It would be unjust to write on this vast subject in the given limited space, yet I will try to do justice to make you reasonably aware – from a common (wo)man’s perspective. First, although this affects mostly females, about 1-2% cases are men. Also, though this cancer can run in families, hereditary breast cancer account for only 2-3% of all breast cancers. With these facts on record, let’s see what would be worth knowing.
BREAST CANCER AWARENESS AND SELF BREAST CANCER EXAMINATION
All females need to be aware of the changes happening in their breast. And for this they need to understand the importance of self breast examination, which should be performed once in a month form the age of 25 yrs, taking about 5 mins. It should be done with the flat of the fingers, pressing against the chest wall feeling for any lump – in one of the patterns shown in the figure. Premenopausal woman are advised to do it at the end of their menstrual cycle. Any abnormality hence detected should be brought to the notice of a specialist. Go for specialists in breast cancer treatment in Delhi.
Annual mammography (Xray of the breast) with or without ultrasonography of both breast is recommended after age of 40 years for screening.
DIAGNOSIS AND STAGING
Diagnosis of a breast lump requires a biopsy and a pathological examination. Once a diagnosis of cancer is confirmed, an Xray of the chest, an ultrasound of the abdomen and a bone scan is ordered to rule out spread to lungs, liver, bones etc. If the disease is localized to breast as is mostly the case a clinical staging is done, which depends on the size of the lump and enlargement of axillary (armpit) lymph nodes (AN) if any. There are 4 stages of cancer and simply put, they are –
Stage 1 – Tumors of less than 2 cms (longest diameter) and no spread to AN
Stage 2 – Tumors of 2-5 cms with no or minimal spread to AN
Stage 3 – Large Tumors of more than 5 cms and/or gross involvement of AN
Stage 4 – Spread to other parts of body such as lungs, liver, bones etc.
SUB-TYPES OF BREAST CANCER
There are 4 major subtypes of breast cancer which have implications on treatment and prognosis and hence are important to be known.
Before I elaborate further, it should be known that similar to normal breast tissue breast cancer may also be dependant on female hormones, namely estrogen and progesterone, for its growth, though not necessarily.
Luminal A – Are hormone dependant slow growing tumors with best prognosis.
They are positive for hormone receptors (estrogen receptor-ER and progesterone receptor-PR).
Luminal B – They are like Luminal A but relatively faster growing and have good prognosis.
Her2neu – This is an onco (cancer) gene which promotes growth of the tumor and imparts aggressive behavior. About 25% breast cancers are positive for this.
Triple Negative – They are negative for ER, PR and Her2 neu and carry worst prognosis.
For stage 1, 2 and 3 – Surgery is the mainstay of the treatment which removes the breast and also the lymph nodes in the axilla. In appropriately selected cases a lumpectomy (removal of the lump) with only lymph node sampling may suffice – called as breast conservation surgery.
Surgery is followed by chemotherapy in most cases. Those with early stage and low risk (Luminal A) subtype can be spared chemotherapy. Chemotherapy protects from spread of disease and increase cure rates by 20-30%. Chemotherapy may precede surgery in stage 3 patients to help down stage the tumor and facilitate surgical outcomes.
Targeted therapy for Her2 neu positive tumors is available and is incorporated with chemotherapy. It increase cure rates by additional 20-30%.
Chemotherapy is followed by radiotherapy (RT) and is rendered to all stage 3 patients and those who undergo breast conservation surgery. RT protects from local recurrence and in turn increases cure rates.
Radiotherapy is followed by hormonal treatment for those whose tumor is positive for ER and PR (Luminal A & Luminal B). This is generally given for 5 to 10 years and amounts to taking a pill a day. Hormonal therapy further increases cure rates by 20-30%.
This completes the successful treatment of a localized breast cancer.
For Stage 4 – Chemotherapy is the mainstay of the treatment here, especially when vital organs are involved. For selected patients with low volume disease particularly Luminal A and B subtypes hormonal therapy is the treatment of choice. Radiotherapy is used for pain relief and surgery is seldom used in this stage.
Targeted therapy is reserved for those with Her2 neu subtype and enhances response rates and survival.
To conclude, no two breast tumors are alike and there are great variations seen in clinical practice. The above stated sub-division to predict outcome is just the beginning of our understanding of these variations which is only going to become better in future. Yet, the key to real success is staying healthy and being “breast” aware.