More than 50% of women suffering from breast cancer are in the 25 to 50 years age group. (Expert interview)

Dr Sumeet Shah busts common myths about breast cancer, and tells you why you need to be aware of the condition.

Breast cancer can affect women at any age even in their twenties and the belief that it affects only older women is false. On World Cancer Day we bring you an interview with Dr Sumeet Shah, a renowned oncologist, who specializes in treating breast cancers, about the disease and busting some myths commonly attached to it.

How significant is the problem of breast cancer in India?

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! (Source: NCRP). 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.

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Breast cancer usually occurs in old age. Is it true?

No! More than 50% of women suffering from breast cancer are in the 25 to 50 years age group. In cities, we are seeing more and more women being diagnosed with breast cancer, and who are less than 50 years of age, in the premenopausal age group. You may like to read about a real story of a brave 25 year old who fought breast cancer.

Why is breast cancer rising so much?

We still do not know the exact causes. Early menarche (age at which menstruation begins), late first child beyond 30 years of age, late menopause are some of the risk factors. City life style, stress, imbalanced food, irregular sleeping hours, etc. contribute to this as well. There are many other reasons which have been put forward. A detailed discussion on this is beyond the scope of this article.The rising statistics also gives rise to various myths about breast cancer, find out which is a myth and which is a fact.

Is breast cancer preventable?

No. Breast cancer is NOT preventable. Hence, it is essential to detect it early, so as to ensure a maximum survival. However, we can bring about certain changes in our lifestyle, which may reduce the chances of developing breast cancer. They can be:

  • 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
  • Healthy food and sleeping habits. Junk food cannot be completely avoided, but we can make a resolution that Mon to Sat to eat healthy home food, and Sunday can be left for outside food. This is especially important for the younger generation, as healthy habits have to be formed now. Once a faulty habit is formed, it s difficult to change.
  • Eat more fruits . 'An apple a day keeps the doctor away', the adage is actually true.
  • 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!

Even if you can not prevent breast cancer, you should be aware of certain risk factors that make you prone to developing this cancer.

How do I go about early detection of breast cancer? Should I do a mammography?

No. Do not decide on mammography yourselves. It is very prudent to consult a specialist experienced in breast diseases and get yourself evaluated. The following are standard guidelines for early detection of breast cancer:

Women between 20 to 40 years of age:

  • Breast Awareness: This means, a woman should regularly do a breast self examination once every month (around the 5th day of periods) and should report any changes to her doctor
  • Clinical Breast Examination once in two to three years: A woman should consult her doctor, or a breast surgeon or a Surgical Oncologist once in every two to three years. To ensure that you don't exhibit any signs and symptoms of breast cancer you do a breast examination by yourself.

Women more than 40 years of age:

  • Breast Awareness
  • Clinical Breast Examination annually
  • Mammography annually

So, do not decide on mammography yourself. Let your doctor decide for you. Sometimes, we even delay mammography till 50 years of age. Sometimes, we do other investigations like MRI, especially in high risk individuals. So, consult your doctor and then decide

Does a mammography detect all breast cancers?

No. Mammography is not a foolproof investigation. Below 40 years of age, the breast tissue is very dense and small tumors do not show up on mammography at all. The sensitivity of mammography below 40 to 45 years is very low. After 45 years or so, as there is more fat in the breast and less of glandular tissue, smaller tumors may be picked up. But even then, its sensitivity is only around 80%; which means that out of 100 ladies with small tumors, only 80 will be picked up by mammography, while in rest 20, they will be missed. This implies that only one single mammography will not help. It has to be done at regular intervals, around every one or two years after age of 40 (depending on the index of suspicion). Again, let your doctor decide. To help you decide on how to choose a doctor and eliminate the probability of suffering from this dreaded disease here are some tips.

What are the symptoms of breast cancer?

The commonest symptoms are:

  • 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.

Does the breast need to be removed in all women suffering from breast cancer?

Absolutely not! 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. You may like to read about one sure-fire tip to beat breast cancer.

But won t a Breast Conserving Surgery increase the risk of cancer coming back?

After a Breast Conserving Surgery (BCS), there is a slightly increased risk of the cancer coming back in the same breast, as compared to when the complete breast is removed. But apart from this risk, the chances of the cancer coming back elsewhere in the body remain the same, whether it was a BCS, or the complete breast was removed. BCS is definitely the standard of care worldwide and we should be doing BCS wherever feasible.

What is your message to the readers?

  • No race, age, caste is exempt from breast cancer. It crosses all boundaries. So be alert, be aware.
  • Follow the guidelines above. It s not that all lumps are cancerous. In the younger age group, 9 out of 10 lumps may not be cancerous. But it is essential to be aware and act accordingly
  • In case of a lump in the breast, it is essential to be treated by the right doctor. Insist to your gynaecologist or General Surgeon, to take an expert opinion from a Surgical Oncologist, if necessary
  • Spread awareness. India is woefully behind in this matter, and we rank as one of the worst in the world in survival from breast cancer. So please spread awareness. Let other women in your family know about breast cancer. Let your friends know. Let your neighbours know. Let everyone know.

Image source: Getty Images

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