breast cancer

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A ticking time bomb

Your Health DR GITA MATHAI

The figures are disturbing. One in 30 urban women and one in 60 rural women in India develop breast cancer by the age of 70. This difference in incidence may be real, or because rural women (out of fear, socioeconomic reasons or ignorance), do not come forward for treatment. Breast cancer develops silently and painlessly. A lump that is “just there” may be ignored. By the time action is taken, it may be really large or have spread to adjacent lymph nodes or disseminated via the blood stream to various other organs like the lungs, liver or bones. There is a great deal of scientific research on breast cancer. This makes it one of the more treatable cancers. The downside is that even though technically the person is cured, the cancer can recur elsewhere — in the same breast, at the scar site or metastasise (spread) to a distant organ even 10-15 years later. Once diagnosed, even if treatment is taken and completed, the disease remains a ticking time bomb. Regular follow up is required. Breast cancer is more likely to develop if: Menstruation began before the age of 12 and menopause after the age of 54 The woman has no more than one child Child birth occured after the age of 30 The woman has a high fat diet BMI (weight divided by height in metre squared) is more than 30. The woman has no aerobic exercise. Some families are more prone to breast cancer. Many of the first-degree relatives (mother, aunts, grandmother, sisters) have breast cancer. These families carry genes and mutations that make them 60-80 per cent more prone to developing the disease. The commonly known genes are the BRCA1 and the BRCA2. The BRCA2 gene is associated with bilateral disease. Men who carry this gene can develop breast cancer. Other less-known genes are also associated with breast cancer. Breast self examination familiarises women with the shape, size and texture of their breasts. It helps them to pick up subtle changes, which may require further investigation. It should be done every month 5-7 days after the periods. Breast cancer can be present in the milk ducts alone. It then causes unilateral discharge of milky fluid or a brown or blood stained discharge. The nipple may get pulled inwards so that its shape is distorted. Bilateral milky discharge is more likely to be non cancerous. It can be due to thyroid deficiency, pituitary disease, fibrocystic changes in the breasts or the side effect of certain motility medications like perinorm or domperidone. The cancer may be in the lobules of the breast. The lump may be clearly felt. The skin overlying it may change in appearance, causing it to have an orange peel (peau de orange) appearance. Once a lump or cancer is suspected, the following may be done: Ultra sound scanning (for screening) Mammogram PET scan MRI Lumpectomy (removal of the tumour) and pathology studies Fine needle aspiration cytology Sentinel node biopsy to see if it has spread. Cancer always starts in a single cell whose multiplication is rapid and uncontrolled. As long as it remains localised, it is called “cancer in situ” or non-invasive cancer. As it grows, it becomes invasive. Some cancers grow fast in the presence of estrogen. They are called ER (estrogen receptor) positive cancer. Aggressive spread of the cancer and a tendency to recurrence occur in women who carry the HER2 gene. If the cancer type is known it is possible to specifically target the estrogen receptors and the HER2 gene. Previously, the entire breast with cancer, the regional lymph nodes and the muscles of the anterior chest wall were removed. Now just the lump is removed, leaving a healthy tissue margin. Sometimes the tumour is shrunk before surgery with radiation or chemotherapy. Carriers of the BRAC2 gene have a four per cent chance of a recurrence in the opposite breast. Some women opt for prophylactic removal of the normal breast. This is an informed choice and not a necessity. Surgery can always be done later if cancer crops up. Personal preventive methods: Breast-feed children to the age of one Maintain ideal body weight Avoid fat-laden food Exercise for an hour a day Perform breast self-examinations regularly to detect changes early Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in