Breast Cancer Is a malignant tumor that develops from cells in the breast. Breast cancer is the most common cancer in women worldwide, comprising 16% of all female cancers (WHO Global Burden of Disease, 2004).
Causesand risk factors of breast cancer
In patients who do not have a family history, one single factor cannot be pointed as being causative for the cancer. The following factors are known to play a role-
* Age -The chance of developing breast cancer increases with age. Eighty percent of all breast cancers are found in women over the age of 50.
* Gender – Risk of developing breast cancer increases as one gets older. Women are 100 times more likely to get breast cancer than men.
* Menstrual history – A woman who began having menstrual periods early (before age 12) or went through menopause late (after age 50) has a slightly higher than average risk of breast cancer. This may be related to the overall amount of estrogen the breast is exposed to over a lifetime.
* Alcohol – Regular alcohol intake (the equivalent of one drink daily, over time) may slightly increase the risk of breast cancer. Having two or more drinks per day further increases risk.
* Reproductive history – Women who had a first child after the age of 30 or who never had children have a slightly higher risk for the disease. This may be due to protective changes in breast tissue that occur with full-term pregnancy.
* Weight – Research shows that being overweight or obese, particularly after menopause, increases the risk of breast cancer and recurrence. Having excess fat tissue may increase breast cancer risk by increasing estrogen levels. Overweight is defined as having a body mass index (BMI) of 25 or greater. Obesity is defined as having a body mass index (BMI) of 30 or greater.
* Dietwhich is rich in saturated fats and low on fibre and green leafy vegetables are not healthy and could be potentially linked to development of breast cancer.
* Radiation – Exposure of breast tissue to radiation, particularly during the first two or three decades of life, has been associated with an increased risk of breast cancer. The amount of radiation from a mammogram, however, is very small and does not increase risk.
* Exercise – Engaging in regular exercise is also a key component of good health. It helps to achieve and maintain an ideal body weight and may reduce breast cancer risk and improve survival among women diagnosed with the disease.
* HRT – Long term usage of Hormone Replacement Therapy (HRT) in post menopausal women is associated with a slightly increased risk of developing breast cancer .
Symptoms of breast cancer
Early breast cancer usually does not cause symptoms. As the cancer grows, symptoms may include –
* Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt
* Change in the size, shape, or feel of the breast or nipple. For example, one may have redness, dimpling, or puckering that looks like the skin of an orange
* Fluid coming from the nipple is bloody, clear to yellow, green and looks like pus
Men can get breast cancer too. Symptoms include breast lump and breast pain and tenderness.
Symptoms of advanced breast cancer may include-
* Bone pain
* Breast pain or discomfort
* Skin ulcers
* Swelling of one arm (next to the breast with cancer)
* Weight loss
Diagnostic tests for breast cancer
At Medanta, we strongly propagate the role of screening tests to detect breast cancer at an early stage.Our state-of-the-art screening and diagnostic services include-
* Ultrasound – Medanta offers 3D, electrography, contrast ultrasounds in addition to routine sonography and doppler.
* Vaccum Assisted Biopsy – At Medanta, we use a full field digital mammograph machine to perform vacuum assisted breast biopsy using a device called mammotome. It is used under ultrasound and stereotactic guidance to reduce the chances of under sampling. More tissue can be obtained using this technique. Medanta is one of the few centres in India to possess a mammotome.
* Magnetic Resonance Imaging (MRI)an imaging technique is used in radiology to visualize internal structures of the body. Medanta is among few top hospitals who have the latest technology in MRI called the 3 TESLA MRI. It is the most powerful scanner available.
* MR Guided Core Biopsy -Medanta is one of the few centres which utilises breast coil and biopsy kit to perform MR guided core biopsy for MR only visible lesions.
* PET CT is used for complete staging of the locally advanced breast cancers.
Treatments available for breast cancer
Treatment for breast cancer involves a combination of different modalities like surgery, chemotherapy, radiotherapy and hormonal blockade with tablets. The requirement and sequence of these treatments depend on the stage at which the patient presents.
Patients who present with early breast cancer undergo surgery first, whereas patients with advanced breast cancer generally undergo chemotherapy first.
Surgical options –
Breast Conservation Surgery (BCS) is a term used for surgeries that involve removing only the cancer and not the entire breast. Types of breast-conserving surgery offered at Medanta include lumpectomy (removal of the lump), quadrantectomy (removal of one quarter, or quadrant, of the breast), and segmental mastectomy (removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor).
This is appropriate in patients in whom the tests before surgery have shown that it is possible to do so.
Sentinel Node Biopsy is a reliable and safe procedure which is done during the primary breast cancer operation. It is performed by making a small cut in the armpit and a few nodes are identified and sent for testing during the operation. Based on the result of the intra operative testing, it is decided whether all the lymph glands need to be removed or can be spared.
Radiation Therapy (also called radiotherapy) is a type of local therapy. It affects cells only in the treated area. Radiation therapy is used alone for small tumors or for patients who cannot have surgery. It may be used before surgery to kill cancer cells and shrink the tumor. It also may be used after surgery to destroy cancer cells that may remain in the area. At Medanta, we use Cyberknife Robotic Radiosurgery System to treat cancer. It is world’s first system, designed to treat tumors of all kinds anywhere in the body. With its unique precision and accuracy, it treats both static and moving lesions and tumors, giving surgeons the power to treat patients non-invasively, with successful outcomes.
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from growing.
How do I know if I have breast cancer?
To know if you have breast cancer, get the diagnostic tests done immediately on onset of any of the listed symptoms.
How is the treatment plan finalised?
At Medanta, we have a very coordinated multimodality approach where the patient is guided through various treatments.
Medanta has a dedicated breast services team of world renowned surgeons that focuses only on breast related surgeries. Our breast services team works with the chemotherapy and radiation team to finalisebest treatment plan for patients.
At Medanta, we provide latest technology with expertise to treat patients with breast cancer, including digital mammography and MR guided core biopsy.
For complex cases, a multidisciplinary tumor board makes important decisions.
Medanta follows an integrated multispecialty approach, focused on cancer prevention, diagnosis and treatment, to provide world class care to patients.