Horizon Hospital - Thane

Woman Becomes ILL, Affects Entire Family Structure

Breast cancer has an impact on the psychological and social well-being, not only of the woman affected but also on her immediate family members. In 2022, there were 2.3 million women diagnosed with breast cancer and 670 000 deaths globally. Breast cancer occurs in every country of the world in women at any age after puberty but with increasing rates in later life.  Each year, about 30% of all newly diagnosed cancers in women are breast cancer.

Breast cancer is a disease in which abnormal breast cells grow out of control and form tumours. If left unchecked, the tumours can spread throughout the body and become fatal. Breast cancer cells begin inside the milk ducts and the milk-producing lobules of the breast. The earliest form is not life-threatening and can be detected in early stages. Cancer cells can fast spread into nearby breast tissue. This creates tumours that cause lumps or thickening. Invasive cancers can spread to nearby lymph nodes or other organs.  Metastasis can be life-threatening and fatal. Treatment is based on the person, the type of cancer and its spread. Treatment combines surgery, radiation therapy and medications.

As a woman, she is expected to play different roles as daughter, wife, mother, or mother-in-law. During the time of treatment (surgery, chemotherapy, and radiation therapy), her ability to fulfil these roles and responsibilities are severely impacted. Due to the treatment and its side effect, the patient has to deal with multiple issues such as disfigurement of her body, sexual intimacy with the husband, and the ability to care for her children.

Dr Ria Vaidya, CEO, Horizon Group of Hospitals said “Breast cancer that was once known to be a disease of the old, is becoming so prevalent among younger women. Technological innovations and better accessibility have provided doctors with the tools to detect cancer quickly, and spreading awareness about early diagnosis. While awareness may help experts to spot the disease early, but that is just one side of the coin. Over a decade back, the average age for diagnosing Stage 3 breast cancer was roughly 50 to 64 years. But recently, people in their 20s and 30s are highly prone to it”.

Dr Ria Vaidya, further said “The incidence of breast cancer in urban Indian women has been increasing steadily, and it has now surpassed cervical cancer to become the most frequently diagnosed cancer in this population. Distressingly, the 5-year cumulative mortality remains unacceptably high at 50%, primarily due to a late-stage presentation”.

Dr Ria Vaidya added “On the social front, the organization of most families is still patriarchal and hence Indian women are often perceived to be subordinate to men regardless of whether they are from rural or urban areas, educated or uneducated, employed or not. Hence, a significant proportion of Indian women rely on their husband, father or son for making decisions that concern their bodies and lives. This is a striking contrast to the approach of emancipated women in high-income Western societies”.

Dr Hrushikesh Vaidya, Medical Director and Chairman, Horizon Group of Hospitals said “The Indian Council of Medical Research (ICMR), the country’s apex medical research body, revealed in a study that women diagnosed with breast cancer in India have a 5 year survival rate of 66.4 percent. This rate indicates the percentage of people who are alive five years after diagnosis, excluding those who pass away from other causes. Technological innovations and better accessibility have provided doctors with the tools to detect cancer quickly, and spreading awareness about early diagnosis”.

Dr Hrushikesh Vaidya further added “Breast cancer constitutes 25 percent of all female cancers and it’s the highest. It has become the disease of the young and witnessed more in urban cities. The study done by ICMR found that patients diagnosed early had a 4.4 times better chance of living for five years compared to those diagnosed with advanced cancer. Although there’s been improvement, the survival rate in India is lower than in developed countries like the United States which is 90.2 percent. Delayed diagnosis and limited access to treatment facilities may contribute to this difference. It has been seen that Indian breast cancer is different from Western breast cancer. In the West, the peak age at which breast cancer occurs is in the early 50s whereas in India, the peak occurs a decade earlier,”

Dr Manali Shilotri, Leading Gynaecologist and Consultant Horizon Prime Hospital said “Breast cancer is a combination of multiple things. Changes like reduced breastfeeding, not having children, obesity, smoking and alcohol, have a contribution in causing breast cancer. Reduced breastfeeding, in particular, is linked to an increased risk of breast cancer due to less hormonal protection, fewer beneficial changes in breast tissue, and reduced shedding of potentially damaged cells”.

Dr Manali Shilotri further said “Having no children or having children at a later age is one of the other risk factors. Early menarche and late menopause are among the non-modifiable risk factors. Managing diet, exercising, reducing stress, and avoiding smoking and alcohol, which are lifestyle-related factors, can lower the incidence of breast cancer”.

Dr Manali Shilotri added “As the incidence of breast cancer is increasing in Indian women, the advances in its diagnosis and treatment have also taken a giant leap in the last few decades. Nowadays, Indian women are becoming more aware of the symptoms of this cancer leading to early self-detection. Mammography, Ultrasound Screening are more easily available nowadays making the diagnosis easy even in women without obvious symptoms of a lump in the breast.”

Dr Manali Shilotri stresses on Breast self-examination which is an essential step in taking care of a woman’s breast health. A breast self-exam is a procedure that can be performed at home to identify breast lumps, which can be a sign of breast cancer. She pointed out that it is necessary that women learn these simple procedures, as this will allow them to identify changes in their breasts that may indicate abnormalities such as tumours or irregularities.

How to Perform Breast Self-Examination

Here is a step-by-step guide to performing a breast self-examination (BSE):

1. Choose a Consistent Time: Select a time each month to perform BSE. Many women find it convenient to do it a few days after their menstrual period ends when breast tissue is less tender.
2. Visual Inspection: Stand in front of a mirror with your arms at your sides. Examine your breasts for any changes in size, shape, or contour. Pay attention to any skin changes, dimpling, or nipple abnormalities.
3. Raise Your Arms: Raise your arms overhead and look for the same changes in the mirror.
4. Breast Palpation: Lie down on your back with a pillow under your right shoulder and your right arm behind your head. Use the pads of your three middle fingers on your left hand to feel for lumps or abnormalities in your right breast. Use a circular motion, covering the entire breast from the outside to the center, including the armpit area. Repeat this process for your left breast.
5. Nipple Examination: Finally, examine your nipples for any unusual discharge, changes in position, or inversion.
6. Report Changes: If you notice any changes during your BSE, such as a lump, skin dimpling, or nipple discharge, it’s crucial to consult a healthcare professional promptly.

In conclusion, breast self-examination is a vital component of women’s health. It empowers women to actively participate in the early detection of breast cancer, reduces anxiety, and enhances their overall well-being. By incorporating BSE into their monthly routine, women can contribute to their own health and potentially save lives. Remember, early detection is key, and BSE is a valuable tool in achieving that goal.

Sonomammography is another critical ultrasound test to check for any abnormalities on the breast. It is non-invasive and painless and causes no side effects. It is effective in detecting breast cancer. A sonomammography is an ultrasound test performed on the breast (or mammary region of females). Recently, the United States Preventive Services Task Force finalized new recommendations seeing the sudden rise of the disease amongst the young. This US task force is one of the seven leading independent organizations and panels that make breast cancer screening recommendations and other cancer care guidelines. They advise women start regular yearly mammograms screening at 40 years old instead of the previously recommended age of 50.

Dr Manali Shilotri said “Annual screening is critically important. Having a smaller cancer improves the chance of a cure and also makes it easier for us to achieve that cure with less surgery, less systemic therapy, and better quality of life. Breast cancers in younger women tend to be faster growing. We know that if a woman is diagnosed in her 40s, it is more likely to be a more aggressive type of breast cancer, The American College of Radiology (ACR)—another independent organization that advises on screening—last year recommended that all women get a breast cancer risk assessment by age 30. Indian women need to understand the importance of this screening requirement and come forward for screening and not wait for cancer to progress to last stages”.

Dr Manali Shilotri added “When breast cancer is caught early, it is nearly 100 percent curable. Women diagnosed with early-stage breast cancers can also be cured with fewer and/or less-intense treatments and surgeries. Mammograms and breast cancer screening have saved millions of lives”.

Explaining further on the benefits of early stage detection, Dr Manali Shilotri added that if cancer is detected early, doctors can perform Lumpectomy which is also called breast-conserving surgery where the surgery is performed to remove cancer or other abnormal tissue from your breast. Lumpectomy is also called breast-conserving surgery because only a portion of the breast is removed. In contrast, during a mastectomy, all of the breast tissue is removed.  Lumpectomy is a treatment option for early-stage breast cancer. Sometimes lumpectomy is used to rule out a cancer diagnosis. When a lumpectomy surgery is performed to remove cancer, it usually is followed by radiation therapy to the breast to reduce the chances of cancer returning.

Risks

Lumpectomy is a surgical procedure that carries a risk of side effects, including:

• Bleeding
• Infection
• Pain
• Temporary swelling
• Tenderness
• Formation of hard scar tissue at the surgical site
• Change in the shape and appearance of the breast, particularly if a large portion is removed

The goal of lumpectomy is to remove cancer or other abnormal tissue while maintaining the appearance of your breast. Studies indicate that lumpectomy followed by radiation therapy is as effective in preventing a recurrence of breast cancer as removal of the entire breast (mastectomy) for early-stage breast cancer. Your doctor may recommend lumpectomy if a biopsy has shown that you have cancer and that the cancer is believed to be small and early stage. Lumpectomy may also be used to remove certain noncancerous or precancerous breast abnormalities.

Symptoms

Breast cancer can have combinations of symptoms, especially when it is more advanced. Most people will not experience any symptoms when the cancer is still early hence the importance of early detection.

Symptoms of breast cancer can include:

• a breast lump or thickening, often without pain
• change in size, shape or appearance of the breast
• dimpling, redness, pitting or other changes in the skin
• change in nipple appearance or the skin surrounding the nipple
• abnormal or bloody fluid from the nipple.

People with an abnormal breast lump should immediately seek medical care, even if the lump does not hurt. Most breast lumps are not cancer. Breast lumps that are cancerous are more likely to be successfully treated when they are small and have not spread to nearby lymph nodes. Breast cancers may spread to other areas of the body and trigger other symptoms. Often, the most common first detectable site of spread is to the lymph nodes under the arm although it is possible to have cancer-bearing lymph nodes that cannot be felt. Over time, cancerous cells may spread to other organs including the lungs, liver, brain and bones. Once they reach these sites, new cancer-related symptoms such as bone pain or headaches may appear.

Diagnosis

Breast cancer diagnosis often begins with an exam and a discussion of your symptoms. Imaging tests can look at the breast tissue for anything that’s not typical. To confirm whether there is cancer or not, a sample of tissue is removed from the breast for testing.

• Breast exam : During a clinical breast exam, a healthcare professional looks at the breasts for anything that’s not typical. This might include changes in the skin or to the nipple. Then the health professional feels the breasts for lumps. The health professional also feels along the collarbones and around the armpits for lumps.
• Mammogram : A mammogram is an X-ray of the breast tissue. Mammograms are commonly used to screen for breast cancer.
• Breast ultrasound : Ultrasound uses sound waves to make pictures of structures inside the body. A breast ultrasound may give your healthcare team more information about a breast lump.
• Breast MRI : MRImachines use a magnetic field and radio waves to create pictures of the inside of the body. A breast MRI can make more-detailed pictures of the breast. Sometimes this method is used to look closely for any other areas of cancer in the affected breast. It also might be used to look for cancer in the other breast. Before a breast MRI, you usually receive an injection of dye. The dye helps the tissue show up better in the images.
• Biopsy Testing : A biopsy is a procedure to remove a sample of tissue for testing in a lab. To get the sample, a healthcare professional puts a needle through the skin and into the breast tissue. The tissue sample from a biopsy goes to a lab for testing. Tests can show whether the cells in the sample are cancerous. Besides, there are other tests done that give information about the type of cancer and how quickly it’s growing.

Breast cancer stages : Once your healthcare team diagnoses your breast cancer, you may have other tests to figure out the extent of the cancer. This is called the cancer’s stage. Your healthcare team uses your cancer’s stage to understand your prognosis. Complete information about your cancer’s stage may not be available until after you undergo breast cancer surgery.

Tests and procedures used to stage breast cancer may include:

• Blood tests, such as a complete blood count and tests to show how well the kidneys and liver are working.
• Bone scan.
• CT.
• MIR.
• Positron emission tomography scan, also called aPET.

Not everyone needs all of these tests. Your healthcare team picks the right tests based on your specific situation.

Breast cancer stages range from 0 to 4. A lower number means the cancer is less advanced and more likely to be cured. Stage 0 breast cancer is cancer that is contained within a breast duct. It hasn’t broken out to invade the breast tissue yet. As the cancer grows into the breast tissue and gets more advanced, the stages get higher. A stage 4 breast cancer means that the cancer has spread to other parts of the body.

Treatment

Treatment for breast cancer depends on the subtype of cancer and how much it has spread outside of the breast to lymph nodes (stages II or III) or to other parts of the body (stage IV).

Breast cancer treatment often starts with surgery to remove the cancer. Most people with breast cancer will have other treatments after surgery, such as radiation, chemotherapy and hormone therapy. Some people may have chemotherapy or hormone therapy before surgery. These medicines can help shrink the cancer and make it easier to remove.

Doctors combine treatments to minimize the chances of the cancer coming back (recurrence). These include:

• surgery to remove the breast tumour
• radiation therapy to reduce recurrence risk in the breast and surrounding tissues
• medications to kill cancer cells and prevent spread, including hormonal therapies, chemotherapy or targeted biological therapies.
• Treatments for breast cancer are more effective and are better tolerated when started early and taken to completion.
• Radiotherapy plays a very important role in treating breast cancer. With early-stage breast cancers, radiation can prevent a woman having to undergo a mastectomy. With later stage cancers, radiotherapy can reduce cancer recurrence risk even when a mastectomy has been performed. For advanced stages of breast cancer, in some circumstances, radiation therapy may reduce the likelihood of dying of the disease. The effectiveness of breast cancer therapies depends on the full course of treatment. Partial treatment is less likely to lead to a positive outcome.

Conclusion

While advancements in technology and increased awareness have improved early diagnosis and treatment outcomes, challenges still remain. By fostering a comprehensive approach, we can work towards reducing the burden of breast cancer and improving survival rates for all women.