other body parts. It is also called invasive or infiltrating Lobular carcinoma.

Lobular carcinoma in situ is not cancer, just the beginning of abnormal proliferation.

• Inflammatory breast cancer.

These breast cancers are not very common. In this type of Cancer, cells block the lymphatic drainage in the breast. Due to which the skin swells, and inflammation occurs. The skin appears wrinkled like the skin of an orange. These cancers can spread abruptly.

• Paget's disease of the breast: It is a condition of the nipple and areola. The underlying breast cancer causes eczema-like changes in the nipple and areola. It is very rare. 
• Angiosarcoma: It is also a very rare type in which cancer cells arise from the wall of blood vessels or lymphatic vessels.
• Metastatic carcinoma of the breast: It includes the tumor cells that have arisen from the cancers of other organs and travel to the breast and grow into new tumor cells.

Genetic or hormonal types of breast cancer:  With the advent of hormonal therapy, breast cancers can also be divided into different types based on the type of hormonal/protein receptors. For example;

• HER2-positive: They have a receptor called human epidermal growth factor receptor 2 (HER2). They are treated by a combination of pertuzumab and trastuzumab.
• Hormone receptor-positive or negative: These cancers contain estrogen or progesterone receptors.
• Triple-negative: These cancers do not contain any receptor. Neither HER2 nor estrogen or progesterone. So these cancers are challenging to treat.

The purpose of awareness programs is to diagnose any suspicious lumps in your breasts and consult your physician if you feel the need to do so. Your doctor will then obtain your history, asking about your symptoms, risk factors, past medical and surgical history, any medications you might be using, and will examine you and your breasts to find the physical evidence of the disease. The approach usually adopted includes the three steps;

• Clinical examination of the breast
• Imaging: the modality used is usually mammography, ultrasonography, or both.
• Needle biopsy: a needle is inserted into the lump of the breast under ultrasound guidance, and some fluid-containing cells are drawn out and sent for laboratory analysis. 

Further testing includes;

• Breast MRI
• Core or excisional biopsy
• Complete blood count, bone scan, pet scan for staging

Screening: Along with self-examination, cancer screening can be done using a mammogram (X-ray of the breast ), which is the best screening method. It is recommended to start screening by mammogram of females at the age of 45-54 annually. 

When you are under treatment, your doctor will try to achieve certain goals. The first goal is to completely eradicate cancer cells in the body, which is only possible when the cancer is benign or not widely spread. Another target is to avoid the recurrence of cancer. And this can be achieved by certain drug therapies. Some specific factors will be considered when choosing the treatment plan.

• Age of the patient.
• Menopause
• Underlying health conditions.
• Personal choices for surgical extraction of the breast.
• Stage of disease.
• Tumor containing receptors for HER 2 protein, estrogen, progesterone

Types of treatment

• Surgery

a) Lumpectomy: Removal of the lump only (also called breast-conserving surgery)

b) Mastectomy: Removal of the breast

• Radiation therapy: High energy rays(radiations) are used with lumpectomy to eradicate cancer cells from the body. This treatment is recommended for widespread diseases. It removes all the dispersed cancer cells that cannot be removed surgically.    
• Chemotherapy: Medication is given intravenously or oral route to kill cancer cells. It is usually done after surgical procedure and sometimes before surgery to regress the tumor. So the extraction becomes more accessible.
• Hormone therapy: Hormones are used to stop aggressively growing tumors. It includes tamoxifen, exemestane, Anastrazole, letrozole. Faslodex inhibits the attachment of estrogen and cancer cells.
• Targeted therapy: In this therapy, medications Specifically boost the immune system to fight against cancer cells. They target cancer cells that have increased levels of a protein named her2.

Side effects of treatment: Treatment may have the following side effects:

• Insomnia
• Infertility
• Alopecia
• Skin and nail changes. 
• Nausea, vomiting
• Weight gain or loss
• Fatigue
• Depression
• Chemobrain (distorted thought process)

Due to the advancements made in the early detection and treatment of breast cancer, the death rates have been decreased to 39% from 1990 – 2015. The average life expectancy of five years for patients with non-invasive cancers is 90%, and it is 99% for the invasive cancers that are limited to the breast only.

Following lifestyle changes need to be made to prevent yourself from getting the tumor;

• Maintain a healthy weight
• Limit alcohol
• Physical fitness
• Promoting breastfeeding
• Avoiding hormone therapy (postmenopausal)
• Gene testing and counseling 
• Avoiding cosmetic breast surgeries.
• High intake of vegetables, fruits, and calcium-rich dairy products.
• Avoiding processed red meat.
• Dietary supplements (multivitamins linked to breast health)