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Breast cancer cases have seen a steady rise in India and worldwide in recent years. Studies state that breast cancer makes up the second most common cause of death in women. Despite, the disease being common, there is a significant lack of awareness about the causes, diagnosis, treatment, and measures to prevent breast cancer. People often are bothered by apprehensions and questions about breast cancer. In this blog, we attempt to present to you a set of chosen questions and their answers from an expert oncologist’s perspective:
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What is screening? Who should get breast cancer screening?
Screening is a term used for tests done for detecting disease in a person with no symptoms. Breast cancer screening is recommended for ladies above 40 years of age, including a detailed clinical evaluation and Mammogram. Further interval of performing tests depends on the risk category the individual is assigned.
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What are the options for preventing breast cancer?
Lifestyle modifications - to be followed by all…
- Alcohol - Studies have shown that daily consumption of a moderate quantity of alcohol (30ml liquor or 250ml of beer or 180ml of wine) increases breast cancer risk. Additionally, there is a 10% increase in the risk of breast cancer for every 10g of alcohol consumed daily. Quitting alcohol has several health benefits, including risk reduction for breast cancer.
- Exercise - There is an estimated 20% reduction in the risk in those active compared to those inactive, with the highest benefit seen in those walking or hiking for >10 hours per week.
- Diet - A diet rich in fruits and vegetables may be associated with decreased risk even among those who are less physically active throughout their lifetimes.
- Other lifestyle modifications - Planning first childbirth at a younger age and encouraging breastfeeding does have a protective role.
Risk-reducing Medications
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Some of the medications used in the treatment of breast cancer have also shown their benefit in preventing breast cancer in a high-risk subset population as determined by the oncologist.
Risk-reducing Surgery
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Individuals carrying BRCA gene mutation are at high risk for breast and ovarian cancer. Carriers of BRCA-1/2 gene mutations benefit from surgical removal of both breasts and ovaries even before the appearance of cancer. There is an example of a leading Hollywood actress at the peak of her career undergoing surgical removal of her breasts and ovaries to prevent a possible breast cancer and ovarian cancer when she tested positive for the carrier of BRCA mutation.
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I have a Breast Lump. What are the tests that I should be undergoing?
You should first visit a Surgical Oncologist for clinical examination. The oncologist would then decide if Ultrasonography is better or Mammography, if FNAC (Fine needle aspiration Cytology) is sufficient, or if a biopsy is necessary. Often individuals come with sub-optimal tests, warranting re-evaluation with new tests, adding to costs and delay in diagnosis and starting treatment.
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What is the difference between FNAC and Biopsy?
FNAC yields only a few cells from the tumour, while the biopsy gives a larger tissue sample from the tumour. Diagnosis is more accurate on a biopsy specimen, moreover biopsy sample is useful for additional tests such as Hormone receptor and Her2neu testing. These tests help decide on the correct treatment plan for the patient (Chemotherapy followed by surgery or surgery followed by chemotherapy). Thus biopsy is superior to FNAC.
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I want to get rid of the Tumour, but not my breast. Is it possible?
Yes. Conserving the breasts is an option in properly selected patients. Breast oncoplasty (where the tumour is removed and the breast conserved) is equivalent to Mastectomy (Removal of the whole breast) concerning survival and has the advantage over mastectomy in terms of the positive psychological impact it has on the woman.
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Why is surgery also done in the Axilla for Breast Cancer?
Breast cancer cells travel via lymph fluid to the lymph nodes in the axilla. Hence, in all breast cancer surgeries, lymph nodes have to be removed (either sentinel node biopsy or Axillary lymph node dissection) to determine the accurate tumour stage.
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Is surgery compulsory? Are there any other treatments in addition to surgery?
Yes. Based on the stage and tumour characteristics, there will possibly be a need for additional chemotherapy, radiation therapy, hormonal therapy, targeted anti-Her2neu therapy, and immunotherapy.
