Wednesday, August 5, 2020

What is Breast Cancer?

Breast cancer is a cancer that forms in the tissues of the breast – usually in the ducts (tubes that carry milk to the nipple) or lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare. Ductal cancer is the commoner variety.

It may be in-situ (cancer still inside ducts / lobules and not spread to healthy breast tissue) or invasive (cancer has spread beyond ducts/lobules) to healthy breast tissue.

Staging Breast Cancer

λ Early stage (Stage I, Early Stage II) – the cancer is limited to the breast or axillary lymph nodes (nodes in armpit).

λ Locally Advanced stage (Late Stage II, Stage III) – the cancer involves the skin of breast or the chest wall.

λ Metastatic stage (Stage IV) – the cancer has spread to other organs.

Incidence – how common is breast cancer?

Breast Cancer Map

Breast cancer is a leading cause of cancer-related deaths in women, with almost 1.7 million cases diagnosed per year and more than half a million deaths every year. Female breast cancer incidence rates vary widely between regions, with the highest incidence rates in Western Europe and the United States, and the lowest in Africa and Asia.

Below is a figure to depict numbers of new cases of breast cancer diagnosed in 2012 per 100,000 people of each region’s population.

What are the risk factors for breast cancer?

λ Female gender

λ Increasing age

λ Having fewer children

λ No breastfeeding

λ Genetic predisposition (family history or mutations in certain genes)

λ History of atypical hyperplasia (overgrowth of breast tissue)

λ Obesity

λ Exposure to estrogens

λ Alcohol

What are the symptoms?

The symptoms include one or more of the following –

λ A lump in the breast

λ Change in the size or shape of the breast

λ Dimpling of the skin or thickening  in the breast tissue or reddening of breast skin

λ Nipple inversion, discharge

λ Swelling or a lump in the armpit

λ In conjunction with these , any bony pains, persistent cough , yellowing of eyes should also not be overlooked

How to diagnose?

Once a patient reports with any of these symptoms, a thorough clinical examination is required which includes bilateral breast and axilla examination, examination of neck. A bilateral mammography (basically an X-ray of the breast) is then performed which characterizes the breast disease .Then we perform a small needle biopsy to prove the disease pathology and also to find out the hormonal and other receptor status (e.g. Her2) of the cancer – as these can be targeted specifically with drugs

In locally advanced cases we usually do a CT scan to check for disease spread elsewhere.

How to treat?

It is usually a curative disease if detected in early or locally advanced stages , and even in advanced metastatic stage , there are chances of long term control and survival benefits with the treatment options available today.

The treatment options are:

1. Surgery – it is the mainstay of treatment in early and locally advanced disease. Removal of only the tumor and conserving the healthy breast tissue is the norm.

2. Chemotherapy – is mainly used after surgery in early breast cancer to improve survival , in some cases of locally advanced cancers it is used before surgery also to decrease the size and extent of the cancer and improve outcomes

3. Hormonal therapy – Breast cancer is a hormone dependent tumor in almost 60 % cases and they respond to hormonal manipulation (in form of tablets and injections) very well. These tablets are quite inexpensive and give long term benefits in all stages.

4. Targeted therapy – It is very useful in cases where the cancer is positive for the specific receptor (e.g. Her2). They are comprised on monoclonal antibody injections or tablets and are used either alone or in conjunction with chemotherapy / hormonal therapy.

5. Radiation therapy – it is useful in preventing local disease reoccurrence after surgery and is also helpful if there is disease spread to the bone, brain.

What is life after treatment of breast cancer?

It is a largely curable disease with over 80% survivals in early and over 65% survivals in locally advanced breast cancer. Usually three monthly routine checkups with the doctor for the first 2 years and then 6 monthly for the next three years are recommended. Even in advanced metastatic disease, with the wide array of options available, survival and quality of life is constantly getting improved.

It is advised hence to immediately consult the doctor once any suspicion of above said symptoms arise and to get evaluated properly.  It is curable if detected early.

Dr. Subhadeep Bose

Medical Oncologist

Bahrain Specialist Hospital

Email: subhadeep.bose@bsh.com.bh

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