Breast Cancer

By: Dr Sajid Ali Shah

All over the world, October is Breast Cancer Awareness Month, an annual campaign to raise awareness about the impact of breast cancer. Breast cancer is the most prevalent type of cancer in the world. Throughout the world breast cancer poses a major health risk for women. Every year, one million women are diagnosed with breast cancer worldwide. Breast cancer is the most common cause of cancer-related deaths.

In Asia, Pakistan has the highest rate of breast cancer. Approximately 1 out of 9 women in Pakistan is affected by breast cancer at some stage of their lives. Everyone is affected by cancer the old and young, the poor and rich, children and women. It is creating severe financial and social problems for families in our country. It is worrying that in our country young women present at an advanced stage of breast cancer, which has a negative effect on prognosis.

What actually happens in Breast cancer is that the cells in the breast grow out of control. There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer. The breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together. Most breast cancers begin in the ducts or lobules.

Different people have different symptoms of breast cancer. The most common symptoms of breast cancer are:

• New lump in the breast or underarm (armpit).
• Thickening or swelling of part of the breast.
• Irritation or dimpling of breast skin.
• Redness or flaky skin in the nipple area or the breast.
• Pulling in of the nipple or pain in the nipple area.
• Nipple discharge other than breast milk, including blood.
• Any change in the size or the shape of the breast.
• Pain in any area of the breast.

Keep in mind that these symptoms can happen with other conditions that are not cancer and every lump in the breast is not cancer. If you have a lump or any other sign and symptom that worries you, always seek a doctor’s advice.

Many conditions can cause lumps in the breast, including cancer. But most breast lumps are caused by other medical conditions. The two most common causes of breast lumps are fibrocystic breast condition and cysts. Fibrocystic condition causes noncancerous changes in the breast that can make them lumpy, tender, and sore. Cysts are small fluid-filled sacs that can develop in the breast.

The risk for breast cancer is due to a combination of factors. The main factors that influence risk of breast cancer include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older.

Some women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean a person will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer.

Of these risk factors, we can’t change certain risk factors as mentioned below

• Getting older. The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50.
• Family history of breast cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
• Genetic mutations (changes). Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.
• Reproductive history. Early menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.
• Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
• Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.

Some measures can help lower the risk of breast cancer in the following ways

• Not being physically active. Women who are not physically active have a higher risk of getting breast cancer.
• Being overweight or obese after menopause. Older women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.
• Taking hormones. Some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. Certain oral contraceptives (birth control pills) also have been found to raise breast cancer risk.
• Reproductive history. Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk.

It is pertinent to mention here once again that people with a strong family history of breast cancer or women who have inherited changes in certain genes (BRCA1 and BRCA2 genes) have a high risk of getting breast cancer. If anybody has a family history of breast cancer or they need to talk to a doctor about other ways to lower your risk.

To diagnose breast cancer the doctor, usually a surgeon examines the breast and then orders for a breast ultrasound or a mammogram (breast x-ray). If there is a lump he will perform the needle test of the lump which is also called a biopsy.

Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread. People with breast cancer often get more than one kind of treatment.

• Surgery. An operation where doctors cut out cancer tissue.
• Chemotherapy. Using special medicines to shrink or kill the cancer cells. The drugs can be pills you take or medicines given in your veins, or sometimes both.
• Hormonal therapy. Blocks cancer cells from getting the hormones they need to grow.
• Biological therapy. Works with your body’s immune system to help it fight cancer cells or to control side effects from other cancer treatments.
• Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer cells.

Doctors from different specialties often work together to treat breast cancer. Surgeons perform operations. Medical oncologists treat cancer with medicine. Radiation oncologists treat cancer with radiation.

To sum up, the key to success is early detection of the cancer. At an early stage breast cancer can be completely curable. To help detect the cancer early  a mammogram (breast x-rays) is very helpful and effective. Women with family history of breast cancer will need a screening mammogram at an early age.

The other simple technique is monthly Breast self-examination (BSE). Trained medical practitioners and nurses at health centers can teach technique of breast self examination to the women. Women can use this technique themselves and may detect breast cancer at an early stage.

And importantly try to reduce the risk factors by staying healthy throughout your life. It will lower risk of developing cancer, and also improve chances of surviving cancer if it occurs.

• The writer is Consultant General Surgeon, Assistant Professor at Department of General Surgery, PIMS, Islamabad.