Q1) I HAVE A LUMP IN MY BREAST AND I AM AFRAID IT IS CANCER. SHOULD I BE WORRIED?
80% of the women who feel lumps in their breast have benign lumps (not cancerous).20% of the women could have malignant lumps (cancerous in their breast). A benignlump can be a collection of normal or hyperactive breast gland cells, or maybe a waterfilled sac (cyst) and it does not have cancer. If you feel a lump and you are worried,DO NOT HESITATE TO SEE A DOCTOR.It willease your fears and if it is something serious you can start the treatment immediately.
Q2) WHAT IS BREAST CANCER?
Breast cancer is the collective term for all the cancers that originate in breast tissue.Breast cancer is a disease in which malignant (cancer) cells form in the tissue of thebreast.
Q3) WHAT ARE THE WARNING SIGNS?
The commonest signs of breast cancer are
a) Lump or thickening in the breast
b) Change in the size or shape of the breast
c) Discharge from the nipple
d) Change in the colour or feel of the skin of the breast or nipple (dimpled, puckered,scaly, warm, red or swollen)
e) Nipple turning inwards
f) Lump in the under arm area.
There may be no warning signs or symptoms.Breast self examination, clinicallybreast examination, regular mammogram are essential for early detection of breastcancer.
Q4) WHAT ARE MY RISKS FOR GETTING BREAST CANCER?
Being a woman and getting older are biggest risk factors.Others being
a) Onset of menstruation before 12 years of age
b) Onset of menopause after 50 years of age
c) Not having children or having a first child after age 30
d) Family history of breast cancer
f) Alcohol consumption
g) Using hormone replacement therapy or birth control pills.
Q5) HOW DOES WEIGHT INFLUENCE BREAST CANCER AND CAN EXERCISEREALLY HELP TO CUT DOWN THE RISK OF BREAST CANCER?
Maintaining a healthy weight is one thing that can be done to lower the life time risk ofbreast cancer. Higher BMI (body mass index) can increase the risk of breast by 30 to 60% (particularly worrisome is often hidden abdominal fat).Physical activity reduces breast cancer risk. Exercising three or more hours per weekcould reduce the risk by 20 to 30%
Q6) IF NO ONE IN MY FAMILY HAS BREAST CANCER, CAN I STILL GET IT?
Yes you still can.Only about 30% of women who develop breast cancer have a familyhistory of the disease. The other 70% have what is called a‘sporadic occurrence’(withouta known family history of the disease)
Q7) WHEN SHOULD I START HAVING MAMMOGRAMS AND HOW OFTEN SHOULDI HAVE THEM?
Women from the age of 40 years should have a mammogram done yearly. The youngerwomen typically have dense breasts and on a mammogram this dense breast shows upas white-which is the same colour that cancer appears as on mammogram. As thewoman ages the dense tissue in the woman’s breast is replaced with fatty tissue whichlooks grey on a mammogram. It is much easier to see the white cancer against this greybackground. Mammogram can help you find your cancer early.
Q8) IS A MAMMOGRAM PAINFUL?
The pressure caused by spreading the breast tissue maybe uncomfortable, but notpainful.
Q9) IS THE RADIATION EXPOSURE FROM GETTING A MAMMOGRAM HARMFUL?
The radiation exposure from low dose, modern mammography machines is minimal.Radiation doses usually are so low that they are negligible. The medical benefits of earlydetection outweigh any potential risk.
Q10) HOW IS BREAST CANCER DIAGNOSED?
When you are referred to a specialised breast centre, physical examination and somefew tests will be organised to determine if you have breast cancer.
b) Ultrasound/ MRI breast
c) Biopsy- a small sample of breast tissue is removed using a needle on an outpatientbasis. The result of biopsy is available within 3 or 4 days.
Q11) HOW DOES BREAST CANCER SPREAD?
Breast cancer cells can break away from the original site and move around the body toform secondary breast cancer. This spread usually occurs via blood and lymphatics.Lymph nodes in the arm pit are a common place for breast cancer to spread. Suchspread can happen to some of the distant organs like liver, lungs, bones, brain, etc.
Q12) HOW DO I DECIDE WHICH TREATMENT OPTION IS BEST FOR ME?
Your physician will discuss about the treatment options. Although there are fourstandard ways to treat breast cancer, surgery, chemotherapy, radiation therapy,hormonal therapy, several treatments may be combined. Your doctor will recommendtreatment depending on the type and location of cancer, the stage at which it isdetected, your age, and general health condition.
Q13) HOW DO I DECIDE WHICH SURGERY IS RIGHT FOR ME?
Two main types of surgery are used in treatment of breast cancer.
First is the breast conservation surgery- Only the cancerous lump in the breast and asmall amount of surrounding normal tissue is removed. Rest of the breast tissue is leftintact.The second is the mastectomy- Whole of the affected breast is operated and removed.
Your surgeon will decide the type of surgery most suitable for you, considering numberof factors like the size and the location of the tumour within the breast.Women who undergo breast conservation surgery will require radiation therapy aftersurgery. Radiation therapy reduces the chances of tumour recurring in the breast.
Q14) IS IT NECESSARY TO UNDERGO AN OPERATION TO REMOVE THE GLANDSFROM THE ARM PIT?
The most common site for breast cancer cells to spread is to the small glands calledlymph nodes in the arm pit. This is done through a procedure known as sentinel lymphnode biopsy or axiliary lymph node dissection. This is normally performed at the sametime as removal of the breast tumour or complete breast. This procedure helps us inplanning the further treatment like chemotherapy and radiation therapy.
Q15) IF I HAVE A MASTECTOMY, DOES THAT MEAN I WONT NEED ANY OTHERTREATMENT AFTER SURGERY?
NO.In some cases after mastectomy it may still be necessary to undergo radiotherapy,chemotherapy and hormonal therapy depending on the type of the tumour and thestage of the disease.
Q16) WHAT ARE THE SIDE EFFECTS OF THE TREATMENT?
The side effects of chemotherapy are different for different people. This also depends onthe different kinds of drugs and drug doses which are used. The side effects ofchemotherapy are
a) Nausea and vomiting
b) Hair loss
e) Mouth sores
Not everyone will experience all the side effects.
Radiotherapy: Fibrosis or scarring of the remaining breast tissue may occur following radiotherapy. Insome cases breast can become noticeably smaller and harder. Fibrosis can also blocklymph drainage of the arm and cause lymphoedema.
Hormonal therapy: The side effects are similar to symptoms experienced by women who are going throughthe menopause such as hot flushes, night sweats, vaginal dryness, irregular periods andin some cases joint pain.
Q17) SHOULD MY FAMILY MEMBERS BE TESTED FOR CANCER?
Some cancers like breast, prostate, pancreatic and colon can have a hereditarycomponent. If someone in the family has one of the these cancers, it may be advisablefor other family members to undergo genetic testing.
Q18) WILL MY CANCER COME BACK?
This is one of the most common questions asked by cancer survivors. In some casescancer can recur or a new cancer can form years or even decades after treatment. Oneof the goals of breast cancer support group is to help patients come to terms with theirfears about cancer recurrence so that they can lead a productive and fulfilling life.Another goal is to ensure that the survivors realize the importance of periodic checkupsafter their last treatment for cancer.
Dr Jayanti S. Thumsi, MBBS, MS, Clinical Attachment is a Breast Oncologist.Read more