Breast Cancer
Breast cancer arises when cells within the breast—commonly from the milk ducts (ductal carcinoma) or lobules (lobular carcinoma)—grow abnormally and unchecked. While most cases affect women, men may also develop breast cancer, albeit less frequently (nearly 1% of the risk compared to women).
How Common Is breast cancer?
It is the most frequently diagnosed cancer among Indian women and represents a growing health concern nationwide. Also, delayed presentation and diagnosis are common problem in India. According to national data, for every two women newly diagnosed with breast cancer in India, one succumbs to the disease—a sobering statistic that underscores the importance of timely detection and intervention.
Key Risk Factors
Some key factors that elevate risk include:
•Being female and of advancing age
•Family history and inherited gene mutations (e.g., BRCA1 or BRCA2)
•Lifestyle and reproductive influences such as obesity, hormone replacement therapy, alcohol use, later age at first childbirth, and early menarche
Epidemiology
While the incidence is lower than in Western countries, it's rising at an alarming rate, especially in urban areas.
Incidence: In India, breast cancer accounts for 25% to 32% of all cancers in women in major cities. The median age of diagnosis is a decade younger than in the West, which is a key difference.
Mortality: The mortality rate is high in India. This is often attributed to a lack of awareness, late-stage diagnosis, and limited access to comprehensive cancer care, especially in rural areas. Many women present with advanced disease, which is more difficult to treat.
Rural vs. Urban: The incidence of breast cancer is significantly higher in urban areas compared to rural regions, with urban women often having a risk profile closer to that of Western women.
Typical Symptoms
Possible warning signs include:
A new breast lump or thickening, usually painless in the beginning
Changes in breast shape, skin dimpling, or nipple inversion
Redness, scaliness, or unusual nipple discharge
Treatment Approaches
Triple assessment is the key to diagnosis and involves physical breast examinations followed by imaging (like mammogram, breast ultrasounds and breast MRI) and a tissue biopsy. Treatment options—tailored to the individual patient—often include surgery (lumpectomy or mastectomy), radiation, chemotherapy, hormonal therapy, and targeted therapies.
FAQs
Q. What is breast cancer surgery?
Breast cancer surgery involves removal of the cancerous tissue from the breast. It may range from breast-conserving surgery (lumpectomy) to complete removal of the breast (mastectomy), depending on the stage and type of cancer.
Q. What are the different types of breast cancer surgeries?
The main types include:
- Lumpectomy: Removal of only the cancerous lump with surrounding tissue.
- Mastectomy: Removal of the entire breast.
- Sentinel lymph node biopsy (SLNB): Removal of first few lymph nodes for checking spread.
- Axillary lymph node dissection (ALND): Removal of multiple lymph nodes if cancer has spread.
- Reconstructive surgery: Rebuilding the breast shape after mastectomy.
Q. How do doctors decide which surgery is best for me?
Your surgeon considers the tumor size, stage, breast size, genetic factors, and personal preferences. The goal is to remove cancer completely while preserving appearance and function as much as possible.
Q. What is breast-conserving surgery and who can have it?
Breast-conserving surgery (lumpectomy or wide local excision) removes only the tumour with a margin of healthy tissue. It is suitable for most early-stage cancers, usually followed by radiation therapy. However, patients with large tumours can be down staged with primary chemotherapy and offered breast conservation surgery.
Q. What is a sentinel lymph node biopsy and why is it done?
The sentinel lymph node is the first node to which cancer cells are likely to spread. This procedure helps to determine whether cancer has reached the lymph nodes, guiding further treatment while avoiding unnecessary extensive surgery.
Q. Is breast reconstruction possible after mastectomy?
Yes. Breast reconstruction can be done immediately during mastectomy or later after other treatments are complete. Options include implant-based or autologous tissue-based reconstruction (using one’s own body tissue).
Q. Will I need radiation or chemotherapy after surgery?
That depends on the stage, type, and biological behaviour of your cancer. After surgery, your oncologist reviews the biopsy report to decide if radiation, chemotherapy, hormonal, or targeted therapy is needed.
Q. How long does recovery take after breast cancer surgery?
Recovery varies with the type of surgery. Most patients return to routine activities in 2–4 weeks after breast cancer surgery.
Q. Will breast cancer surgery cause pain or swelling in the arm?
Some patients experience temporary pain, stiffness, or swelling (lymphedema). Early arm exercises and physiotherapy help prevent and control these symptoms effectively.
Q. Will I lose my entire breast if I have breast cancer?
Not always. Many women can undergo breast-conserving surgery, especially when the cancer is detected early. Even if mastectomy is required, reconstruction options can help restore breast shape.
Q. Can breast cancer come back after surgery?
There is a small chance of recurrence depending on cancer stage and biology. Regular follow-up visits, imaging, and medications (like hormone therapy) help reduce this risk and detect any recurrence early.
Q. Are both breasts removed to prevent future cancer?
Usually, no. Removing the healthy breast (preventive mastectomy) is only advised for women with strong genetic risk (e.g., BRCA mutation) or significant family history.
Q. How safe is breast cancer surgery?
Modern breast cancer surgery is very safe when performed by experienced surgical oncologists. Complications are rare and include bleeding, infection, or wound healing issues, all of which are manageable.
Q. How soon after surgery can I start my normal activities?
You can begin light activities like walking within a few days. Lifting heavy weights or strenuous exercise should be avoided for 3–4 weeks or until your surgeon advises.
Q. How often do I need to follow up after surgery?
Typically, follow-up visits are scheduled every 3 months for the first 2 years, and then every 6 months for next 3 years and then annually. These visits include physical exams, imaging, and review of your recovery and ongoing treatment.