Young breast cancer cases found in India

Dr  P Raghu Ram , Padma Shri  Awardee, founder Ushalakshmi Breast Cancer Foundation , KIMS Hospitals, spoke at length about breast cancer, it’s causes, symptoms, treatment and more

Breast cancer is the commonest cancer affecting women in India. In many parts of the country, it is a taboo - a ‘closet’ issue that is not openly discussed. With a vision to make breast cancer a ‘commonly’ discussed issue and empower women about the importance of early detection of Breast cancer, Dr Raghu Ram established Ushalakshmi Breast Cancer Foundation in 2007 (UBF – www.ubf.org.in). Under auspices of the Foundation, he championed a one-of-its-kind large scale breast cancer awareness drive across Telangana & Andhra Pradesh.

Since 2007, in collaboration with Breast Cancer Care UK (largest Breast Healthcare provider in UK), UBF has printed and distributed 100, 000 Information Booklets about every aspect of Breast Disease in Telugu & English languages in Telangana & Andhra Pradesh.

What is breast cancer and where does it arise?

Breast tissue is made up of ducts and lobules. Breast cancer occurs when a single cell in the breast begins to divide and grow in an abnormal way.

There are different types of Breast cancer – also known as Carcinoma. Broadly, breast cancer arising from the ducts is referred to as Ductal carcinoma & cancer arising from the lobules is referred to Lobular carcinoma.

It is important that doctors have accurate diagnosis so that they can plan the most appropriate treatment for the individual

How common is breast cancer?

In India, well over 150, 000 women are newly diagnosed with breast cancer every year; a staggering number that has overtaken cervical cancer to become the most common cancer affecting women. More than 60% present in advanced stages due to lack of awareness and absence of a population based screening programme. Contrary to the western world where breast cancer is common after the age of 50 years, the highest incidence of breast cancer in India is between the ages of 30-50 years; at least a decade earlier! More than70, 000 women succumb to breast cancer every year - a woman dies of breast cancer every ten minutes in India…

What are the symptoms of breast cancer?

Painless lump in the breast, recent inversion of nipple, blood stained nipple discharge, puckering of skin overlying the breast. These changes DO NOT necessarily mean it is breast cancer. However, one should consult a Specialist if these symptoms are noticed.

How is breast cancer diagnosed?

After evaluation by a process of Triple Assessment, which includes Clinical breast examination, Breast imaging (Mammogram, ie X-ray of the breasts & Breast Ultrasound scan) & ultrasound guided needle biopsy of the lump, a definitive diagnosis of breast cancer can be obtained in most instances

Is Triple assessment essential in the evaluation of every breast lump?

YES. TRIPE ASSESSMENT (Clinical breast examination, Breast imaging and ideally Ultrasound guided needle biopsy) accurately excludes or indeed confirms breast cancer in most circumstances, thus sparing the need for a woman to have open surgery to obtain a diagnosis.

Do Specialist Breast Centres improve Breast cancer care?

It is a well recognised fact that improved outcomes for Breast cancer can be achieved if Specialists with a declared interest and training in Breast Diseases manage these patients in dedicated comprehensive Breast Centres.

What are the aims of treating breast cancer?

   To remove cancerous area from the breast and any affected lymph nodes in the arm pit

    Destroy any cancerous cells that might have already spread from the breast into the body through blood steam or the lymphatic system

Why is counselling important in breast cancer treatment?

Counselling is a very important component of breast cancer care as patients and their relatives are better informed, better prepared and more importantly, feel more in control at every stage of their treatment. Counselling involves discussion about the diagnosis and various treatment options by the Specialist in a sensitive and supportive environment. Equally, adequate psychological and emotional support is given during the Counselling Sessions that takes care of individual needs of patients and their families affected with breast cancer. 

What are the possible questions that one might want to ask the Specialist?

One should feel free to ask questions to the Specialist relating to various treatment options. They might include:

 Why is this the best treatment for me?

Are there any options?

What are the possible side effects?

Are there any short term & long term complications?

How will these treatments impact on everyday life?

It is the duty of the Specialist to clarify questions posed in an unhurried manner. Ideally, trained breast care Counsellors should be available to reinforce the points highlighted by the Specialist in simple easy to understand language. The Breast care Counsellor should be able to provide extended care in the comfort of the patient’s home to address any concerns following discharge from the hospital.

What are the modalities available for treating breast cancer?

There are essentially four modalities to treat breast cancer.

 Surgery

 Chemotherapy

    Radiotherapy

   Hormone therapy

It is important to remember that not all patients would require Chemotherapy, radiotherapy and Hormone therapy.

What is the relevance of Hormone receptor tests in Breast cancer?

Some breast cancers are stimulated to grow by hormones oestrogen & Progesterone. A test to discover whether breast cancer cells are sensitive to these hormones (hormone positive) should be routinely carried out after surgery. This test is known as Hormone receptor Test. A positive Hormone receptor test means that breast cancers sensitive to either oestrogen (oestrogen receptor positive or ER +ve) or progesterone (Progesterone receptor positive or PR + ve) or both. If breast cancer is hormone receptor positive, it may respond to hormone therapy. A negative Hormone receptor test where cancer is Oestorgen receptor negative (ER – ve) and progesterone receptor negative (PR – ve) means that breast cancer is unlikely to respond to Hormone therapy and so there would be no benefit in taking hormonal drugs.

Where can the breast cancer spread to?

Depending on the size, grade & lymph node involvement, staging tests are done to assess if cancer has spread. Cancer can potentially spread to four areas – ie liver, lungs, brain and bones. Staging tests aim to assess if the cancer has spread to the areas mentioned above.

What is Breast awareness. Is it different from Breast self examination?

Breast self-examination (BSE) is a regular and repetitive monthly examination of the breast performed by the woman at the same time each month to a set method. The concept of BSE has not been proven to be beneficial. Instead, the concept of Breast Awareness is replacing BSE.

Being Breast Aware is about becoming familiar with the breasts and the way they change throughout one’s life. It means knowing how breasts look and feel normally, so that one can feel confident about noticing any change that might be unusual for the individual. This can be as simple as feeling breasts from time to time; whether while bathing, undressing or applying body lotion. There is no set way of doing this.

5 point code in breast awareness –

   Know what is normal for you

    Know what changes to look and feel for

   Look and feel

  Report any changes to your Doctor without delay

    Attend routine Breast Screening if you are aged 40 or over

Can we prevent breast cancer?

No. However, Breast cancer can be detected early.