1. What is breast cancer?

Breast cancer is a type of cancer that occurs in the breast. This is the most common cause of death in middle-aged women, and the incidence is increasing worldwide. These cancer cells are psychopaths, do not care much about the surrounding environment, and keep on dividing until they destroy the whole breast architecture.

2. Causes

  • Family history plays a significant role in determining if you are likely to develop breast cancer or not. For example, a woman's risk of breast cancer is higher if she has another sister, daughter (first-degree relative), or multiple family members on either side of her mother's or father's side having breast or ovarian cancer.
  • Age. Being 55 or older increases your risk of breast cancer. Rare before the age of 20, at 90 years of age, 20% of ladies are affected.
  • Excessive exposure to hormones like estrogen and progesterone increases the risk of breast cancer. Females who take oral contraceptive pills are at higher risk of developing breast cancer later.
  • A long menstrual cycle period with early menarche (age at which a female has her first periods) and late menopause (age at which women's periods stop) increases the risk.
  • First pregnancy after the age of 30 significantly increases the risk.
  • Hormone replacement therapy increases the risk slightly.
  • A high intake of alcohol increases the risk.
  • Radiation exposure increases the risk. 
  • Many genetic mutations have a drastic effect on the development of breast cancer like BRCA1 and BRCA2, Li Fraumeni syndrome (mutation in p53), and Cowden disease (Germline mutation in PTEN).
  • Obesity and being overweight increase the risk.
  • Nulliparous women are at a higher risk of developing breast cancer than multiparous women.

Factors that decrease the risk of breast cancer

  • Early pregnancy before the age of 30.
  • Breastfeeding is protective.
  • Avoidance of alcohol and smoking.
  • Less radiation exposure.
  • Marinating weight within normal range.

Early Symptoms of breast cancer

  • Lump in the breast, which may be ulcerated. In 60% of patients, the upper outer quadrant is involved, but a node can be present anywhere in the breast.
  • Nipple retraction is another symptom of breast cancer. The nipple is inverted or pulled inward into the breast instead of pointing outward.
  • Blood-stained discharge from the nipple. Usually, there is no discharge from the nipple except in breastfeeding mothers, where there can be milky discharge from the nipples.
  • Feeling of lumpiness in the axilla or feeling of heaviness in the arm.
  • Change in breast size and appearance.
  • The skin over the breast becomes tight, discolored, and pigmented.
  • Peeling and scaling of the pigmented skin area surrounding the nipple (areola) or breast skin.
  • Redness or pitting of the skin over your breast like the skin of the orange.

Late symptoms of breast cancer

  • Low-grade fever
  • Bony pain
  • Shortness of breath
  • Abdominal pain
  • Swelling of arms
  • Color changes in breast skin
  • Blood in sputum
  • Significant weight loss
  • Loss of appetite.

3. When to seek a doctor immediately?

If you find a lump or other changes in your breast, even if a recent mammogram was regular, make an appointment with your doctor for prompt evaluation.

Preparing for your appointment

  • Breast health specialists
  • Breast surgeons
  • Doctors who specialize in diagnostic tests, such as mammograms.
  • Doctors who specialize in treating cancer (oncologists).
  • Genetic counselors]
  • Plastic surgeons.

Questions to ask your doctor

  1. What type of breast cancer do I have?
  2. What is the stage of my cancer?
  3. Can you explain my pathology reports to me?
  4. Do I need any more tests?
  5. What treatments are options available for me?
  6. What are the benefits of each treatment you recommend?
  7. What are the side effects of my treatment?
  8. What happens if I don't want to treat cancer?
  9. What is the total cost of my treatment?
  10. Can I get help from a psychiatrist?
  11. Can I continue to do my daily tasks?
  12. Should I seek a second opinion?
  13. Which hospital do you recommend?
  14. What website or books do you recommend?

4. Tests and diagnosis

  • Breast exam. Your doctor will check both your breasts and axillary area.
  • A mammogram is an x-ray picture of the breast. Regular mammograms are the best test to detect cancer at its early stage. In addition, mammograms are commonly used to screen for breast cancer. If an abnormality is seen on a screening mammogram, your doctor may recommend you a diagnostic test.
  • Breast ultrasound uses sound waves to produce images of structures deep within the body. For example, it may help differentiate a solid mass from a cystic mass.
  • A biopsy is the removal of small pieces of breast tissue for testing. Biopsy samples are sent to the laboratory for analysis, where experts determine whether the cells are cancerous. A biopsy sample is also analyzed to determine the type of cells involved in breast cancer, the aggressiveness of cancer cells, whether the cancer cells have hormone receptors, and whether the cancer cells are hormone receptor-positive or negative.
  • Breast magnetic resonance imaging is a machine that uses magnets and radio waves to create a picture of the interior of your breast; before a breast MRI, you receive an injection of dye.

5. Which hospital should you prefer?

It would be best if you always preferred getting treated in a tertiary care hospital. But your preference and first choice always should be a cancer hospital. Because the multidisciplinary team is in cancer hospitals and your case is discussed among doctors from various specialties such as medical oncologists, surgical oncologists, radiologists, physiotherapists, and nurses.

6. Treatment and drugs

Your treatment depends on the stage of your disease. Your doctor determines your breast cancer treatment options based on your breast cancer type. Most women undergo surgery for breast cancer and receive additional treatment before or after surgery, such as chemotherapy, hormones therapy, or radiation.

Breast cancer surgery

Operations used to treat breast cancer include.

  • Removing breast cancer (lumpectomy). During lumpectomy, which may be referred to as breast-conserving surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue. Lumpectomy is typically reserved for small tumors.
  • Removing the entire breast is called mastectomy. Most mastectomy procedures remove all the breast tissue, including the nipple, areola, skin, and fat.
  • Removing a limited number of lymph nodes to determine if cancer cells have invaded the lymph nodes or not is called sentinel node biopsy. Sentinel lymph node biopsy helps the surgeon access the cancer stage, and it also helps the surgeon decide whether he will perform axillary dissection. If the sentinel node contains tumor cells, removing more nodes in the area is mandatory. On the other hand, if the sentinel node is negative, this obviates the need for extensive dissection of the regional lymph node.
  • Removing several lymph nodes is called lymph nodes dissection. If cancer is found in the sentinel node, your surgeon will discuss the role of removing additional lymph nodes in your armpit.
  • Removing both breasts. Prophylactic Bilateral mastectomy is advised in patients with a positive genetic predisposition to breast cancer. For example, those who prove to be BRCA 1 positive have a 50-80% risk of developing breast cancer.
  • Angelina Jolie (a famous American actor) underwent a bilateral mastectomy with breast reconstruction 37 years after knowing that she had carried the BRCA1 defective gene. Her genetic testing was done because she had a strong family history of breast cancer (her mother had breast cancer).

Complications of breast surgery

  • Bleeding during surgery
  • Pus in wound
  • Wound infection
  • Flap necrosis
  • Nerve injuries
  • Pain in the surgical area
  • Arm swelling

Reconstruction of breast

Breast reconstruction can be done at the same time or after an interval. Reconstruction can be done by silicone prosthesis implantation under plastic surgery or with the help of a flap.

Radiation therapy

Radiation therapy uses high-powered energy beams, such as x-rays to kill cancer cells. Radiation therapy is typically done using a large machine that aims at the energy beams in your body. But radiation can also be done by placing radioactive material inside your body.

Side effects of radioactive therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Rarely do more severe problems may occur, such as damage to the heart or lungs or, very rarely, second cancers in the treated area.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. If your cancer has an elevated risk of returning or spreading to another part of your body, your doctor may recommend chemotherapy to reduce the chances that cancer will recur. For example, it is sometimes given before surgery in women with large breast lumps. The goal is to shrink the size of the tumor, which makes it easier to remove with surgery.

Side effects of chemotherapy depend on the drugs you receive. Common side effects include hair loss: nausea, vomiting, fatigue, and increased risk of developing an infection. Rare side effects can include menopause, infertility, damage to the heart, kidneys, nerves, and blood cell cancer.

Hormone therapy

This is often used to treat breast cancers that are sensitive to hormones. Doctors sometimes refer to these cancers as estrogen receptor-positive and progesterone receptor-positive cancers. Antiestrogen drug Tamoxifen is the most widely used hormonal agent in breast cancer and is only used when tumor cells are estrogen positive. If cancer has already spread, hormone therapy may shrink and control it. These drugs are given for the duration of two to five years.

7. Lifestyle and home remedies

  1. Ask your doctor about breast cancer screening.
  2. Get to know your breast through self-examination for breast awareness. Self-examination should be done monthly.
  3. Avoid drinking alcohol.
  4. Exercise most days of the week. Try to do exercise for at least 30 minutes a day. You can also do yoga or any other relaxing exercise.
  5. Limit postmenopausal hormone therapy.
  6. Maintain a healthy weight.
  7. Women who are above 35 years of age should go for mammograms yearly.

Prognosis

If breast cancer is diagnosed early, the overall prognosis is excellent.