Breast cancer

Check your breasts for cancer

YOUR HEALTH   DR GITA MATHAI

Cancer. The word is derived from "crab" and conjures up visions of multiple tentacles insidiously spreading all over the body. Unfortunately, the vision includes undiagnosed, undetected, untreated versions of the dreaded disease. Women in India are prone to cervical (lower end of the uterus) and breast cancer. A vaccine (HPV or human papillovirus vaccine) was recently introduced to reduce the incidence of cancer of the cervix. However, there is no vaccine to prevent breast cancer. One in 22 women in India are projected to be diagnosed with breast cancer in the course of their lifetime. The incidence varies from eight per 1,00,000 women in rural India to 27 per 1,00,000 women in urban areas. Breast cancer is not a disease confined to women; in rare occasions, it can occur in men too. Lumps in the breast can be felt when they are pea sized. The tissue feels different, and is firmer and harder than in the surrounding areas. Later the skin over the lump may be discoloured or thickened (resembling an orange peel). Also, there may be retraction (pulling inward) of the nipple. Many lumps are harmless non-cancerous fibroadenomas. Others are not real lumps but nodular breasts reflecting the hormonal changes that occur during the course of a normal menstrual cycle. All lumps, however, must be taken seriously and evaluated as soon as they appear. Evaluation of a breast lump is usually done with a mammogram or an ultrasound examination. Once the position has been accurately localised, the lump is aspirated with a fine needle. Cells obtained during the procedure are used to diagnose the nature of the lump. Depending on the diagnosis, the breast is operated. This is followed by chemotherapy, radiotherapy, hormone therapy and immunotherapy. Breast cancer can occur at any age, though it is less common under the age of 25 years. The exact mechanism which sets in motion the changes responsible for breast cancer is not known. Certain environmental and genetic factors are associated with an increased risk of breast cancer. • Long years of menstruation with early menarche (less than 12) and late menopause (over 55) • Delayed childbirth • Failure to breast-feed children • Breast or ovarian cancer in first degree relatives • Smoking and drinking alcohol • Obesity • Cancer elsewhere and exposure to radiation • Post menopausal hormone replacement therapy for more than four years. In developed countries, the majority