Basic Information About Breast Cancer

By Dr. Charu Garg in Breast Cancer

Oct 12 , 2022 | 3 min read

Breast cancer is the most common cancer among women globally and in India. Until a few decades back, cancer of the cervix was the most common, but breast cancer has overtaken it.

As per GLOBOCAN 2020, 178361 women had breast cancer, and there were 90408 deaths in India. According to recent SEER data, the five-year survival rate in the US is more than 95%, but it is estimated to be around 60% in India. The main reason for the lower survival rate in India is the presentation of cancer in its advanced stages. The causes for this are the lack of awareness about breast cancer, the social stigma attached to it, the lack of treatment facilities leading to delays in the initiation of treatment, staunch belief in alternative therapies and financial issues. In India, nearly 60% of cancer is diagnosed in stage III or IV. The message is loud and clear "cancer is curable when detected early", but difficult to treat in the later stages.

Breast cancer is mostly an illness of the elderly (50-69 years old), but not so anymore. Nearly 38% of all newly detected breast cancers are in the age group of 25 to 49 years.

Every person should be aware that lumps in the breasts, which are mainly painless, need to be addressed as soon as they are felt. Everyone should know and perform breast self-examination starting at the age of 20 and also get periodic breast examinations by healthcare workers. Mammography for breast cancer screening should begin at the age of 45 years. The factors which increase the chances of breast cancer are being a woman, physical inactivity, obesity, smoking, alcohol, stress and a family history of breast cancer. A Norwegian study followed up 25624 women for 13.7 years and found a 37% decrease in the risk of breast cancer among those who exercised regularly. The American Cancer Society recommends 45 -60 minutes of exercise 5 or more days a week.

Tools like telemedicine have helped patients to get access to cancer care. Artificial intelligence and machine learning are coming into the healthcare industry in a big way. A US company has created a deep learning model that can predict from a mammogram if a patient is prone to develop breast cancer as much as five years in the future. The goal is to make it a standard of care. 

The treatment for breast cancer may involve surgery, chemotherapy, radiation therapy, immunotherapy and hormonal therapy in different combinations. 

The surgery has evolved from a mastectomy (complete breast removal) to breast-conserving surgery. When radiation therapy is added, it gives similar outcomes and can save an organ. Sentinel lymph node is being practised to address the nodes in the axilla, which aims at reducing pain and lymphoedema (swelling in the arm). Oncoplasty under a specialist surgeon maintains the aesthetic look of the breast.

Radiation therapy plays an important role in the treatment of breast cancer. It provides an option to the patient to keep her breast, which in turn gives better body image scores and higher levels of satisfaction. It has evolved from 5 weeks to 3 weeks and sometimes even a 1-week treatment. Partial breast irradiation, deep inspiration breath hold technique, IMRT and IGRT have helped decrease short- and long-term side effects.

Genomic testing has helped skip chemotherapy in certain low and mid-risk groups, hence avoiding the side effects of chemotherapy. We can now test for genetic mutations that may increase a person's risk of certain cancers, including breast cancer. Women with a strong family history can be tested for the same, and preventive therapies for the patient and their family members can be advised accordingly.

Newer therapies like targeted oral therapies, monoclonal antibodies and CDK 4/6 inhibitors have been real game changers in managing breast cancer. They have not only increased survival but have ease of administration as well.

The key to controlling breast cancer is early detection and rapid treatment. Let us live by this mantra and pledge to make early detection of breast cancer a social goal.

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