Are we aware of breast cancer yet?

Dr. Arpan Choudhury

Female breast cancer is the most commonly diagnosed cancer in the world. It is the fifth-leading cause of cancer mortality worldwide. It ranks first for incidence in the majority of countries, including India. Every 4 minutes, an Indian woman is diagnosed with breast cancer. India has seen a phenomenal rise in literacy rates since independence. But still, there is a huge gap that needs to be filled with regards to breast cancer awareness.

Let us first try to understand a few basic points about cancer. Just as the wall of a building is made of bricks, our body is made up of cells. Even if one brick of the wall develops a crack through it, the building is damaged. If the wall is not repaired on time, the entire building collapses. Similarly, even if one cell of the body grows out of control, it may cause cancer. If cancer is not detected and treated at an early stage, it can spread and cause death. Breast cancer is a malignant tumour (i.e., a tumour that can invade other tissues and spread to other parts of the body), which starts in the cells of the breast.

 There are many risk factors that increase the likelihood of developing breast cancer. These include:

1. i) Early menarche (onset of menstruation or periods) before 12 years of age

2. ii) Nulliparous women, i.e., women who have not given birth to children.

iii) Women who get pregnant for the first time after 35 years of age.

1. iv) Women who have not breast-fed their child

2. v) Late menopause (stoppage of periods) after 55 years of age

3. vi) Use of a combined oestrogen-progesterone oral contraceptive pill

vii) Use of hormonal menopausal therapy

viii) Alcohol consumption

1. ix) Obesity

2. x) Lack of physical activity

3. xi) Exposure to ionising radiation

xii) Family history of breast cancer

 The signs and symptoms of breast cancer include:

1. Lump in the breast

2. ii) Change in the shape or size of the breast

iii) Retraction of the nipple (inward drawing)

1. iv) swelling in the armpit or neck

2. v) Depression or pitting over the skin of the breast

3. vi) Blood-stained, watery, or greenish discharge from the nipple

vii) Orange-peel appearance of breast

viii) Redness of skin over the breast

 If you feel any of the previously mentioned changes, do not panic, but please visit a breast specialist. Every breast lump is not cancer, but it is important to get evaluated. Malignant lumps are mostly painless, so do not wait for pain to get alarmed. Contrary to popular belief, breast cancer is not exclusively seen in women. It can also occur in the small amount of breast tissue that is present in men. Another common notion among the general public is that cancer is incurable. But the reality is that cancer can very well be treated and cured if detected at an early stage.

Methods for early detection of breast cancer include

1. Self-breast examination:

n It must be done every month.

n Premenopausal women: 5th–10th day of the menstrual cycle

n Women who have stopped menses: one fixed day, every month

n 2 components: look and feel

n 5 steps

Steps 1 and 2 consist of inspection (looking) for any skin changes, redness, visible bumps, crusts, or symmetry.

Step 1: Both arms should be placed over your waist. Place your hands on your waist and press inward, and turn side to side to note any changes.

Step 2: With both arms raised above your head, place your hands behind your head and press forward. Again, turn side to side and look for changes.

Steps 3, 4, and 5 consist of palpation, i.e., feeling

Step 3: Put one hand behind the head. Examine the breast on that side of the body with the other hand.

Step 4: Perform the same examination as step 3, but in a lying downposition.

Step 5: Put fingers around the areola press outwards around the nipple. Look for any discharges.

1.      Clinical breast examination: After the age of 30, you should go for clinical breast examination screening by visiting a breast specialist once every year. The doctor will do all the steps described in the self-breast examination plus feel the underarm area and area above the collar bone.

2.      Mammography: Mammography is one of the most useful tools for the early detection of breast cancer. It should be done every year, starting at the age of 40–45. If found positive in the screening test, further evaluation is done for confirmation.

We conducted a study to assess the level of knowledge about breast cancer and its screening amongst people by distributing a questionnaire about breast cancer to randomly selected 300 participants at shopping malls, colleges, and home visits. 79% of the respondents claimed that they had heard about self-breast examination, while 44% claimed that they also knew the steps. But on objective analysis, only 25% could correctly say that it needs to be done very monthly, and only 8% of the respondents agreed that they do self breast examinations regularly. On enquiring about the reasons for not practicing it regularly, the following reasons were found to be at the top of the list:

1. i) Lack of time

2. ii) Lack of privacy

iii) Not necessary

1. iv) Unaware of the need

2. v) Inadequate training

The non-existence of breast cancer awareness in India is well-known to the oncology community, but such dismal results were eye-opening. Today, we are on par with the world in terms of treatment modalities, but there is still a fundamental need for knowledge about early diagnosis and screening. A multidisciplinary approach to breast cancer, including awareness programmes, preventive measures, screening programmes for early detection, and the availability of optimal treatment facilities, is vital for reducing both the number of cases and deaths due to breast cancer in Indian women. Community education at the grassroots level for both men and women is the need of the hour.

We are sharing a QR code that you can scan to open a presentation on “Breast Cancer Awareness,” which has been prepared by our team of cancer specialists.