Over the years, breast cancer has become the nemesis of Indian women, overtaking cervical cancer to establish its dominance as the most common cancer in Indian women. The sheer number of cases is so huge that even with both sexes combined, breast cancer ranks as the number one among all cancers in terms of numbers. So, what causes it? Factors are numerous such as: 1) Prolonged exposure to oestrogen during reproductive phase of life which can be due to early menarche, late menopause, delayed child birth or lack of children etc; 2) Obesity; 3) Increased breast density; 4) Genetic mutations; 5) Familial mutations; and 6) Exposure to ionizing radiation.
Breast lumps, like most cancers, are silent killers. They sneak up stealthily on unsuspecting patients with painless, hard masses which are noticed accidentally only after they become big enough to be palpable. Diagnosis is further delayed by societal taboos and denial mentality of patients. Studies have shown that a number of factors such as educational status, religion, marital status and socio-economic status contribute to a delay in diagnosis of breast cancer in Indian women. Lack of education and low socio-economic status, contribute to avoidance of breast cancer screening and even if a mass is identified, these women are reluctant to seek medical help as they prioritize needs of family over theirs and fear the economic burden of medical treatment and loss of income as they would have to discontinue their jobs. Divorced and widowed women, especially in the older age group, often find themselves living alone without a support system. This results in a delay in seeking remedial therapy for any breast mass, even if they identify it at an early stage.
Another variable causing delay in diagnosis of breast cancer is the rampant use of alternative medicine. Many patients report to a doctor after having tried alternative therapies for resolution of mass. If the mass is malignant, the therapies don’t work, causing tumor progression and often present as a metastatic disease. Indian women most commonly present as Stage IIb and above, unlike their western counterparts who undergo rigorous screening which helps in detecting small non-palpable tumours. In advanced disease, there maybe skin ulcers, nipple erosion, nipple inversion, bloody nipple discharge, bone pain, breathing difficulty, etc. It is high time that we educate our women, starting with our family members, about the value for routine screening of breast cancer and to ensure that they seek medical help at the earliest, if a mass is detected. Catching it early gives us the best shot at curing the disease completely.
The American Cancer Society recommends that all women over the age of 40 years should undergo regular breast screening and practice breast self-examination which is a series of simple steps that women can perform on themselves on a monthly basis to identify suspicious lumps. If a lump is identified, it is not a cause for panic. It is advisable to contact a family doctor or an oncologist, as most breast lumps, especially in younger age groups, are benign or harmless. The oncologist will examine the patient and advise a mammogram and needle evaluation of the breast lump, either as a Fine Needle Aspiration Cytology (FNAC) or Trucut biopsy, which yields more tissue. If malignancy is confirmed in the specimen, then further staging workup is done in the form of Ultrasound Abdomen, Chest X-ray, PET CT scan, etc. based on physician’s judgment.
Treatment for breast cancer consists of the following modalities: Surgery, Radiation, Chemotherapy and Hormonal therapy, used in combination based on stage, tumour type, age and general condition of patient. Each of these treatment modalities can be further tailored for each patient. For patients who wish to preserve the breast, it is possible to so in early breast cancer by breast conservation techniques; similarly, chemotherapy drugs and regimens vary based on tumour types and its hormonal receptor markers. Radiation therapy has evolved over the years to become extremely precise, allowing patients to be treated with limited adverse events.
Once treatment is complete, patients have to be close follow up for a number of years. Some patients who have hormone receptor markers positive in their tumour tissue are advised to take hormonal therapy for 5-10 years.
In conclusion, breast cancer is not the death sentence it once was. Advanced treatment options have ensured that patients presenting at any stage can enjoy a long and healthy life. In the words of Cayla Mills, “You never know how strong you are until being strong is the only choice you have.” Help is at hand.
(Dr M Banu Priyaa is the Clinical Lead and Consultant Radiation Oncologist at Kauvery Cancer Institute, Chennai)