01 June, 2009

Breast Cancer

Breast cancer is spreading at a phenomenal speed.

Every 6.5 minutes, a fresh case is reported somewhere in india. As the population continues to age and increase and more Indians adopt western lifestyles, numbers are expected to climb sharply.

More than 400000 women die every year globally from breast cancer-related causes—more than 75% of them are from countries like India. But that’s because we are way behind in detection.

With the right moves: a monthly self examination, an annual check-up by the physician and periodic mammograms you can conquer it.

What sets it off
Like other cancers, breast cancer arises from the abnormal growth of cells, which may progress into a malignancy. No one knows precisely what causes the disease. Surprisingly, about 4 out of 5 women diagnosed with breast cancer have no family history of the illness and many have no known risk factors. Still, women with certain characteristics are more prone to developing breast cancer.

Risk factors
Researchers have linked a number of factors to a higher risk of breast cancer. Yet most women who are diagnosed have none of them. What does that mean for you? It means you should be vigilant about getting mammograms done, regardless of whether you have known risk factors. Step up the vigilance as you get older, since the risk of breast cancer rises with age and is greatest after age 60.

Known risk factors include :
•Belonging to a family with a strong history of breast cancer. The more first-degree relatives, mother, sister or daughter, who have had the disease, particularly before age 50, the more you should watch out.

•Having an inherited mutation in the genes that normally regulates cell growth. BRCA1 and BRCA2 gene mutations increase your lifetime risk to between 40 and 80%.

•Beginning menstruation before the age of 12 or reaching menopause after the age of 55, which increase a woman?fs exposure to estrogen.

•Hormone replacement therapy (especially the estrogen-progesterone combination) after menopause may put women at greater risk.

•First pregnancy after age 35.

How to keep it away

Changes in your lifestyle can reduce risks. Studies blame obesity and physical inactivity. Weight gain in midlife significantly increases the risk of breast cancer. Maintain a healthy body weight (BMI less than 25) throughout your life.

•Minimise/avoid alcohol. It is the bestestablished dietary risk factor for breast cancer.

•Consume fruits and vegetables, as much as you can. The superstars include all cruciferous vegetables (broccoli, cabbage, Brussels sprouts, cauliflower); dark leafy greens (palak, methi); carrots and tomatoes.

•Exercise regularly. Studies have shown that habitual exercise provides powerful protection. Consistency and duration, not intensity, are the key!

•Cut out high glycemic-index (GI) foods like white flour, white rice, potatoes, sugar and products containing them. These foods trigger hormonal changes that promote cellular growth in breast tissue.

•Lifetime exposure to estrogen plays a fundamental role in the development of breast cancer. Minimise exposure to pharmacologic estrogen. Do not take prescription estrogen unless unavoidable.

What to check

A woman's breasts undergo regular changes in size or texture during the menstrual cycle. It is important to become familiar with what's normal for you.

This will spare you undue alarm and help you identify any change that may be suspicious. In the early stages, breast cancer usually doesn?ft cause pain. In fact, when breast cancer first develops, there may be no symptom at all.

As the cancer grows, it may cause changes that should be evident.

These include :

•A lump or thickening in or near the breast or in the underarm.
•A change in the size, shape or feel of the breast.
•Nipple discharge or tenderness, or an inverted nipple.
•Ridges or pitting of the breast, making the skin look like the skin of an orange.
•A change in the look or feel of the breast, areola or nipple such as warmth, swelling, redness or scaliness.

Screening and tests

Besides the monthly self-exam, screening tests women typically undergo on a routine basis are mammography and clinical breast examination, in which a healthcare provider systematically palpates the breasts to detect changes or irregularities.

Besides being a screening tool, mammography is used to further examine a lump or area of new concern. The technique uses low-dose X-rays to produce photographic images of breast tissue or mammograms. This method has proved to be the most effective means of detecting cancers early and is credited with a 20 to 30% reduction in the death rate from breast cancer.
An ultrasound may be used as a complementary study to diagnostic mammography to evaluate a suspicious mass.

Once a lump or lesion is confirmed through breast imaging and/or a clinical breast exam, women typically undergo a biopsy, in which tissue is obtained for analysis. This analysis will tell your doctor whether the sampled cells are cancerous or benign.

Women newly diagnosed with cancer and with a family history of the disease should consider meeting a genetic counsellor or geneticist to discuss obtaining a blood test to determine whether they carry the BRCA 1 or 2 gene mutation.

If you are considering testing, discuss the risks, benefits, and possible psychological impacts before a final decision.

Knowing that you have the altered gene may increase self-monitoring and help you guide family members, but it doesn’t tell you whether you will indeed develop breast or ovarian cancer.

Some women with a mutation choose to have their breasts removed prophylactically. Other options include close surveillance or reducing risk by taking tamoxifen.

Treatment by stage

Lesions (when they are non-invasive or pre-cancerous), are almost always treated successfully. Most women with pre-cancerous lobular carcinoma don’t undergo surgery, but tamoxifen or a similar hormonal treatment, known to reduce the likelihood of future cancers, may be prescribed.

Stage I:
In early-stage invasive cancer, breast-conserving surgery such as lumpectomy, followed by radiation is done. Chemotherapy is often given prior to radiation.

Stage II: When a tumour is fairly large or a small tumour is accompanied by lymph-node involvement, lumpectomy with subsequent radiation may be appropriate, as may be simple mastectomy. Chemotherapy and hormonal treatment are also commonly prescribed.

Stage III: Often requires more extensive surgery and more aggressive ‘adjuvant therapies’, as the cancer has spread from the breast into the nearby lymph nodes or chest wall.

Stage IV: Cancers have metastasised to the lungs, liver, bones, or brain. Treatment of these advanced cancers is tough. The emphasis is on chemotherapy, and hormonal medication to slow the disease’s progression.