Breast Cancer

Breast cancer, a common but complex disease, requires specialised and comprehensive care for effective treatment. At Max Hospitals, we recognize the intricacies of breast cancer and are dedicated to offering a holistic approach that blends advanced medical expertise with compassionate care. Our multidisciplinary team of oncologists, surgeons, and support staff collaborates to create personalised treatment plans tailored to each patient's unique needs. From state-of-the-art diagnostic tools to the latest in therapeutic options, Max Hospitals leads the way in breast cancer treatment, committed to achieving the best possible outcomes for our patients.

What is Breast Cancer?

Breast cancer is a type of cancer that originates in the cells of the breasts. It is one of the most common cancers diagnosed in women worldwide, but men can also develop it. Breast cancer occurs when abnormal cells in the breast begin to grow and divide uncontrollably, forming a tumour. These cancerous cells can invade surrounding tissues and spread (metastasize) to other parts of the body.

Types of Breast Cancer

Breast cancer can be classified into several types based on where it originates and its characteristics. The main types include:

• Invasive Carcinoma: This is the most common type, where cancer cells spread beyond the initial location in the breast tissue.
• Ductal Carcinoma In Situ (DCIS): This is an early-stage cancer where abnormal cells are present only within the milk ducts and haven't invaded surrounding tissues.
• Lobular Carcinoma In Situ (LCIS): Similar to DCIS, but the abnormal cells are found in the milk-producing lobules. While not cancerous itself, LCIS increases the risk of developing invasive breast cancer later.
• Less common types: Other less frequent types include inflammatory breast cancer, Paget's disease of the breast, and metastatic breast cancer (cancer that originated elsewhere and spread to the breast). Similarly, there are others such as Medullary, Mucinous, Tubular, Metaplastic, Papillary, and Apocrine.

Breast Cancer Causes

The exact cause of breast cancer remains unknown. However, several factors are believed to contribute to its development:

• Genetic mutations: Inherited changes in genes like BRCA1 and BRCA2 significantly increase breast cancer risk.
• Hormonal factors: Exposure to oestrogen over a longer period increases the risk. This includes factors like starting menstruation at a young age, having late menopause, or taking hormone replacement therapy (HRT) for an extended period.
• Lifestyle factors: Obesity, lack of physical activity, and excessive alcohol consumption can increase risk.
• Dense breast tissue: Breasts with more glandular tissue and less fatty tissue might be harder to screen for abnormalities and carry a slightly higher risk.
• Family history: Having a close relative (mother, sister, daughter) with breast cancer increases one’s risk.

Breast Cancer Risk Factors

Several risk factors can increase the likelihood of developing breast cancer. Some of these factors are modifiable, while others are not. Key risk factors include:

• Age: The risk of breast cancer increases as a woman gets older. Most breast cancers are diagnosed after age 50.
• Genetic Mutations: Inherited mutations in the BRCA1 and BRCA2 genes significantly increase the risk of breast and ovarian cancer.
• Family History: Having a first-degree relative (mother, sister, daughter) with breast cancer nearly doubles a woman’s risk.
• Reproductive History: Early menstruation (before age 12) and late menopause (after age 55) increase the risk due to prolonged exposure to hormones.
• Dense Breast Tissue: Women with dense breast tissue have a higher risk of breast cancer and may have more difficulty detecting it on mammograms.
• Previous Breast Conditions: Certain non-cancerous breast conditions, such as atypical hyperplasia or lobular carcinoma in situ (LCIS), are associated with an increased risk.
• Hormone Replacement Therapy: Long-term use of hormone replacement therapy (HRT) during menopause is linked to an increased risk of breast cancer.
• Radiation Exposure: Women who received radiation therapy to the chest for other cancers (such as Hodgkin's lymphoma) before age 30 have a higher risk of developing breast cancer later in life.
• Lifestyle Factors: Obesity, lack of physical activity, alcohol consumption, and poor diet are associated with an increased risk of breast cancer.
• Reproductive History: Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can increase the risk of breast cancer.

Understanding these risk factors can help in developing strategies for prevention, early detection, and treatment of breast cancer. Regular screenings, lifestyle modifications, and genetic counselling for those with a family history are essential components of breast cancer management.

Breast Cancer Symptoms

Breast cancer symptoms can vary from person to person, and some women might not experience any noticeable changes at all. However, it's important to be aware of potential signs and symptoms to facilitate early detection. Here's a list of breast cancer symptoms one must watch out for:

• Lump in the Breast or Underarm: The most common symptom is a new lump or mass in the breast or underarm (armpit). These lumps are often hard, irregular in shape, and painless, though some can be soft, round, and tender.
• Change in Breast Size or Shape: Any unexplained change in the size, shape, or appearance of the breast should be evaluated. This may include swelling of part or all of the breast, even if no distinct lump is felt.
• Skin Changes: Look for dimpling, puckering, or redness of the breast skin. Sometimes the skin may have a texture resembling an orange peel.
• Nipple Changes: This includes nipple discharge (other than breast milk), particularly if it is bloody, clear, or occurs without squeezing. Inversion (turning inward) or retraction of the nipple and any changes in the appearance of the nipple, such as scaling or thickening, are also concerning signs.
• Pain: Although most breast cancers do not cause pain, persistent breast pain or discomfort that does not correlate with the menstrual cycle or other benign conditions should be checked.
• Breast or Nipple Pain: Pain or tenderness in the breast or nipple area can be a symptom. However, it's important to note that breast pain alone is rarely a symptom of cancer.
• Swelling in the Armpit or Around the Collarbone: Swelling or lumps in these areas can indicate the spread of breast cancer to lymph nodes.
• Thickening of Breast Tissue: Any thickening in the breast that feels different from the other tissue may be a sign.
• Visible Veins: Sometimes, increased visibility of veins on the surface of the breast can indicate changes in the breast tissue.
• Breast Rash: A rash or redness around the nipple can sometimes be a sign of Paget's disease of the breast, a rare form of breast cancer.

If an individual experiences any of the above symptoms, it is important to see a healthcare provider as soon as possible. While many breast changes are not cancerous, only a professional evaluation can determine the cause. Regular self-examinations and routine mammograms are crucial for early detection. Early-stage breast cancer often has a better prognosis and a wider range of treatment options, underscoring the importance of being vigilant about any changes in the breasts.

Breast Cancer Diagnosis

Diagnosing breast cancer typically involves a multi-step process. Here's a breakdown of what one can expect:

Physical Examination

A doctor examines the individual’s breasts and lymph nodes for lumps, changes in size or shape, or other abnormalities.

Imaging Tests

The imaging tests play a crucial role in detecting and characterising breast abnormalities. Common tests include:

• Mammography: X-ray images of the breast tissue to identify lumps, masses, or calcifications.
• Breast Ultrasound: Uses sound waves to create detailed images of the breast, helpful in differentiating between solid lumps and fluid-filled cysts.
• Breast MRI (Magnetic Resonance Imaging): Provides detailed 3D images, often used for high-risk individuals or for women with dense breast tissue where mammograms might be less effective.

Biopsy

If imaging tests reveal suspicious areas, a biopsy is necessary to confirm the presence of cancer cells. A small tissue sample is extracted using a needle or surgical procedure and examined under a microscope by a pathologist.

Additional Tests (if cancer is diagnosed)

Once cancer is confirmed, further tests might be needed to determine the stage and type of breast cancer, which helps guide treatment decisions. These may include:

• Hormone receptor testing: Determines if the cancer cells are sensitive to hormones like oestrogen and progesterone, which can influence treatment options.
• HER2 testing: Evaluates the presence of a protein called HER2 on the cancer cells. HER2-positive cancers often require targeted therapy drugs.
• Genetic testing: May be recommended in certain cases to assess the risk of hereditary breast cancer and guide future screening recommendations.

Breast Cancer Treatment

The course of treatment for breast cancer depends on various factors, including the stage and type of cancer, your overall health, and your preferences. Here's an overview of common treatment options:

Surgery

The most common treatment for breast cancer is surgery to remove the cancerous tissue. The type of surgery performed depends on the extent of the cancer:

• Lumpectomy: Removal of the tumour and a small margin of healthy tissue surrounding it. Often followed by radiation therapy.
• Mastectomy: Removal of the entire breast can be performed with or without reconstruction of the breast.
• Lymph node surgery: Removal of lymph nodes in the armpit to check for cancer spread.

Radiation Therapy

High-energy rays are used to destroy cancer cells and prevent them from recurring. Radiation therapy can be administered after surgery (to eliminate any remaining microscopic cancer cells) or before surgery (to shrink the tumour and make it easier to remove).

Chemotherapy

Medications are used to kill cancer cells throughout the body. Chemotherapy can be given before surgery (neoadjuvant) to shrink the tumour or after surgery (adjuvant) to reduce the risk of recurrence.

Hormone Therapy

For hormone receptor-positive cancers, medications can block the effects of oestrogen or progesterone on cancer cell growth. Hormone therapy can be taken as pills or injections for several years.

Targeted Therapy Drugs

These drugs target specific molecules or pathways involved in cancer cell growth and survival. They may be used in combination with other therapies for HER2-positive cancers or other specific subtypes.

Immunotherapy

A relatively new approach that helps the body's immune system recognize and attack cancer cells. Immunotherapy is still under development for breast cancer but may play a role in future treatment options.

Reconstruction

Breast reconstruction surgery can be performed after a mastectomy to restore the appearance of the breast. Reconstruction can be done at the time of mastectomy or in a separate procedure later.

Regular follow-up care is crucial for monitoring the patient's recovery, managing any side effects, and checking for signs of recurrence. Follow-up typically includes physical exams, imaging tests, and laboratory tests to ensure that any changes are detected early and managed effectively.

Breast Cancer Complications

While breast cancer treatment aims for a cure or long-term control, there can be potential complications associated with the disease and its treatment. Here's a breakdown of some possible complications:

• Physical side effects of surgery: Depending on the type of surgery performed (lumpectomy or mastectomy), there can be pain, scarring, swelling, and lymphedema (fluid buildup in the arm).
• Side effects of radiation therapy: Radiation therapy can cause fatigue, skin irritation, and soreness in the treated area. In some cases, it can also lead to long-term effects like lung problems or heart issues.
• Side effects of chemotherapy: Chemotherapy drugs can cause various side effects, including nausea, vomiting,hair loss, fatigue, and mouth sores. The severity of these side effects depends on the specific drugs used and the dosage.
• Side effects of hormone therapy: Hormone therapy medications can cause hot flashes, vaginal dryness, joint pain,and an increased risk of blood clots.
• Lymphedema: This is a potential complication after surgery that involves lymph node removal. It can cause swelling in the arm, chest, or back due to fluid buildup.
• Breast cancer recurrence: There's always a risk that cancer may recur after treatment. Regular follow-up appointments with your doctor are crucial for monitoring and early detection of any recurrence.
• Emotional and psychological effects: A breast cancer diagnosis and treatment can be emotionally challenging. It's common to experience anxiety, depression, fear, and body image concerns.

Breast Cancer Prevention

While there is no guaranteed way to prevent breast cancer, certain lifestyle changes and preventive measures can reduce the risk. Key strategies for breast cancer prevention include:

• Maintain a Healthy Weight: Being overweight or obese, especially after menopause, increases the risk of breast cancer. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce this risk.
• Stay Physically Active: Engaging in regular physical activity helps maintain a healthy weight and can lower breast cancer risk. Aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity each week.
• Limit Alcohol Consumption: Alcohol consumption is linked to an increased risk of breast cancer. Limiting alcohol intake to no more than one drink per day can help reduce this risk.
• Eat a Balanced Diet: A diet rich in fruits, vegetables, whole grains, and lean proteins can help maintain overall health and potentially reduce cancer risk. Limiting saturated fats and red meats is also beneficial.
• Breastfeed: Breastfeeding, especially for a year or more, has been shown to reduce the risk of breast cancer. It offers protective benefits for both mother and child.
• Avoid Hormone Replacement Therapy (HRT): Long-term use of combined oestrogen-progestin hormone therapy for menopause symptoms is associated with an increased risk of breast cancer. Discuss alternatives with a healthcare provider.
• Avoid Exposure to Radiation and Environmental Pollutants: Limiting exposure to radiation during medical imaging and avoiding environmental pollutants may help reduce the risk.
• Genetic Counseling and Testing: For those with a family history of breast cancer or known genetic mutations (e.g., BRCA1 or BRCA2), genetic counselling and testing can help assess risk and guide preventive measures, such as increased surveillance or preventive surgeries.
• Regular Screening: Regular mammograms and clinical breast exams can help detect breast cancer early when it is most treatable. Follow guidelines based on age, risk factors, and personal health history.
• Medications: In some high-risk women, preventive medications (chemoprevention) such as selective oestrogen receptor modulators (SERMs) or aromatase inhibitors can reduce the risk of developing breast cancer.
• Prophylactic Surgery: For women with a very high risk of breast cancer (e.g., those with BRCA mutations), prophylactic mastectomy or oophorectomy (removal of ovaries) can significantly reduce the risk of developing breast cancer.

Adopting these preventive measures can help lower the risk of breast cancer and promote overall health and well-being.

Frequently Asked Questions

Can men get breast cancer?

Yes, while breast cancer is much more common in women, men can also develop breast cancer. It is important for men to be aware of changes in their breast tissue and consult a healthcare provider if they notice any abnormalities.

What lifestyle changes can help during and after breast cancer treatment?

Maintaining a healthy diet, staying physically active, managing stress through mindfulness or therapy, and avoiding tobacco and excessive alcohol can help improve overall health and recovery during and after treatment.

What are the side effects of breast cancer treatment?

Side effects vary depending on the type of treatment and may include fatigue, nausea, hair loss, lymphedema, pain, cognitive changes, and emotional challenges. Discussing potential side effects with a healthcare provider can help in managing them effectively.

How does breast cancer affect fertility and pregnancy?

Some breast cancer treatments can affect fertility. It's important to discuss fertility preservation options with a healthcare provider before starting treatment. Breast cancer can be diagnosed during pregnancy, and treatment plans are carefully tailored to protect both the mother and the baby.

What is the role of genetic testing in breast cancer?

Genetic testing can identify mutations in genes like BRCA1 and BRCA2 that increase the risk of breast cancer. Knowing one's genetic risk can guide preventive measures and inform family members of their potential risk.

Are there different stages of breast cancer, and what do they mean?

Yes, breast cancer is staged from 0 to IV, indicating the extent of the cancer. Stage 0 is non-invasive, while stage IV indicates metastatic cancer that has spread to other parts of the body. Staging helps determine the best treatment approach.

What are the latest advancements in breast cancer research and treatment?

Recent advancements include targeted therapies, immunotherapy, personalised medicine based on genetic profiling, and improvements in surgical and radiation techniques. Staying informed about new research can provide options for cutting-edge treatments.

Can diet and exercise impact breast cancer prognosis?

Yes, a healthy diet and regular exercise can improve overall health and may positively impact prognosis by reducing the risk of recurrence and improving quality of life.

How does one manage the emotional impact of a breast cancer diagnosis?

Seeking support from friends, family, support groups, and mental health professionals can help manage the emotional impact. Mindfulness practices, stress reduction techniques, and maintaining a healthy lifestyle can also contribute to emotional well-being.

Can breast cancer recur after treatment, and how is recurrence monitored?

Yes, breast cancer can recur. Regular follow-up visits, imaging tests, and self-examinations are crucial for monitoring recurrence. Early detection of recurrence can lead to more effective management.

What is the impact of breast cancer on long-term health and quality of life?

Long-term health effects can include chronic pain, fatigue, and emotional challenges. Quality of life can be improved through comprehensive survivorship care plans, which address physical, emotional, and social aspects of recovery.

Are there support groups or resources for breast cancer survivors?

Yes, many local and national organisations offer support groups, counselling, educational resources, and survivorship programs for breast cancer survivors. Connecting with these resources can provide valuable support and information.

How can I support a loved one who has been diagnosed with breast cancer?

Providing emotional support, helping with daily tasks, accompanying them to appointments, and listening to their concerns are all valuable ways to support someone with breast cancer. Joining support groups and seeking professional counselling can also be beneficial.

Review 

Reviewed By Dr. Charu Garg, Senior Director - Cancer Care / Oncology, Gynecologic Oncology, Thoracic Oncology, Radiation Oncology, Breast Cancer on 19 Sep 2024.