Cancer is a large group of diseases that can start in almost any organ or tissue of the body when abnormal cells grow uncontrollably, go beyond their usual boundaries to invade adjoining parts of the body and/or spread to other organs.

Breast cancer is the most common cancer in women both in the developed as well as developing countries. It is estimated that worldwide over 50, 8000 women died in 2011 due to breast cancer (Global Health Estimates, WHO 2013). Breast cancer is on the rise, both in rural and urban India. A 2018 report of Breast Cancer statistics recorded 1, 62,468 new registered cases and 87,090 reported deaths.

Breast cancer is a disease in which 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.

Breast cancer can begin in different parts of the breast. A 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.

Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized.

What are the different kinds of breast cancer?

The most common kinds of breast cancer are—

  • Invasive ductal carcinoma: The cancer cells grow outside the ducts into other parts of the breast tissue. Invasive cancer cells can also spread, or metastasize, to other parts of the body.
  • Invasive lobular carcinoma: Cancer cells spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread to other parts of the body.

There are several other less common kinds of breast cancer, such as Paget’s disease, medullary, mucinous, and inflammatory breast cancer.

What are the risk factors for breast cancer?

Being a woman and getting older are the main risk factors for breast cancer.

Studies have shown that your risk for breast cancer is due to a combination of factors.

  • Getting older: The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50.
  • Genetic mutations: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 tumours 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.
  • Family history of breast or ovarian 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 or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
  • Previous treatment using radiation therapy: Women who had radiation therapy to the chest or breasts (like for treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.
  • Drug diethylstilbesterol: Women who took the drug diethylstilbesterol (DES),which was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage, have a higher risk. Women whose mothers took DES while pregnant with them are also at risk.

Modifiable Risk Factors

  • 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 oestrogen 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.
  • Drinking alcohol: Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.

Research suggests that other factors such as smoking, being exposed to chemicals that can cause cancer, and changes in other hormones due to night shift working also may increase breast cancer risk.

What are the symptoms of breast cancer?

Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all. Some warning signs 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.

Control of breast cancer

WHO promotes comprehensive breast cancer control programmes as part of national cancer control plans. The recommended early detection strategies for low- and middle-income countries are awareness of early signs and symptoms and screening by clinical breast examination in demonstration areas. Mammography screening is very costly and is feasible only in countries with good health infrastructure that can afford a long-term programme.

Early detection

Although some risk reduction might be achieved with prevention, these strategies cannot eliminate the majority of breast cancers that develop in low- and middle-income countries. Therefore, early detection in order to improve breast cancer outcome and survival remains the cornerstone of breast cancer control.

Breast cancer screening tests

Breast cancer screening means checking a woman’s breasts for cancer before there are signs or symptoms of the disease. All women need to be informed by their health care provider about the best screening options for them.

Screening that is the systematic application of a screening test in a presumably asymptomatic population. It aims to identify individuals with an abnormality suggestive of cancer. Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat.

Mammogram screening:

Mammogram screening is the only screening method that has proven to be effective. A mammogram is an X-ray of the breast. For many women, mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer. At this time, a mammogram is the best way to find breast cancer for most women.

Breast magnetic resonance imaging (MRI)

A breast MRI uses magnets and radio waves to take pictures of the breast. MRI is used along with mammograms to screen women who are at high risk for getting breast cancer. Because breast MRIs may appear abnormal even when there is no cancer, they are not used for women at average risk.

Clinical breast exam

clinical breast exam is an examination by a doctor or nurse, who uses his or her hands to feel for lumps or other changes.

Breast self-examination (BSE)

A breast self-exam is a technique that a woman can use to examine her breasts to look for changes (such lumps or thickenings) that may signal breast cancer. Many breast problems are first discovered by women themselves, often by accident.

BSE is recommended for raising awareness among women at risk rather than as a screening method.

Common ways to perform the manual part of the breast exam include:

  • Lying down.Choose a bed or other flat surface to lie down on your back. When lying down, breast tissue spreads out, making it thinner and easier to feel.
  • In the shower.Lather your fingers and breasts with soap to help your fingers glide more smoothly over your skin.

When examining your breasts, some general tips to keep in mind include:

  • Use the pads of your fingers: Use the pads, not the very tips, of your three middle fingers for the exam. If you have difficulty feeling with your finger pads, use another part of your hand that is more sensitive, such as your palm or the backs of your fingers.
  • Use different pressure levels: Your goal is to feel different depths of the breast by using different levels of pressure to feel all the breast tissue. Use light pressure to feel the tissue closest to the skin, medium pressure to feel a little deeper and firm pressure to feel the tissue closest to the chest and ribs. Be sure to use each pressure level before moving on to the next spot. If you’re not sure how hard to press, talk with your doctor or nurse.
  • Take your time: Don’t rush. It may take several minutes to carefully examine your breasts.
  • Follow a pattern: Use a methodical technique to ensure you examine your entire breast. For instance, imagine the face of a clock over your breast or the slices of a pie. Begin near your collarbone and examine that section, moving your fingers toward your nipple. Then move your fingers to the next section.

To inspect your breasts visually, do the following:

  • Face forward and look for puckering, dimpling, or changes in size, shape or symmetry.
  • Check to see if your nipples are turned in (inverted).
  • Inspect your breasts with your hands pressed down on your hips.
  • Inspect your breasts with your arms raised overhead and the palms of your hands pressed together.
  • Lift your breasts to see if ridges along the bottom are symmetrical.

When should you see a doctor?

A physician must be consulted if any of the changes mentioned below is observed during breast self-examination:

  • Any new lump. It may or may not be painful to touch.
  • Unusual thick areas.
  • Sticky or bloody discharge from your nipples.
  • Any changes in the skin of your breasts or nipples, such as puckering or dimpling.
  • An unusual increase in the size of one breast.
  • One breast unusually lower than the other.

How breast cancer is diagnosed?

Some of the diagnostic measures are:

  • Breast ultrasound: A machine that uses sound waves to make detailed pictures, called sonograms, of areas inside the breast.
  • Diagnostic mammogram: If you have a problem in your breast, such as lumps, or if an area of the breast looks abnormal on a screening mammogram, doctors may have you get a diagnostic mammogram. This is a more detailed X-ray of the breast.
  • Magnetic resonance imaging (MRI):  A kind of body scan that uses a magnet linked to a computer. The MRI scan will make detailed pictures of areas inside the breast.
  • Biopsy: This is a test that removes tissue or fluid from the breast to be looked at under a microscope and do more testing. There are different kinds of biopsies (for example, fine-needle aspiration, core biopsy, or open biopsy).

Treatment:

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.

All types of cancer treatments can exert a significant psychosocial and financial impact on a patient and his or her family that should be considered when developing programmes to improve access to and coverage of cancer services.

Palliative care:

Palliative care is an essential part of cancer control, both for adults and children. In 2014, the first ever global resolution on palliative care, World Health Assembly resolution WHA67.19, called upon WHO and Member States to improve access to palliative care as a core component of health systems, with an emphasis on with an emphasis on primary health care and community/home-based care.

When breast cancer is detected early, and if adequate diagnosis and treatment are available, there is a good chance that breast cancer can be cured. If detected late, however, curative treatment is often no longer an option. In such cases, palliative care to relief the suffering of patients and their families is needed.

Prevention

Control of specific modifiable breast cancer risk factors as well as effective integrated prevention of non-communicable diseases which promotes healthy diet, physical activity and control of alcohol intake, overweight and obesity, could eventually have an impact in reducing the incidence of breast cancer in the long term.

October- breast cancer awareness month

 The breast cancer awareness month, marked in countries across the world every October, helps to increase attention and support for the awareness, early detection and treatment as well as palliative care of this disease.

The Breast cancer awareness month began in 1985 as a partnership between the American Cancer Society and the pharmaceutical division of Imperial Chemical Industries. Betty Ford helped kick off the week-long event, as she was herself a survivor of breast cancer. She was diagnosed when her husband, Gerald Ford, was president of the United States and brought even more attention to breast cancer

Goal of breast cancer awareness month

The early goal of Breast Cancer Awareness Month was to educate women about breast cancer and early detection tests so that they could take charge of their breast health. One of their key goals that they wanted to achieve was to promote mammograms as an important tool to be used in the fight against breast cancer.

During the month of October, breast cancer survivors and those with breast cancer are celebrated and encouraged to share their stories. The month is also dedicated to raising funds for breast cancer research and other related causes.

The Pink Ribbon:

The first nation-wide campaign that utilized the pink ribbon was back in 1992 by Estée Lauder cosmetics. They handed out an impressive 1.5 million of them and ushered in the pink ribbon as the premier visual reminder of Breast Cancer Awareness Month.

The NFL has become one of the largest supporters of breast cancer awareness month and nearly all players, coaches, and referees don the pink ribbon each October to show their support.

Conclusion:

Breast cancer is the top cancer in women worldwide and is increasing particularly in developing countries where the majority of cases are diagnosed in late stages. The breast cancer awareness month, marked in countries across the world every October, helps to increase attention and support for the awareness, early detection and treatment as well as palliative care of this disease.

Through research, awareness, education, prevention, early detection, diagnosis and treatment, rehabilitation and palliative car ewe will be able to make a difference.

Papori Pathak Choudhury

Mrs Papori Pathak Chowdhury is the Professor cum Principal of NEMCARE Group of Institutes, Mirza. She can be reached at - papori78@gmail.com