Breast Cancer - I
Breast cancer is the most common female cancer in India accounting for 115,251 cases in 2008 (1). With modernization and change in life style there is an increase in various risk factors for breast cancer such as delayed pregnancy, obesity (overweight), change in breast feeding habits etc. This increased exposure has led to an increase in the number of breast cancer cases in India in the last few years (2). In this series of articles titled ”Basics of Breast cancer” we present basic information on Breast cancer that we think all people need to be empowered with.
What is breast cancer?
Cancer arising in the glands of the breast is called breast cancer.
What are breast glands made up of?
Breast glands are made up of Milk ducts (tubes) and Lobules (sacs). Cancer arising in the milk ducts is called ductal carcinoma and in the lobules is called lobular carcinoma. Ductal carcinoma is the most common type of Breast cancer.
Precancerous lesions that can turn cancerous
There are few precancerous (non-invasive) lesions that can turn into cancer. Two main types of these lesions are:
Ductal carcinoma in situ (DCIS): cells lining the milk ducts multiply in an uncontrolled fashion but do not invade (grow into) the neighboring tissue.
Lobular carcinoma in situ (LCIS) Cells lining the lobules multiply in an uncontrolled fashion but do not invade (grown into) the neighboring tissue.
There are many known risk factors/causes for breast cancers. Here we list some of the important factors:
- Old Age: Breast cancer is more common in women older than 50. There has been a slight shift in the incidence (new cases found) in India with many younger patients being diagnosed with breast cancer in the recent years
- Female Gender: Women are much more likely to develop breast cancer than men
- Family history of breast cancer
- Genetic mutations for breast cancer such as BRCA1 and BRCA2
- Prolonged duration of menstrual cycles: It has been shown that women with more number of menstruating years of life have higher risk of breast cancer. So women with early onset of menses (menarche) and late stoppage of menses (menopause) have higher incidence of breast cancer
- Pregnancy: Risk of breast cancer goes down with increasing number of pregnancies. Having first pregnancy at a younger age is also shown to decrease the risk of breast cancer
- Lactation: Breast feeding decreases the risk of cancer
- Obesity: Obese women tend to produce more estrogen and have higher chances of breast cancer. One more reason to lose weight
- Hormone replacement therapy: Menopausal Hormone replacement therapy especially combination of estrogen and progesterone (female hormones) has been shown in a large Women’s health initiative study to increase the risk of breast cancer (3)
- Alcohol use: A recent study reported that even mild intake of alcohol about 3-6 drinks per week increases the risk of breast cancer (4).
- Others: Radiation exposure, dense breasts and Vitamin D deficiency have been shown to increase the risk of breast cancer
Breast cancer can be identified in asymptomatic women by screening mammogram or routine clinical exam or on self-breast exam. Please read our screening section for guidelines. In India many women do not undergo recommended screening and present with various symptoms at diagnosis. Here are some of the common symptoms:
Local (within the breast) symptoms:
- Change in the shape of the breast,
- Nipple retraction
- Change in the skin over the breast (like the peal of an orange)
- New Nipple discharge
Systemic (outside the breast) symptoms: depend on the organ involved with cancer
- Weight loss
- Bone pain (when bones are involved with cancer)
- Jaundice (if liver is involved and causing obstruction)
- Difficulty breathing (if lung involvement)
It should be noted that all of the above symptoms can be seen in various other conditions and evaluation by a qualified physician is important to make a diagnosis.
Please refer to part 2 and part 3 for diagnosis and treatment.