Breast cancer -- causes, symptoms, myths, diagnosis, treatment

Breast cancer is a major problem in India. According to Dr Sumeet Shah, 'Breast cancer is the most common cancer in Indian cities, accounting for a staggering 25 to 35 percent of all cancers in women in cities! Even in rural areas, the incidence is steadily rising. In the year 2008, almost 1,15,000 new cases of breast cancer were reported in India, and about 53,000 death due to breast cancer were recorded.' Certainly more awareness is needed and many campaigns have taken place over the last few years. In this mega guide, we'll tell you everything you need to know about the disease.

Causes

Unhealthy style, stress, imbalanced food, irregular sleeping hours, etc. are some of the things that can lead to breast cancer.

Other reasons include:

• Early menarche (start of menstruation) and late menopause which exposes the body's cells to more than normal oestrogen. While oestrogen is an important and protective hormone, it has a proliferative effect on cells of the breast and uterus which results in cancer.
• First delivery beyond 30 years of age increase chances of developing breast cancer
• Genetic predisposition about 6-8% of breast and ovarian cancers seem to be family-based. The genetic changes are passed down the generation, which will increase their chance of developing cancer.

Symptoms

According to Dr Sumeet Shah, here are some common symptoms of breast cancer.

• A hard 'lump' or a 'knot' in the breast. Usually, these lumps are painless.
• Occasionally, a clear cut lump cannot be felt, but a 'lumpish' feel is there. And this feel is different as compared to the same area of the opposite breast.
• Bloody or a blood stained nipple discharge
• A recent 'in drawing' or 'inward pull' on the nipple or even a change in direction
• Changes in the skin over the breast, which feels thick, hard and like an 'orange' peel
• Occasionally, small 'knots' or nodes may be felt in the armpit.

Diagnosis

A mammogram is used to detect breast cancer. Early detection of the disease is the most effective way to treat the ailment but that doesn't happen due to lack of awareness. Sadly, patients with advanced breast cancer end up being either exposed to aggressive treatment options like chemotherapy or surgery or have to be given palliative care to ease their suffering. If breast cancer is diagnosed and treated early the chances of cure and survival rates improve significantly, making it even more important to detect its presence.

According to the American Cancer Society's guidelines for early detection of breast cancer:

• A woman should undergo yearly mammograms starting at the age of 40. This practice should be continued for as long as the woman is healthy.
• They should get a clinical breast examination (CBE), approximately every 3 years for women in their 20s and 30s and every year for women in their 40s and over.
• Women should know how their breasts normally look and feel and should report any breast changes promptly to their health care provider. Alternatively they could perform a breast self exam (BSE) starting in their 20s.

How to do a breast self exam

The National Breast Cancer Foundation recommends that all women over the age of 20 should perform this test once every month. You should remember that while doing these tests you should use light to medium pressure and not press too hard as it could lead to a lot of discomfort. Also, avoid doing this test during your periods as your breasts will tend to be much more sensitive during this time.

Step 1: Standing

This part of the examination can be performed in your room or in the shower. Raise your arm over your head, so as to expose your armpits. Now, use the pads of your fingers to feel around the breast (from the outer area to the inner area) in a circular motion. Make sure not to miss out the part under the armpits. You should be looking for any lump, thickening or hardened knot. If you do find one, visit your doctor for a more thorough examination.

Step 2: In front of the mirror

In this test, stand in front of the mirror with your arms by your sides. Check your breast for any changes in their contour, dimpling of the skin or changes in the shape and structure of your nipples. Raise your arms above your head and check for the same.

Next place your hands on your hips and press down firmly to flex your chest muscles. Yes, there are muscles there! Now check for any changes in the shape, size, changes in skin colour or dimpling. Since, in most women the left and the right breasts are not identical check each breast individually.

Step 3: Lying down

Lie down and place a pillow under one of your shoulders. Now raise the arm of that side and check the breast with the other hand. Use the pad of your fingers and look for any lumps, thickening or hardened masses around your breasts and under your arm pits.

For the other breast, change the position of your pillow so it is below the breast. Check and repeat the process. As a final step press your nipples to check for any discharge or lumps.

Read more

• 'Breast cancer is not preventable' (Expert interview)
• Beware high cholesterol can cause breast cancer!
• How to do a breast self-examination to check for cancer
• One sure-fire tip to beat breast cancer!
• Breast cancer runs in your family? Genetic assessment can help!

Treatment

The standard treatment methods include surgery, chemotherapy and radiation therapy. These methods have undergone vigorous trials over several decades and are the best forms of treatment. The proof of the same is the fantastic increase in survival in almost all cancers in the western nations.

Treatment - chemotherapy

Chemotherapy is the injection of drugs in saline, into the body. These drugs are programmed to kill rapidly multiplying cells. Radiation Therapy is subjecting a particular area (of cancer) in the body, with 'ionizing rays'. These types of rays kill the dividing cells.

The main reason for side effects, especially in chemotherapy, is due to the fact that we cannot target only cancer cells, because they are like normal cells and there is no way of differentiating them. So while killing cancer cells, some normal cells also get affected and hence the severe side effects.

Do the breasts need to be removed to cure breast cancer?

Even though, some people believe that the only treatment for breast cancer is removal of breasts but that is not true. 'In more than 70 percent women, we can very well do a breast conserving surgery (BCS)! Even if a tumour is large, we can give chemotherapy first, which will reduce the size of the tumour, and then a Breast Conservation Surgery can be done! The only important requisite of BCS is that, after surgery, radiation therapy is compulsory.', said Dr Sumeet Shah, a renowned oncologist.

Prevention

Breast cancer is NOT preventable and even healthy people can get it. Which is why, early detection is extremely important. However, leading a healthy lifestyle can reduce the chances of having breast cancer. Here are some things you can do:

• Regular exercise. It could be in any form brisk walking, gym, aerobics, yoga etc. 45 minutes of daily exercise has definitely shown to reduce the risk of breast cancer
• Battle stress away. Easier said than done, but stress is a silent killer. Stress depresses our body's immunity (our body's resistance mechanism), and so decrease the capacity of our body to fight off a cancer cell. Don't worry, be happy!

Besides these, here are some food habits that can keep cancer at bay.

• Focus more on plant based foods like fruits, vegetables, whole grains, nuts, pulses etc. Start your day with fruits and nuts. Have some whole grain cereal for breakfast. Make sure to have a big portion of salad with vegetables like lettuce, tomatoes, beetroot, cucumbers etc pre-lunch and pre-dinner. Carry snacks like fruits, trail mixes (sunflower seeds, flaxseeds, almonds, walnuts etc), opt for sandwiches with multigrain breads and lot of veggies in it.
• Fiber is the key component to prevent cancer. All plant based foods are rich in fiber which helps to keep your digestive system clean and healthy and push the cancer causing compounds out of the gut before they can harm you. You can add fiber to your diet by replacing white rice with brown rice, eating the fruits with skin, choosing popcorn over potato chips etc.
• Avoid processed foods. The more you eat food in its original form, the better protection it gives. For example instead of drinking orange juice, peel and eat the orange or prepare oatmeal porridge with raisins rather than having an oatmeal raisin cookie.
• Cut down on red meat and whole fat milk as research shows that vegetarians are about fifty percent less likely to develop cancer than those who eat meat. That is because meat and milk lack fiber, antioxidants and nutrients that have cancer protective properties and is high on saturated fat which is linked with increased risk of cancer. But you don't need to eliminate meat completely. A good visual reminder is to have 2/3^rd of your plate filled with plant foods and 1/3^rd of it with meat and dairy products. You can cut them down by cutting animal products to a palm-size, adding some salads or beans to it rather than using it as the main element. Choose fish or lean chicken as they are low on fat, avoid processed meats like sausages, salamis etc.
• Choose your fats smartly. Saturated and trans fats are demons for health, so limit them. Saturated fats (bad fats) are found in butter, ghee, eggs, whole fat milk and red meats and trans fats are found in processed and junk foods like burgers, pizzas etc. On the other hand unsaturated fats (good fats)like MUFA and PUFA are found in oils that are liquid at room temperature eg: olive oil, ricebran oil, etc. The other sources of unsaturated fats are avocados, nuts like walnuts, almonds etc. Also focus onomega-3 fatty acids, which fight inflammation and support brain and heart health. Good sources include fish like salmon, tuna, and flaxseeds. You can add them by eating fish once or twice a week, adding flaxseeds to your salad, avoiding fried foods, checking the label for bad fats.
• Opt for cancer-fighting foods. You immune system needs to be strong to fight against cancer causing agents. You need to eat a variety of colourful foods with antioxidants (vitamin A, C, E and selenium) and phytochemicals that help strengthen immunity and fight diseases. Such foods are tomatoes, broccoli, dark green leafy vegetables, grapes, cranberry, carrots, cabbage, garlic, onions, grapefruits, blueberries, chilli peppers, jalapeno, soy products like tofu etc. Green tea is also antioxidant rich, so replace your black tea with three cups of green tea per day.
• Drink plenty of water as it helps to eliminate toxins from the body and supply nutrients to the cancer cells which can kill and prevent them from multiplying. Avoid sugary drinks like colas, juices etc as they increase inflammation and cancer growth.
• Preserve nutrients when you cook. Wash the vegetables and fruits with a brush to remove all pesticide residues. Eat raw as much as possible, this helps retain the nutrients. Steam the vegetables using very little water. Prevent over-heating of oil as it can become carcinogenic.
• Instead of deep-frying, pan-frying, and saut ing, opt for healthier methods such as baking, boiling, steaming, or broiling. Store oils in a cool dark place to prevent it from becoming rancid. Use microwave friendly containers of good quality to prevent plastic material interaction with food.
• Avoid foods that look or smell mouldy, as they are likely to contain aflatoxin, a strong carcinogen. Nuts will stay fresh longer if kept in the refrigerator or freezer.

Other than this, some people detect risk factors before having breast cancer and one of the most famous cases of this was that of Angelina Jolie. The actress's mother died at the age of 52 from ovarian cancer, and she herself was found to have the mutated form of the BRCA1 genewhich put her at a 80 per cent risk of developing breast cancer.

What is a preventive mastectomy and why is it needed?

Also known as prophylactic or risk reducing mastectomy, it involves removing both breasts in order to reduce the chances of breast cancer in the future. A preventive mastectomy is recommended for women who are at a very high risk of suffering from the disease. The risk factor for a woman is decided by certain tests that detect the genetic mutation within certain genes. In Angelina Jolie's case, it was the BRCA1gene.

What is the BRCA1 gene?

There are two genes that make a woman susceptible to breast cancer the BRCA1 and BRCA2 gene.The BRCA1 gene is a type of tumor suppressor gene. It is named the breast cancer, early onset geneand its main function is to repair damaged DNA. The gene is primarily found in the breast tissue and is largely responsible for breast cancer, ovarian cancer and cervical cancer in women. The mutation of this gene results in a malformation or broken DNA which then leads to the formation of a cancer. (Read: Angelina Jolie's preventive double mastectomy your questions answered)

Myths

There are more misconceptions related to breast cancer than there are facts. Here's busting some common myths.

Myth# 1: Only women over 40 need to worry about breast cancer

Living with this false belief can be dangerous. Breast cancer can affect an individual of any age. The disease is more common in post-menopausal women, but 20 per cent of women with breast cancer are younger than 40. Hence, younger women should have their breasts examined by a doctor at least once a year; and begin regular mammographic screening after they turn 40. Though, there is a low risk of a breast mass in younger women being cancerous, but if you feel a growth, it's always advisable to have it checked as soon as possible. (Read: 'Breast cancer is not preventable' (Expert interview))

Myth#2: Men can't get breast cancer

Because of their anatomy, it's believed that only women get breast cancer. The truth is that although women develop breast cancer at a much higher rate, men can develop breast cancer, too. In fact, in the US alone, about 1600 men will develop breast cancer by the end of this year. The symptoms and the treatment of the disease in men is the same as that in women. Just as in women, the risk in men also increases with advancing age. (Read: Man struck with breast cancer twice!)

Myth#3: Antiperspirants and deodorants can cause breast cancer

A lot of people believe that if you get a cut near your breast [while shaving your armpits] and you use an antiperspirant or deodorant over that area, it leaks into the skin, which causes breast cancer. According to the American Cancer Society, there is no scientific evidence supporting this belief. In fact, a study published in the Journal of the National Cancer Institute, carried out to investigate a co-relation between antiperspirants and breast cancer, found no increase in the incidence of breast cancer in women who used antiperspirants. The study concluded: there are other factors that cause breast cancer, and antiperspirants aren't one of them.

Myth#4: Birth control pills, mammograms cause cancer

The amount of oestrogen in birth control pills is too small to trigger development of cancer in the breast. Yet, it's safer to choose a contraceptive after discussing your health with your gynaecologists. Exposure to radiations is one of the risk factors of breast cancer. However, the radiation emitted out of a mammogram isn't high enough to cause harm. (Read: Birth Control: Dos and Don'ts)

Myth#5: A breast lump means cancer

Many women report having lumps in their breasts, however, 80 per cent of such lumps are harmless. Often, they are either cysts or fibrocystic changes or fibroadenomas, which are all benign conditions. However, don't dismiss any lump as unimportant because it could be pre-cancerous. Once again, get any abnormal growth checked thoroughly.

Myth#6: Small breasts means low risk.

In that case, men shouldn't be getting breast cancer at all. Breast size is determined by the amount of breast tissue one has. And how much breast tissues one has [meaning small or large breasts], is irrelevant when it comes to developing breast cancer.

Myth#7: Mastectomy is the only treatment.

There are several options to treat breast cancer such as chemotherapy, radiation therapy and hormone therapy. Mastectomy is not the only option. It is suggested only in specific cases where either the patient isn't responding to other treatment or if the type of cancer warrants such treatment. (Read: Mastectomy blouse: For women who've lost breasts to cancer (interview))

Myth#8: Cancer isn't in my genes

Having a family history of cancer increases your risk by 5 10 per cent as compared to other factors. If you have a BRCA gene mutation, your risk for breast cancer is much higher than the risk of the average woman, say about 60 per cent 80 per cent. But not being genetically predisposed, doesn't mean you won't develop breast cancer. (Read: Breast cancer runs in your family? Genetic assessment can help!)

Myth#9: My diet is healthy, so I will be immune to breast cancer

Although it's important to eat nutritious food, that alone can't protect you from developing a cancer. No one food or vitamin by itself is enough to keep away such a dreadful disease. Like mentioned before, other factors play a role too. That does not mean you have to quit eating a healthy diet.

Myth#10: My mammogram was normal, now I don't have to worry

A mammogram only helps screen for cancer. You shouldn't rely on that alone and get a physical examination done too. Also, if your mammogram is clear, it only means that you don't have breast cancer at that time. So, you must repeat the screening test again after a year.

Read more..

• Breast cancer: Top 10 myths busted
• 'Fear prevents women from reporting breast cancer'
• Mastectomy blouse: For women who've lost breasts to cancer (interview)
• Angelina Jolie's preventive double mastectomy your questions answered
• 10 simple lifestyle changes to prevent cancer
• Top 10 food habits to prevent cancer

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