Albeit being the most common cancer among American women, except for skin cancer, almost 12% women in the United States develop invasive breast cancer during their lifetime. Estimates predict 231,840 new cases of invasive breast cancer to be diagnosed this year in US alone alongside 60,290 new cases of carcinoma in situ. Of these 40,290 women are estimated to die in 2015. Female breast cancer is the second leading cause of cancer deaths among women worldwide & which is only exceeded by lung cancer. However, death rates from breast cancer are presently on the decline due to early detection through screening, increased awareness, access to improved treatment procedures & decline in use of hormone therapy after menopause.
What is Breast Cancer?
Usually starting in the inner lining of milk ducts or lobules which supply milk, Breast Cancer is a malignant tumor which can spread to other parts of the body as well. Breast cancer which started in lobules is known as lobular carcinoma & the one which began from ducts is called ductal carcinoma. Although they happen in both sexes, large majority of breast cancer incidences occur in females. Accounting for 16% of all cancers in female & 22.9% of invasive cancers in women, breast cancer is a cause of 18.2% cancer deaths worldwide. Cases of breast cancer are much higher in developed countries & are more common among elderly women in rich countries who live much longer than women in poor nations. Eating habits & different lifestyles of females in poor & rich countries can also be contributing factors for disparity in quantum of cases for breast cancer.
Starting symptoms of breast cancer usually appear as thickened area of tissue or a lump in female breasts. However, majority of lumps are non-cancerous but then, women should get these examined by healthcare professionals anyway.
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Consult your doctor immediately in case you notice any of these signs & symptoms –
Lump in breast.
Pain in armpits or breasts which is unrelated to menstrual period.
Redness or pitting of skin of breast, like orange skin.
Rash on or around nipples.
Swelling or lump in one armpit.
Area of thickened tissue in breast.
Discharge from a nipple & which sometimes may contain blood.
Change in appearance of nipple, which may have sunken or inverted.
Change in size or shape of breast.
Breast skin or nipple skin beginning to peel, scale or flake.
Causes of Breast Cancer
Experts are yet unsure as to what causes breast cancer. It is hard to say as to why one person develops breast cancer while the other does not. However certain risk factors impact on likelihood of a woman developing breast cancer.
Risk Factors for Breast Cancer include –
Getting Older – Age is a risk factor for women as chances of developing breast cancer increase as they age. More than 80% of female breast cancers occur after menopause among women who are above 50 years of age.
Genetics – Women who have close relatives having had breast or ovarian cancers are more likely to develop breast cancer. Even if two family members develop this disease, it does not however mean they shared genes which make them more vulnerable as breast cancer is a common cancer & majority of cases are not hereditary.
History of Breast Cancer – Women who have had breast cancer in the past, even non-invasive cancer, are more likely to develop it again when compared with women have absolutely no history of this disease.
Certain Types of Breast Lumps – Even women who have had benign or non-cancerous breast lumps are more likely to develop breast cancer later on. Best examples include lobular carcinoma in situ or atypical ductal hyperplasia.
Dense Breast Tissue – Women having dense breast tissue display a greater chance of developing breast cancer in future.
Estrogen Exposure – Women who start having periods early or enter menopause later than normal pose higher risk of developing breast cancer. Reason being that their bodies are exposed to estrogen for longer time. Estrogen exposure, start with onset of periods & dramatically drop during menopause.
Obesity – Obese & overweight women post menopause have higher risk of developing breast cancer. Higher levels of estrogen in obese menopausal women, is considered to be the cause of higher risk.
Height – Experts are still not sure as to why, but taller than average women are found to have a slightly greater chance of developing breast cancer than shorter than average women.
Alcohol Consumption – Risk of developing breast cancer is directly proportional to the amount of alcohol women consume on a regular basis. Doctors say than women wanting a drink should not exceed a single alcoholic drink per day.
Radiation Exposure – Exposure to X-rays & CT scans may eventually slightly raise risk of developing breast cancer among women. Sloan-Kettering Cancer Center found that women treated with radiation to chest for childhood cancer have higher risk of developing breast cancer in future.
Hormone Replacement Therapy (HRT) – Combined & estrogen only HRT therapies slightly increase risk of developing breast cancer in women. Combined HRT however, poses a higher risk.
Certain Jobs – Researchers have found that women who worked at night prior to first pregnancy have higher risk of developing breast cancer. Other jobs which bring women in contact with carcinogens & endocrine disruptors are considered as posing higher risk for breast cancers.
Cosmetic Implants – Especially, women who undertake cosmetic implants & develop breast cancer have higher risk of dying prematurely. Cosmetic breast implants also make it harder to detect malignancy in early stages as they produce shadows on mammograms.
Diagnosis of Breast Cancer
Normally, women are diagnosed for breast cancer after routine breast cancer screening or after noticing certain signs & symptoms followed by a visit to the doctor. The doctor will carry a physical exam & then will refer the case to a specialist for further assessment.
Diagnostic Tests & Procedures for Breast Cancer
Breast Exam – Both breasts of the patient will be examined by the physician. He will look for lumps & other abnormalities like nipple discharge, inverted nipples and/or change in shape of the breasts. Patient will also be asked to sit/stand with arms in different positions like above head & by the sides.
X-ray – Mammogram – This is commonly used for screening breast cancer. In cases where anything unusual is noticed, doctors may order a diagnostic mammogram. Difference of opinion persists among doctors as to the right age for have routine screening. Some say 40 years as base while others insist on 50 years. Quite a few also believe that only high-risk groups should undergo routine screening.
2D Combined with 3D Mammogram – This combination effectively reduces incidences of false positives. Researchers found that where 66% of adult females were detected in 2D & 3D screenings, only 33% tested positive in 2D combined with 3D mammograms.
Breast Ultrasound – This type of scan will enable doctors determine if a lump or abnormality is solid mass or fluid filled cyst.
Biopsy – Sample of tissue from a lump or abnormality is the best guide to presence of cancer in the breasts. This small piece of tissue which is surgically removed is sent to the lab for analysis. If cells are found to be cancerous under the microscope, the lab will also additionally determine the grade of cancer. However, for accurate diagnosis, biopsy samples from multiple tumor sites need to be taken.
Breast Magnetic Resonance Imaging (MRI) – This is done with the help of dye which is injected into the patient. This scan will also help doctors determine the extent of cancer. MRI also provides a useful indication of breast tumor’s response to pre-surgical chemotherapy through clinical examination.
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Staging will describe the extent of breast cancer. Staging will let us know whether cancer is invasive or non-invasive, the size of tumor, whether lymph nodes are involved & how many of them, & also if cancer has metastasized or spread to other parts of the body. Staging is crucial to deciding upon the type of treatment to be employed & in determining prognosis. Normally done after diagnosing, doctors may prescribe several other tests including blood tests, mammogram, chest X-ray, bone scan, CT scan or PET scan.
Treatment Options for Breast Cancer
Usually, a multidisciplinary team of medical professionals will be involved in the treatment of breast cancer. Consisting of oncologists, specialist cancer surgeon, reconstructive surgeons, specialist nurse, radiographer, radiologist & pathologist, the team may sometimes also include physical therapist, occupational therapist, psychologist & dietitian.
Factors they will take into account while deciding the type of treatment will include –
Type of breast cancer.
Grade & stage of breast cancer, including size of tumor & extent of spread.
Lumpectomy – This is surgical removing of tumor & small margin of surrounding tissue. Often referred as breast-sparing surgery, this is mostly recommended when tumor is small & surgeon feels it is easy to separate from tissue around it. However, almost 20% of breast cancer patients who choose lumpectomy instead of mastectomy eventually need to be re-operated.
Mastectomy – It is the surgical removing of breast. Simple mastectomy involves removal of ducts, lobules, nipple, areola, fatty tissue & some skin. Radical mastectomy involves removing the entire breast including muscle of chest wall & lymph nodes in armpit. Quite a few women undergo pointless mastectomies due to fear even though this does not improve survival rates.
Sentinel Node Biopsy – Only one lymph node is surgically removed in this procedure. In case breast cancer has reached lymph node, it poses threat as it can spread to other parts of the body through the lymphatic system.
Axillary Lymph Node Dissection – If the sentinel node is found to be cancerous, doctors often recommend removal of several lymph nodes in armpit connected with it.
Breast Reconstruction – This involves a series of surgical procedures designed to recreate breast & which as far as possible look like the other breast. This procedure can be carried out at the same time as mastectomy & for which surgeons may use breast implant or tissue from other parts of patient’s body.
Measured & controlled doses of radiation are targeted at tumors so as to destroy breast cancer cells. Radiation Therapy Procedure is usually employed after surgery & chemotherapy in order to destroy any remaining cancer cells. Typically, given about a month after surgery or chemotherapy, each radiotherapy session lasts a few minutes & patients may often require 3 – 5 sessions per week for 3 – 6 weeks. The type of patient’s breast cancer will decide the type of radiation therapy to be undertaken. However, radiation therapy is not required in quite a few cases.
Types of Radiation Therapy
Breast Radiation Therapy – Usually applied after lumpectomy, doses of radiation are administered to the remaining breast tissue.
Chest Wall Radiation Therapy – This procedure is normally applied after undergoing mastectomy.
Breast Boost – It is a high-dose radiation therapy which is administered to the area from where the tumor was surgically removed. This may alter the appearance of the breast in cases where breasts are large.
Lymph Nodes Radiation Therapy – This radiation treatment is aimed at the armpit (axilla) & surrounding tissue so as to destroy cancer cells that have encroached connecting lymph nodes.
Breast Brachytherapy – Women with early-stage breast cancer in milk-ducts which has not yet spread seem to benefit from breast brachytherapy with strut-based applicator. This is a 5-day treatment given to patients after undergoing lumpectomy surgery. Designed to lower recurrence rates, this therapy has fewer & less severe side effects.
Shorter radiation therapy is quite safe & effective. Irrespective of age, stage, tumor grade, chemotherapy or tumor bed boost outcomes of women given shorter radiation therapy are similar. Common side effects of radiation therapy include fatigue, lymphedema, & irritation & darkening of breast skin.
Medications called cytotoxic drugs are used in chemotherapy so as to destroy breast cancer cells. In cases where there is high risk of cancer recurrence or chances of cancer spreading to other body parts, oncologists invariably recommend adjuvant chemotherapy after breast cancer surgery. In women where tumors are large, Chemotherapy Procedure is also recommended before surgery & which is aimed to shrink the size of tumor so as to make removal easier. Chemotherapy is also administered when cancer has metastasized to other regions of the body. It is useful in reducing some common symptoms caused by cancers. Moreover, chemotherapy is also helpful in stopping production of certain hormones like estrogen which encourage growth of some breast cancers.
Protecting Female Fertility
Researchers have designed an arsenic-based chemo medication which can aggressively attack breast cancer & which goes much gentler on the ovaries. This novel method helps protect female fertility in women undergoing breast cancer treatment. Rapid testing of chemotherapy drugs for effects on ovary function will enable doctors & patients make decisions regarding treatments which minimize damage to ovaries as significant number of female patients face fertility loss after traditional chemotherapy.
Chemotherapy Side Effects
Side effects of chemotherapy include fatigue, loss of appetite, nausea, vomiting, hair loss, sore mouth & slightly higher susceptibility to infection. Quite a few of these side effects can be effectively controlled through additional medications prescribed by the doctor. Moreover, it is likely that women above 40 years of age may enter early menopause.
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Some types of breast cancers are sensitive to hormones. Often referred as ER Positive (estrogen receptor positive) & PR Positive (progesterone receptor positive) cancers, the aim of this treatment is to prevent cancer recurrence. Hormone Blocking Therapy is normally employed after surgery but may also be required prior to surgery in some cases so as to shrink tumors. This is also an ideal treatment for patients who for some reason cannot undergo surgery, chemotherapy or radiation therapy. Nevertheless, hormone therapy will have no effect on cancers, including breast cancers, which are not sensitive to hormones. Most hormone therapies usually last up to five years post surgery.
Hormone Therapy Medications
Tamoxifen – prevents estrogen to bind with ER Positive cancer cells. Common Tamoxifen side effects include aching joints, fatigue, vomiting, nausea, headaches, weight gain, hot flashes & change in periods.
Aromatase Inhibitors – This type of medication is normally offered to women who are through menopause. These drugs effectively block aromatase which help women produce estrogen after menopause. Normally, ovaries in women produce estrogen before menopause. Good examples of aromatase inhibitors include anastrozole, exemestane & letrozole. Common side effects of aromatase inhibitors include hot flashes, sweats, loss of libido, aching joints, bone pains, headaches, skin rashes, fatigue, vomiting & nausea.
Ovarian Ablation or Suppression – Pre-menopausal women produce estrogen in ovaries. Therefore, ovarian ablation or suppression will stop ovaries from producing estrogen. While ablation can be done through surgery or radiation therapy, this will permanently damage ovaries & the patient will enter menopause early. Goserelin is a luteinizing hormone-releasing hormone agonist (LHRHa) drug which will suppress the ovaries & the patient’s periods will stop during treatment. However, menstrual periods will restart again when she stops taking this drug. Menopausal women aged about 50 years though may probably never have periods again. LHRHa side effects include hot flashes, sweats, sleeping problems & mood changes.
Biological Therapy – Targeted Drugs
Trastuzumab (Herceptin) – It is a monoclonal antibody which targets & destroys cancerous cells which are HER2 Positive. Quite a few breast cancer cells produce huge amounts of growth factor receptor 2 or HER2 protein which Herceptin selectively targets. General side effects from Trastuzumab include headaches, skin rashes and/or heart damage.
Lapatinib (Tykerb)– While targeting HER2 protein, Tykerb is also used for treatment of advanced metastatic breast cancer. This drug is quite helpful for patients who do not well to Herceptin. Common side effects with Tykerb include nausea, vomiting, diarrhea, extreme tiredness, mouth sores, skin rashes, painful hands & painful feet.
Bevacizumab (Avastin) – This effectively stops cancer cells from attracting new blood vessels & thereby starve the tumor of nutrients & oxygen. Although using this drug for breast cancer is controversial, researchers found that Avastin only modestly benefits disease progression among women with advanced stage breast cancer. Common Bevacizumab side effects include mouth sores, headaches, blood clots, heart damage, kidney damage, hypertension & heart failure.
Low Dose Aspirin – Presently under research, studies suggest that regular low-dose aspirin might in fact halt spread & growth of aggressive ‘triple-negative’ breast cancer which is resistant to most current treatments. Low Dose Aspirin not only seems to slow & shrink breast cancer tumors, but also seems to stop metastasis of cancer.
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Breast cancer can seriously hamper emotional stability of women. Taking sensitive care of the patient at this stage is important to proper recovery. Alongside offering you the best breast cancer treatment hospital in India, IndianMedTrip offers understanding & compassionate healing hands so as to help you overcome this medical tragedy. IndianMedTrip healthcare consultants are associated with leading cancer hospitals like Artemis Cancer Institute, Fortis Memorial Cancer Research, HCG Cancer Hospital, & Tata Memorial Cancer Hospital. Cost of breast cancer surgery in India is normally affordable, but planning timely & effective treatment options can be a matter of life & death. IndianMedTrip is your best bet who can provide you excellent breast cancer treatment packages at affordable costs.