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Breast Cancer

Breast Cancer

Despite being the most common cancer in Indian women, at HCG breast cancers are treated with highest 5-year survival rates of 86.9%. Opt for regular screening for early detection & timely treatment.

Overview

Breast cancer is a condition wherein the breast cells grow abnormally and a tumour is formed. The breasts consist of three parts: ducts, lobules and connective tissues. Most breast cancers begin in the ducts and lobules.
 
Statistics show that breast cancer is the most common cancer in Indian women. Awareness and regular screening can help in detecting breast cancer in its earlier stages when the disease can be treated with positive outcomes.
 
The five-year survival rate for breast cancers at HCG stands at 86.9%, which is the highest in India. A case study published in Harvard Business Review has reported that HCG’s five-year survival rates for breast cancer cases are on par with the global standards. 

Types

Breast cancers are categorised based on multiple factors, namely the location of the tumour, the degree of spread, the presence of hormone receptors and aggressiveness. Two broad categories of breast cancer are:
 
1. Invasive Breast Cancer: The type of breast cancer that has spread to surrounding tissues, lymph nodes and other parts of the body through the bloodstream. Major types are invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC), which again has subtypes based on the characteristics of the tumour.
 
2. Non-Invasive Breast Cancer: The type of breast cancer that is localised and has not spread to other parts of the body. Major types include ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS).
 
Types of breast cancers classified based on their aggressiveness are:
 
1. Triple-negative Breast Cancer: A type of aggressive breast cancer where the tumour lacks the receptors for oestrogen and progesterone and additional HER2 proteins on its surface. These tumours grow quickly and spread to other body parts at a faster rate.
 
2. Inflammatory Breast Cancer: Instead of tumour formation, inflammatory breast cancer is characterised by reddening and swelling of the breast along with a tendency to spread quickly.
 
Male breast cancers are rare. Inheritance of the mutated BRCA2 gene is found to increase the risk of breast cancer in men. Risk factors and symptoms for men are similar to those for women.
 
Other rare forms of breast cancer include Paget’s disease of the breast, angiosarcoma and Phyllodes tumour.

Symptoms

Symptoms of breast cancer vary from person to person. Below are the common symptoms of breast cancer:

  • A lump or thickening in or near the breast or underarm
  • Pain or tenderness in the breast or nipple that does not change with the monthly cycle
  • Clear or bloody nipple discharge
  • Change in the breast or nipple such as colour, shape or size; for example, an inverted nipple
  • Swelling in the armpit
  • Skin irritations or change such as redness, puckering, dimpling, peeling, flakiness around the nipple or skin of the breast
               
Most breast lumps are not cancerous. However, women should visit a specialist for an examination if they notice a lump on the breast.

Causes

The exact cause of breast cancer remains unclear. However, several factors are reported to increase breast cancer risk.

  • Age: The risk of developing breast cancer increases with age.
  • Genetics: Mutations in BRCA1 and BRCA2 genes trigger tumour formation in the breasts.
  • Personal History of Breast Cancer: Personal history of breast cancer can lead to 2nd encounter with breast cancer.
  • Family History: Those with a positive family history of breast cancer are at higher risk.
  • Dense Breast Tissues: Dense breast tissues increase the risk of breast cancer by 4-6 times.
  • Menstrual and Reproductive History: Early menstruation (before age 12), first child after age 35 and delayed menopause are reported to increase the risk of breast cancer.
  • Hormone Replacement Therapy (HRT): Post-menopausal HRTs increase breast cancer risk in women.
 
Apart from these, other risk factors include poor lifestyle choices, exposure to radiation and obesity.

Diagnosis

Breast cancer screening helps in detecting breast cancer in its earlier stages, leading to a successful clinical outcome. Breast examination and mammography are common procedures for breast cancer screening.
 
a. Breast Examination (Self/Clinical): Both clinical and self-breast examinations involve careful inspection and palpation of the breasts for any abnormalities in the shape, texture, colour, presence of lumps and discharge from the nipples.
 
b. Mammography: Mammography uses low-dose X-rays to detect precancerous and cancerous growth in the breasts. It helps in detecting the smallest tumours that are not detected during breast examinations.
 
c. Imaging Tests: If cancer growth is suspected, the patient may be asked to undergo further tests like breast ultrasound, fine needle aspiration, biopsies, MRI scans and PET/CT scans. The treatment will be planned based on the test results.
 
d. Biopsy: Biopsy plays a significant role in confirming a cancer diagnosis. For this procedure, a tissue sample from the breast is taken and examined under the microscope for the presence of cancer cells. Different types of biopsies that may be considered for breast cancer diagnosis are fine needle aspiration (FNA) biopsy, core needle biopsy, surgical (open) biopsy and lymph node biopsy.

HCG has the best breast cancer specialists in India who are trained to treat breast cancers with personalised and result-oriented treatment plans that lead to positive clinical outcomes.

Treatment

The treatment planning for breast cancer depends on various factors like the tumour’s location, tumour’s size, menstrual factors of the patient, the type of cancer, patient’s age and the general health of the patient. The key treatment modalities include surgery, radiotherapy and systemic therapy. The treatment could be unimodal or multimodal.
 
a. Surgery: Surgery may be performed to remove just the tumour (lumpectomy) or the entire breast (mastectomy). It may also involve the removal of the lymph nodes and the surrounding tissues.
 
  • Lumpectomy involves the removal of the tumour along with a small, cancer-free margin of healthy tissue around the tumour. It may also involve the removal of the surrounding lymph nodes. Lumpectomy is also known as Breast Conservation Surgery (BCS) or Partial Mastectomy. Better aesthetic outcomes and well-preserved quality of life are the key advantages of this procedure.
  • Mastectomy or the removal of the entire breast is recommended if the tumour is in the middle of the breast, tumours are present in multiple areas of the breast, tumour size is large and if the patient has undergone breast radiotherapy in the past. 
  • Lymph Node Removal is performed during a lumpectomy or mastectomy. It is a procedure wherein a few to a large number of lymph nodes are removed to assess the spread of cancer.
  • Modified Radical Mastectomy is a type of surgery, which involves the removal of the breast, underarm lymph nodes and the lining over the chest muscles; however, the chest muscles are left intact.
 
Most of our surgeries aim for breast conservation and sentinel lymph node biopsy using technetium-99. This reduces morbidity and hospital stay for the patients.
 
Breast Reconstruction Surgery: Breast reconstruction is a surgical procedure that can be opted by women who have undergone lumpectomy or mastectomy. The surgery helps in restoring one or both breasts to near normal shape, symmetry, size and appearance. Breast reconstruction is done at the same time as a mastectomy or lumpectomy in most cases; however, it can also be done many months or even years after mastectomy or lumpectomy. Breast reconstruction surgery is performed in two ways:
 
  • Implant reconstruction: This surgery involves the insertion of an implant that is filled with saline (saltwater) or silicone gel.
  • Autologous or "Flap" Reconstruction: Using tissue transplanted from another part of the body (such as the belly, thigh or back). This procedure may also include an implant in order to achieve better symmetry and appearance.
 
HCG houses experienced and top breast reconstruction surgeons in India who are skilled at restoring the structure of the breasts and in turn boost the sense of wellbeing among breast cancer survivors.
 
b. Radiation Therapy or Radiotherapy: Radiotherapy employs high-energy X-rays or other types of radiation to kill the cancer cells in the breast or control their growth. Radiation may be delivered externally (external beam radiation therapy), or internally by placing the radiation source in the tumour or next to it (internal radiation therapy or brachytherapy).
 
c. Systemic therapy: Systemic therapies act on the entire body and help in treating the cancerous growths wherever they are located, including the ones that are too small to detect.
 
  • Chemotherapy uses potent drugs that are administered orally or injected into the muscle or vein to stop the growth of cancer cells either by killing them or preventing their multiplication.
  • Hormone therapy is effective in treating hormone-positive breast cancers; i.e., those cancers that depend on hormones for their growth. Most breast cancers are hormone-positive. Hormone therapy works either by lowering the levels of the hormones or by blocking their effects. Hormone therapy does not work for triple-negative breast cancer as it is hormone-negative.
  • Immunotherapy is a treatment modality where the body’s own immune cells are extracted, re-engineered to fight against the cancer cells and injected back into the body. 
  • Targeted therapy works on the principle of precision medicine. It works by targeting the cancer-specific genes, proteins or the cellular environment that are contributing to tumour growth and survival. This treatment precisely targets the tumour while reducing the damage to the surrounding healthy tissues.

Frequently Asked Questions

1. What does a breast cancer lump feel like?
 
Firstly, it is important to know that not all breast lumps are cancerous. 
 
Throughout their normal menstrual cycles, women experience changes in their breast tissue. It is normal for both breasts to feel sore, tender or swollen throughout the cycles. These symptoms often vanish within a few days. As long as they don’t persist, there is nothing to be alarmed about.
 
A cancerous lump may feel like a hard or firm lump (nodule). It is usually irregular in shape, and it may also feel like it is attached to the tissue deep inside the breast so that it cannot be moved without moving the breast tissues.
 
There are two common ways to check the breasts for lumps. The first one is the monthly self-breast examination and the second one is the annual mammography. Both these methods are helpful in detecting abnormal growths in their early stages.
 
2. Can breastfeeding reduce the risk of breast cancer?
 
Yes, studies have shown that breastfeeding reduces the risk of developing breast cancer.
 
3. Does smoking cause breast cancer?
 
Yes, both first-hand and second-hand smoking are considered to be risk factors for breast cancers. The harmful chemicals present in tobacco are observed to cause DNA mutations that potentially cause breast cancer.
 
Quitting tobacco and developing a healthier lifestyle could gradually reduce one’s breast cancer risk.
 
4. Is there a link between hormone replacement therapy (HRT) and breast cancer?
 
Yes, hormone replacement therapy is associated with an increased risk of breast cancer. Apart from this, HRT may also lead to delayed diagnosis by creating dense tissues in the breasts and thereby leading to reduced efficacy of mammography. Therefore, women need to opt for safer alternatives to manage their post-menopausal symptoms.
 
5. How do I lower my breast cancer risk?
 
There are a few ways to reduce your breast cancer risk and they include:
 
1. Limiting Your Alcohol Intake: Increased alcohol consumption is a risk factor for breast cancer. Reducing your alcohol intake helps in reducing your breast cancer risk.
 
2. Quitting Tobacco: Tobacco consumption increases your breast cancer risk remarkably. Therefore, it is of paramount importance to quit tobacco to lower your breast cancer risk.
 
3. Maintaining Healthy Weight: Being overweight or obese is a risk factor for breast cancer. Therefore, it is necessary to maintain a healthy weight and stay fit.
 
4. Being Physically Active: Being physically active is necessary for maintaining a healthy weight; this, in turn, helps in reducing your breast cancer risk.
 
5. Breastfeeding: Breastfeeding helps in bringing down one’s breast cancer risk.
 
6. Opt for Regular Screening: Regular screening helps in reducing the risk of advanced-stage breast cancers.