Introduction

Breast cancer is a disease in which cells in the breast multiply and grow abnormally. This can happen if the genes in a cell that control cell growth no longer function properly. As a result, the cell divides uncontrollably and may form a tumor.

You may be able to feel it as a lump under the skin, or you may not realize it’s there at all until it’s found on an imaging test, such as a mammogram (breast x-ray).

Breast tumors can be Benign (not cancerous) which means they can’t spread and are not life-threatening or Malignant tumors are cancerous. If not treated, the cancer can invade surrounding tissue and spread (metastasize) to other parts of the body.

Symptoms of breast cancer

Many breast cancers are discovered through routine screening tests such as mammograms, even when a woman has no other signs of disease. However, on your own, you may notice symptoms that could be point towards cancer. See your doctor right away if you have any of these conditions:

• a lump or thickness in or near the breast or under the arm
• unexplained swelling or shrinkage of the breast, particularly on one side only
• dimpling or puckering of the breast, any change in contour of the breast
• nipple discharge (fluid) other than breast milk that occurs without squeezing the nipple
• breast skin changes, such as redness, flaking, thickening, or pitting that looks like the skin of an orange
• a nipple that becomes sunken (inverted), red, thick, or scaly

Risk for getting breast cancer

Your risk for breast cancer rises as you get older. About 80 percent of breast cancers are found in women over age 50 — many of whom have no other known risk factors for the disease.

Although you’re two to three times more likely to get breast cancer if you have a strong family history of the disease, only 5 to 10 percent of breast cancers are inherited, meaning that they are linked to gene mutations passed down in families, such as the BRCA1 and BRCA2 gene mutations. Several other risk factors may slightly boost your chances of getting breast cancer.

Estrogen

Estrogen promotescell growth

Course leading to increase estrogen exposure and increase chances of developing cancer

• Early menarche (start of menses)
• Late menopause (stopping of menses)
• Alcohol
• Obesity
• Lace of exercise
• Stress etc.

Progesterone

Progesterone causes cell maturation and stabilizing. It is in growth phase that cell undergoes malignant transformation, i.e. cancer formation occurs

Whereas following induce healthy progesterone and decrease the chances of cancer occurrence:

• Timely pregnancy
• Proper and adequate lactation in breastfeeding

Screening for breast cancer

An annual clinical breast examination by a healthcare professional and self-breast examination starting at age 25 and an annual mammogram starting at age 40 for women of average risk without symptoms.

Ask your doctor if you need earlier or more frequent screening or additional tests if you are at above-average risk for breast cancer due to any of the following factors:

• a family history of breast cancer, particularly in close relatives such as your mother or sister, or in several family members
• atypical hyperplasia (a type of benign breast disease) or lobular carcinoma in situ (abnormal cells in the lobule)
• treatment with radiation (a therapy used for Hodgkin’s disease and some other medical conditions) before age 32
• BRCA1, BRCA2, or other  gene mutations and other risk factors

Diagnosis of breast cancer

Diagnosis of breast cancer involves triple assessment, that is

• Clinical breast examination
• Breast Imaging- Mammogram or Ultrasound or MRI breast
• Pathological diagnosis- Core needle biopsy

Types of breast cancer

There are mainly 2 types of breast cancer. Most cancers form in the milk ducts and are called ductal carcinoma. Others start in the breast’s milk-producing lobules or glands; these types are referred to as lobular carcinoma. Rarely, cancer can start in other parts of the breast’s tissue, a type known as sarcoma, or in the skin of the nipple, called Paget’s disease.

Molecular Profiles of breast cancer

Tumor samples are analyzed in a lab by pathologists who determine whether the tumors are sensitive to the hormones estrogen and progesterone, which can fuel breast cancer. Some genes and proteins they create are known to affect cancer cell growth like HER2neu.

According to these, breast cancer is classifies into molecular subtypes like

• Luminal A
• Luminal B
• HER 2 enriched
• Triple negative

This information is very crucial for your doctors; so that they can target treatment to your specific cancer and at the same time predict prognosis.

Lifestyle factors

Eating Unhealthy Food

Diet is thought to be at least partly responsible for about 30% to 40% of all cancers. No food or diet can prevent you from getting breast cancer. But some foods can make your body the healthiest it can be, boost your immune system.

Smoking

Smoking is linked to a higher risk of breast cancer in younger, premenopausal women. Research also has shown that there may be link between very heavy second-hand smoke exposure and breast cancer risk in postmenopausal women.

Drinking Alcohol

Research consistently shows that drinking alcoholic beverages increases a women’s risk of breast cancer, particularly hormone-receptor-positive breast cancer. Alcohol also may increase breast cancer risk by damaging damaging DNA in cells.

Stages of breast cancer

The stages of breast cancer are used to describe the extent of your cancer at the time of diagnosis. This is based on a physical exam and other diagnostic tests. This is known as clinical stage.

The final, or pathologic stage is determined after surgery when the size of the cancer is measured under a microscope and it is definitely known if there is cancer in the lymph nodes.

Knowing the stage helps guide your treatment plan. Breast cancer is typically staged with Roman numerals ranging from 0 (the earliest stage) to IV (the most advanced stage). Cancer stages are based on:

• T- the size of the tumor
• N- whether the cancer has spread (metastasized) to the lymph nodes, and if so, to how many of them
• M- whether the cancer has spread to other parts of the body, such as the lungs or liver

To make an informed choice, ask about the pros and cons of each option, potential side effects, and how effective the treatment is likely to be.

Depending on the type and stage, treatment options can be: 

• SURGERY to remove the cancer, such as lumpectomy (removal of the tumor and a small rim of tissue around it-‘margins’) or mastectomy (removal of the entire breast) along with removal of lymph nodes in armpit
• RADIATION THERAPY, using high-energy rays (such as x-rays) to destroy cancer cells 
• CHEMOTHERAPY with drugs that kill breast cancer
• HORMONE THERAPY medications that block estrogen and other hormones that fuel the growth of some breast cancers
• TARGETED THERAPY drugs that act like smart bombs by targeting specific molecules involved in breast cancer development, growth, and spread while sparing normal cells

Mostly breast cancer treatment usually involves a combination of these approaches.

Frequently Asked questions –

What is the female breast made of?

Also called the mammary glands, female breasts are mostly made of fatty tissue along with blood vessels, nerves, lymph nodes, bands of connective or fibrous tissue (ligaments) to hold everything together, and the milk system, including ducts and lobes. The amount of fat largely determines your breast size.

What are the different types of surgery for Breast Cancer?

The surgery for Breast cancer can be of either Mastectomy commonly called MRM where entire breast including nipple and areola and nodes from the armpit are removed or a Lumpectomy where only the cancer lump is removed.

However, patients who need mastectomy can go for now nipple preserving mastectomy where we save entire breast skin and nipple complex and the breast is made again using either fat or muscle from the body or an implant.

Similarly for a lumpectomy, concepts of plastic surgery are used so that breast shape and fullness are preserved to achieve best results.

Should I go for Breast Reconstruction?

The effect of losing a breast is different on every lady. So while one person may be comfortable with living without a breast for the rest of her life, there is no reason for everyone to do the same. We combine the removal and reconstruction surgery at the same time so that when you come out of surgery, the tumor is gone but the breast is similar to what it was before surgery. Reconstruction not only helps your appearance, but it also has psychological benefits and it helps increase the tolerance to radiotherapy

If you can choose to skip reconstruction, there are options of using external breast forms made of pad or silicone or can even make no attempt to change your appearance.

How is Reconstruction done?

There are many ways to restore the breast. We can use oncoplastic breast reconstruction  or fat from lower tummy or muscle from back or use silicone implant depending upon the suitability and patient’s wishes.

When’s the Best Time to Have Breast Reconstruction?

The timing is based on your desires, medical conditions, and cancer treatment. The best results are obtained if it is done along with the surgery to remove the breast. However reconstruction can also be done months or years after a mastectomy was done. If you’ve started any chemotherapy or radiation treatments, reconstruction is usually postponed until you complete those treatments. Your surgeon can help you decide the right timing for you.

Will I be at risk for lymphedema after surgery?

The risk of arm swelling depends on the surgery done and also upon whether chemotherapy and radiotherapy is needed after surgery. We have procedures like sentinel lymph node biopsy and axillary reverse mapping, etc that reduce the risk of development of arm swelling (Lymphedema)  after treatment.

How long will I stay in the hospital?

The stay will vary upon the procedure planned and it can be from 2 days to 5 days.

How long does it to recover from surgery?

Patient usually resumes routine activities like eating, ambulating 6 hours from surgery.