All You Need To Know About Breast Cancer And Importance Of Breast Self-Examination

Dr Preetam Jain, Medical Oncologist, Bhatia Hospital Mumbai

What Is Breast Cancer?

Breast cancer is a disease where the cells grow out of control. It can begin either in your glands that make milk (called lobular carcinoma), or the ducts that carry it to the nipple (called ductal carcinoma) and spread to nearby lymph nodes or through your bloodstream to other organs.

There are different types of breast cancer according to their growth and the pace at which it spreads. Some take years to spread beyond your breast, while others grow and spread quickly.

Who Gets Breast Cancer?

Breast cancer is the second most common cancer diagnosed and the second leading cause of cancer deaths in women. It affects 1 in 8 women and two-thirds of women with breast cancer are in the age group of 55 years and older. The rest are between 35 and 54 years.

The good thing is that if detected early, breast cancer can be treatable and prevent its spread to other areas of the body.

Incidence of Breast cancer in India as per GLOBOCAN:

Breast Cancer Causes and Risk Factors

There are certain factors such as your age, genetic factors, personal health history, and diet which play an important role in determining the risk of getting breast cancer.

Breast Cancer Risk Factors You Can’t Control

Age. Women over 50 are more likely to get breast cancer than younger women.

Dense breasts. If your breasts have more connective tissue than fatty tissue, it can be hard to see tumors on a mammogram.

Personal history of cancer. Your odds go up slightly if you have certain benign breast conditions. They go up more sharply if you’ve had breast cancer before.

Family history. If a first-degree female relative (mother, sister, or daughter) had breast cancer, you’re two times more likely to get the disease. Having two or more first-degree relatives with a history of breast cancer increases your risk at least three times. This is especially true if they got cancer before menopause or if it affected both breasts. The risk can also arise if your father or brother was diagnosed with breast cancer.

Genes. Changes to two genes, BRCA1 and BRCA2, are responsible for some cases of breast cancer in families. About 1 woman in 200 has one of these genes. While they make you more likely to get cancer, they don’t mean you definitely will.

Menstrual history. Your breast cancer odds go up if:

• Your periods start before age 12.
• Your periods don’t stop until after you’re 55.

Radiation

If you had treatment for cancers like Hodgkin’s lymphoma before age 40, you have an increased risk of breast cancer.

Diethylstilbestrol (DES)

Doctors used this drug between 1940 and 1971 to prevent miscarriage. If you or your mother took it, your breast cancer odds go up.

Breast Cancer Risk Factors You Can Control

Physical activity. The less you move, the higher your chances.

Weight and diet. Being overweight after menopause raises your odds.

Alcohol. Regular drinking — especially more than one drink a day — increases the risk of breast cancer.

Reproductive history. You have your first child after age 30.

You don’t breastfeed.

You don’t have a full-term pregnancy.

Taking hormones. 

Your chances can go up if you:

Use hormone replacement therapy that includes both estrogen and progesterone during menopause for more than 5 years. This increase in breast cancer risk returns to normal 5 years after you stop treatment.

Use certain birth control methods including birth control pills, shots, implants, IUDS, skin patches, or vaginal rings that contain hormones.

Early Warning Signs of Breast Cancer

Common symptoms of breast cancer include:

A lump in your breast or underarm that doesn’t go away. This is often the first symptom of breast cancer. Your doctor can usually see a lump on a mammogram long before you can see or feel it.

Swelling in your armpit or near your collarbone. This could mean breast cancer has spread to lymph nodes in that area. Swelling may start before you feel a lump, so let your doctor know if you notice it.

Pain and tenderness, although lumps don’t usually hurt. Some may cause a prickly feeling.

A flat or indented area on your breast. This could happen because of a tumor that you can’t see or feel.

Breast changes such as a difference in the size, contour, texture, or temperature of your breast.

Changes in your nipple, like one that:

• Pulls inward
• Is dimpled
• Burns
• Itches
• Develops sores
• Unusual nipple discharge. It could be clear, bloody, or another color.

A marble-like area under your skin that feels different from any other part of either breast.

Breast Cancer Screening

You should keep doing breast self-exams, checking the treated area and your other breast each month. You should tell your doctor about any changes right away.

Also, keep getting regular mammograms. In some screening centers, three-dimensional mammograms are available in addition to traditional digital mammograms. If genetic tests show you have the BRCA mutations, you may also need an MRI of your breast. Talk to your doctor about the best screening tests for you.

Importance of Breast Self-Examination (BSE)

About 20% of breast cancers are detected with breast exams. It’s harder to detect breast cancer using a mammogram alone if you have dense breast tissue. On a mammogram, fatty breast tissue appears dark, while dense breast tissue appears white. Women with dense breasts have denser tissue than fatty tissue. This is important because dense tissue is more difficult to see through to detect masses like cancer. That’s why it’s important to use breast self-exams along with mammograms to maximize your chances of finding cancer early.

Recommendations for the Early Detection of Breast Cancer

Women between 40 and 44have the option to start screening with a mammogram every year.

Women 45 to 54should get mammograms every year.

Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.

All women should understand what to expect when getting a mammogram for breast cancer screening – what the test can and cannot do.