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Breast Cancer

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Overview

Breast cancer is the most common type of cancer among women. Recently there has been a rising trend in the incidence rates of breast cancer in India. According to the Globocan 2018 report, 162468 new breast cancer cases and 87090 deaths due to breast cancer were reported in India. It can occur in both men and women, but it accounts for less than 1% of all breast cancer cases in men. It is the most diagnosed cancer (27.7%) among women’s [1] . Breast cancers grow and spread to different part of the body through lymph nodes and blood vessels. Early diagnosis of breast cancer is crucial as the outcomes are good in these cases, but diagnosis in late stages of the disease have poor outcome.

Types of Breast Cancer

In-situ cancers

These types of breast cancer remains confined to the lobules or ducts. They are further divided into two

A.Ductal carcinoma in-situ (DCIS): In this type, there is an abnormal growth of cells within the milk ducts. It is non-invasive and is the earliest form of breast cancer.

B.Lobular carcinoma in-situ (LCIS): In this type, there is an abnormal growth of cells within the lobules. It is not a form of cancer but being diagnosed with it indicates a higher risk of developing breast cancer.

Invasive cancers

These types of breast cancer start spreading beyond the lobules or ducts and invade the surrounding breast tissues. They are also further divided into two

A.Invasive ductal carcinoma (IDC): This type of breast cancer begins to grow in the milk ducts and invades the fatty tissues of the breast. It accounts for nearly 80% of invasive breast cancers.

B.Invasive lobular carcinoma (ILC): This type of breast cancer begins to grow in the lobules and invades the surrounding tissues or other body parts. It accounts for nearly 10% of invasive breast cancers.

Paget’s disease of the breast

Rare form breast cancer, that arises from the nipple and extends to the areola around the nipple.

Inflammatory breast cancer

It is also a rare form of breast cancer that is caused by inflammatory cells in the lymph vessels of the skin.

Phyllodes tumors of the breast

This type of tumor grows quickly in a leaf-like pattern but does not spread beyond the breast.

Causes

Gene predisposition and lifestyle changes are the two main factors identified for the increased risk of breast cancer. Inherited mutation of genes such as Breast cancer gene 1 (BRCA1) and Breast cancer gene 2 (BRCA2) are associated with increase in the risk of breast cancer. Lifestyle factors such as alcohol consumption, smoking, obesity, poor diet, and exposure to harmful chemicals and toxins are also known to cause breast cancer.

Risk Factors

Various risk factors increase the risk of breast cancer- some are modifiable and others are non-modifiable. These are

Family history

The chances of you getting breast cancer are higher by 2-fold when your mother, sister, or daughter is diagnosed with it before menopause or at an early age.

Personal history

If you were diagnosed with cancer in one breast the chances of it developing in the second breast is much higher.

Age

Women in an elderly age i.e. 45 and above are at a higher risk of developing breast cancer than the women in their young age.

Gender

Women are more likely to develop breast cancer than men.

Inherited mutation of genes

BRCA1 and BRCA2 are two most common gene mutations that are known to significantly increase the chances of getting breast cancer and they are inherited from parents to children.

Early menstruation & delayed menopause

There is an increased risk of breast cancer if menstrual period start before the age of 12 and if it stops in an older age i.e. 55 & above.

Radiation

If you have been exposed to radiation for treatment at a younger age, you are at a higher risk of developing breast cancer.

Alcohol consumption

Regular consumption of alcohol can lead to an increased risk of breast cancer.

Hormonal therapy

Higher risk of breast cancer when women are taking hormone replacement therapy medications containing both estrogen and progesterone to treat menopause. The risk reduces after the treatment has been stopped.

Pregnancy history

There is an increased risk of breast cancer in woman having a child after 30 years of age and in woman who have never been pregnant.

Signs & symptoms

A lump or thickening in or around your breast

Redness observed on the breast or nipple

Any changes observed in the breast shape, size, or appearance

The abnormal position of the nipple - example inverted nipple

Bloody/clear discharge from the nipple

Areola could be peeled, scaly, or even flaky

The skin on your breast is dimpled, scaly, or inflamed

Diagnosis

Ultrasound

An ultrasound test uses sound waves to create an image of the breast tissues. It further helps the doctor to distinguish between a benign cyst and a tumor.

Mammogram

In this imaging test, the texture of the breast can be visualized and the doctors will be able to identify spots or lumps from the mammogram.

Biopsy

In this particular test, a sample of breast tissue or fluid is collected and analyzed to find out if they are cancerous or not. This test is done if the results of mammogram and ultrasound could not help in identifying presence or absence of cancer. There are different types of breast biopsy. They are:

  • Fine & core needle biopsy: Fine-needle biopsy is easier to reach lumps or fluids in the breast. Core-needle biopsy removes the tissue using a larger needle.

  • Incision Biopsy: In this biopsy, an entire lump and nearby breast tissues are removed.

  • Lymph node biopsy: In this biopsy, a part of your lymph nodes underneath your arm is removed to check if cancer has started spreading.

  • Image-guided biopsy:In this biopsy, imaging is used to guide the needle by the doctors.

Magnetic resonance imaging (MRI):

In this imaging test, a scan is performed to get a detailed internal picture of the breast by linking a magnet to the computer.

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