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The American Cancer Society recommends that all women over the age of 40 have regular breast screenings and self-exams.
Over the years, breast cancer has become the nemesis of Indian women, overtaking cervical cancer to establish its dominance as the most common cancer in Indian women. The sheer number of cases is so huge that even with both genders combined, breast cancer ranks number one among all cancers in terms of numbers. So what causes it? The factors are numerous, such as: 1) Prolonged exposure to estrogens during the reproductive phase of life which may be due to early menarche, late menopause, late delivery or lack of children, etc. 2) obesity; 3) Increase in breast density; 4) genetic mutations; 5) family mutations; and 6) Exposure to ionizing radiation.
Breast lumps, like most cancers, are silent killers. They sneak up on unsuspecting patients with hard, painless masses that are accidentally noticed only after they become large enough to be palpable. Diagnosis is further delayed by social taboos and denial mentality of patients. Studies have shown that several factors, such as educational level, religion, marital status, and socioeconomic status, contribute to delaying the diagnosis of breast cancer in Indian women. Lack of education and low socioeconomic status contribute to avoiding breast cancer screenings and even if a mass is identified, these women are reluctant to seek medical help as they prioritize the family’s needs over their own and fear the financial burden of medical treatment and loss of income, as they would have to stop working. Divorced and widowed women, especially in the older age group, often find themselves living alone without a support system. This results in a delay in seeking corrective therapy for any breast mass, even if it is identified at an early stage.
Another variable that delays the diagnosis of breast cancer is the unbridled use of alternative medicine. Many patients go to the doctor after having tried alternative therapies for mass resolution. If the mass is malignant, therapies do not work, causing tumor progression, and it often presents as metastatic disease. Indian women most often present at stage IIb and above, unlike their Western counterparts, who undergo rigorous screening tests that help detect small, non-palpable tumors. In advanced disease, there may be skin ulcers, nipple erosion, nipple inversion, bloody discharge from the nipple, bone pain, shortness of breath, etc. breast cancer and to make sure they seek medical help as soon as possible if a lump is found. Finding it early gives us the best chance of completely curing the disease.
The American Cancer Society recommends that all women over the age of 40 have regular breast screenings and do a breast self-exam, which is a series of simple steps women can take on their own monthly to identify lumps. suspects. If a lump is identified, it is not a cause for panic. It is advisable to contact a GP or an oncologist, as most breast lumps, especially in younger age groups, are benign or harmless. The oncologist will examine the patient and recommend a mammogram and needle evaluation of the breast lump, either as a fine needle aspiration cytology (FNAC) or Trucut biopsy, which produces more tissue. If malignancy is confirmed in the sample, then an additional staging study is performed in the form of ultrasound of the abdomen, chest X-ray, positron emission tomography, etc., at the discretion of the physician.
Treatment for breast cancer consists of the following modalities: surgery, radiation, chemotherapy, and hormone therapy, which are used in combination depending on the stage, tumor type, age, and general condition of the patient. Each of these treatment modalities can be further tailored for each patient. For patients who wish to preserve the breast, it is possible to do so in early breast cancer using breast-conserving techniques; Similarly, chemotherapy drugs and regimens vary based on tumor types and their hormone receptor markers. Radiation therapy has evolved over the years to become extremely precise, allowing it to treat patients with limited adverse effects.
After treatment is complete, patients must be closely followed for several years. Some patients who have positive hormone receptor markers in tumor tissue are advised to take hormone therapy for 5 to 10 years.
In conclusion, breast cancer is not the death sentence it once was. Advanced treatment options have ensured that patients presenting at any stage can enjoy long and healthy lives. In the words of Cayla Mills, “You never know how strong you are until being strong is the only option you have.” Help is at hand.
(Dr M Banu Priyaa is the clinical leader and radiation oncologist at Kauvery Cancer Institute, Chennai)
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