Let us speak about breast cancer
Dr Ajit Lukram *
Early signs of breast cancer :: Pix - Wikipedia / National Institutes of Health, USA
October is breast cancer awareness month, when this month is dedicated to spreading the message of “Early detection is the key” in the management of breast cancer.
We at Shija Breast & Thyroid Clinics have been following the good tradition and we create awareness in our own small ways like free health camps, radio talks, TV interaction programmes and health related articles in newspapers.
Breast cancer once diagnosed has to be treated by multimodality approach like any other cancer but the stage of cancer at which it is diagnosed makes a lot of difference in the outcome. Spreading awareness, diminishing social stigma and encouraging womenfolk to come forward, helps in detecting breast cancer at its early stage.
As there is presently no medicine or vaccine to totally avoid the occurrence of breast cancer, the only way to increase survival in cancer affected population is to detect the disease early and treat it early.
How do we detect the disease early?
(1) Encouraging womenfolk to perform self breast examination (SBE). Ideally SBE should be started at the age of 16 years and performed on a monthly basis.
(2) Any new findings in breasts and armpits like a new swelling, discharge from the nipple, retraction or change in direction of the nipple, new change in skin of the breast, difference in size of the breast, swelling in armpit etc. Should be noted and a breast specialist doctor should be consulted as soon as possible.
(3) As breast cancer incidence increases with increase in age, 3 yearly mammograms are advised from the age of 40 up to 80 years, to detect cancerous lumps in breasts. Visiting breast specialist clinics for any complaint is suggested.
What will the breast specialist doctor do if there is an abnormality in the breast?
(1) Once an abnormality is identified in the breast (it can be swelling, nipple discharge, vague lump/thickening etc), the breast specialist doctor will advise you to undergo the triple assessment. The triple assessment comprises of: a) Clinical examination (history + examination of the abnormality) b) Radiological examination (Ultrasonogram/X-ray) c) Tissue biopsy (FNAC/Tru-cut/Excision)
(2) The results of the triple assessment will be conveyed to you. Broadly speaking the results can be grouped into two types. They are benign (non – cancerous) and malignant (cancer). Common benign diseases found in breast are – fibroadenoma, fibrocystic disease, galactocele, lactating adenoma, lipoma, tuberculosis, abscess etc. Out of 100 women presenting to breast clinic with a swelling in the breast, 80% of the swellings are found to have benign pathology while the rest 20% are found to have malignant pathology (cancer) i. e . 2 out of 10 swellings is cancerous.
What will the breast specialist doctor do if my swelling is benign?
(1) If the swelling is benign, the doctor may offer you just reassurance, or may prescribe you medication to relieve pain and discomfort. You may be advised to visit again for a routine review.
(2) If the swelling is benign, but needs removal you may be offered surgery – excision of the lump.
(3) Long term follow up may be offered in certain circumstances.
(4) Higher investigations like MRI, PET scan, guide wire localization biopsy may be advised.
What if my swelling is CANCER?
(1) You will be offered a counselling session and your diagnosis will be made known to you. You will be offered treatment options available according to the stage of the disease.
Broadly speaking treatment of breast cancer according to the stage of the disease can be grouped into:- a) Early breast cancer: When the swelling is confined to the breast, not very big and there is no or minimal involvement of the axillae (if lymph nodes are involved, they are not many, not fixed).
For early breast cancer, the breast specialist will offer you surgery, plus minus chemotherapy and plus minus radiotherapy according to the exact stage and aggressiveness of the tumour (on biopsy).
Surgery of breast cancer can be conservative breast surgery (removal of only the swelling + surrounding healthy tissue), total removal of the breast (mastectomy only) with or without removal of axillary content (modified radical mastectomy – mastectomy + axillary surgery).
Continuation of treatment with adjuvant therapy (chemotherapy/radiotherapy) is essential in achieving complete cancer free state. Chemotherapy may involve 6 to 8 cycles, sometimes more depending on the hormone receptor status in the biopsy report.
b) Locally advanced breast cancer – When the swelling is large, involving skin, nipple, chest wall and axillary nodes are involved. Surgery, chemotherapy plus minus radiotherapy stays the mainstay of treatment. Newer modalities of treatment like hormonal therapy, targeted therapy, herceptin etc play a major role in creating a good outcome.
c) Metastatic breast cancer – Breast cancer has spread to other parts of the body like bones, lungs, liver etc. Nowadays there are many efficient chemotherapeutic agents, hormonal agents and targeted therapy which can delay disease progression and increase quality of life of the sufferer.
Sometimes surgery is indicated to remove ulcerating breast (palliative mastectomy) to remove tumour from lung, liver, bone etc. Radiotherapy is also one of the treatment methods in this group.
The main focus of this article is to make people aware about the importance of diagnosing breast cancer at an early stage, because breast cancer can be considered curative if treated at an early stage. October is breast cancer awareness month, let us all be cancer aware and spread the message of “Early detection is the key”.
* Dr Ajit Lukram wrote this article for The Sangai Express
Dr Ajit Lukram, MBBS, DNB (General Surgery) Fellow (Breast & Endocrine; Colorectal) from Cumberland Infirmary, Carlisle, United Kingdom. Presently – Consultant Surgeon (Breast & Thyroid Specialist) at Shija Hospitals
This article was posted on October 19, 2016.
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