Each year more than one million women are diagnosed with breast cancer worldwide over half of

whom will die from the disease.In India the incidence has been rising alarmingly of late.

Breast cancer is the most common cancer among women in India and the leading cause of cancer death for women

Extensive breast cancer screening programmes and the development of new treatments have improved the prognosis of breast cancer overall. However the average 5 year survival rate for women with late stage or advanced breast cancer remains low. On average only 35-40% of women with advanced breast cancer are alive five years after diagnosis.

What is cancer/breast cancer?

Cancer is a disease that occurs when cells become abnormal and divide without control

or order. Each organ in the body is made up of various kinds of cells. Cells normally divide

in an orderly way to produce more cells only when they are needed. This process helps

keep the body healthy. If cells divide when new cells are not needed, they form too much

tissue. This extra tissue, called a tumor, can be benign or malignant.

Benign tumors are not cancer. Eighty percent of all breast tumors are benign.

They can usually be removed, and, in most cases, they don’t come back. Most

important, the cells in benign tumors do not invade other tissues and do not spread

to other parts of the body. Benign breast tumors are not life-threatening.

Malignant tumors are cancer. The cancer cells grow and divide out of control,

invading and damaging nearby tissues and organs. Cancer cells can also break

away from the original tumor and enter the bloodstream or lymphatic system. This is

how breast cancer spreads and forms secondary tumors in other parts of the body.

This spread of cancer is called metastasis.

Breast cancer is characterised by the uncontrolled growth of abnormal cells in the milk producing glands of the breast or in the passages (ducts) that deliver milk to the nipples.

It occurs in both men and women, although male breast cancer is rare.

What are the Types of breast cancer?

The type of breast cancer is important in determining the most effective treatment approach.

The most common way to classify breast tumours is according to the status of three specific cell surface receptors. These are the oestrogen receptor (ER), the progesterone receptor (PR) and the Human Epidermal Growth Factor Receptor (HER)2/ neu receptor.

The most common type of breast cancer is known as Hormone Receptor-Positive breast cancer; accounting for around 75% of all breast cancers. This type of cancer grows in response to the hormones oestrogen and progesterone, and as such is likely to respond to therapies that aim to inhibit the growth effects of hormones.

Another type of breast cancer classified by the system is ‘HER2-positive breast cancer’ which is typified by cells that make too much of a protein known as HER2/neu.

It represents 20–30% of Hormone Receptor-Positive breast cancers.

Tumours that do not overexpress HER2/neu are described as HER2-negative.

Triple negative breast cancer (TNBC) is a rarer form of breast cancer which is a sub-type of HER2-negative disease. TNBC refers to tumour cells which lack oestrogen and progesterone receptors, and do not overexpress the HER2 protein. This cancer type accounts for around 15-20% of all breast cancers, and is usually more aggressive and difficult to treat as it does not tend to respond to standard therapies.

Due to the aggressive nature of this disease it is important to treat patients early; however with few effective treatments available there is a high unmet medical need.

What are the causes and risk factors of breast cancer?

There are a number of factors that have been shown to increase a woman’s risk of developing breast cancer:

Age: The majority of breast cancer cases in wetern countries occur in women over the age of 50. However we see more women in late 30’s and 40’s getting bresast cancer in India

Family history: If a woman has a personal or family history of breast cancer she is at increased risk of developing breast cancer.

Clinical history: Women who have previously suffered with benign breast cancer are at greater risk of developing breast cancer in the future.

A late first pregnancy: Women who have a late first pregnancy (after the age of 35) are more likely to develop breast cancer.

The Breast Cancer Genes. Some individuals, both women and men, may be born

with an “alteration” (or change) in one of two genes that are important for regulating

breast cell growth. Individuals who inherit an alteration in the BRCA1 or BRCA2

gene are at an “inherited” higher risk for breast cancer. They also may pass this

alteration on to their children.

Scientists estimate that only about 5-10 percent of all breast cancers are due to inherited genetic changes. One out of two women with these changes is likely to develop breast cancer.

Women with a family history of breast cancer are encouraged to speak to a genetic counselor to determine the pros and cons of genetic testing.

Prolonged hormonal exposure: A long menstrual life or possibly use of hormone replacement therapy after the menopause expose women to an increased risk of developing breast cancer.

Lifestyle factors: For example, being overweight or obese after the menopause, physical inactivity, a high fat diet and high alcohol consumption can play an important role in the development of breast cancer.1

what are the symptoms and how do we diagnose breast cancer?

The symptoms of early stage breast cancer can often go undetected.

There are 12 common signs of breast cancer, these are summarised below:

A hard lump developing in the breast or armpit – typically painless and occurring on one side only.

A change in the size or shape of the breast, including indentation, ‘growing’ (particularly prominent) veins or skin erosion.

Changes in the skin such as hardening, dimpling, bumps, redness/heat or an orange peel like appearance.

Changes in the nipple such as retraction, the secretion of unusual discharge or a rash around the nipple

What is mammography?

Mammography is an X-ray machine specifically designed to take high definition radiographs of the breast with excellent soft tissue contrast. It can detect small lesions and charecterize those lesions as benign, suspicious or malignant- these will be reported under Breast Imaging reporting data system BIRADS classification

Is mammography reliable as a screening tool for breast cancer?

A: Mammography screening remains the best available method to detect breast cancer

early. Newer Digital mammography detects even smaller lesions and microcalcifications.

Q: Is mammography screening the only way to detect breast cancer?

A: Other screening tests, such as magnetic resonance imaging (MRI) are available, but

mammography screening remains the best available method to detect breast cancer early.

However, no medical test is always 100 percent accurate, and mammography is no

exception. Research is under way to improve the technology to lead to better accuracy and

to create new technologies.

Q: What is an MRI and isn’t this test more effective than mammography?

A: Magnetic resonance imaging tests, or MRIs, are more thorough than mammograms and

can better spot some cancers, but they also detect more growths that look suspicious but

are actually benign. They’re also much more expensive and may not be suitable for screening.

In addition, MRI-guided biopsies are not widely available.

In short, case-by-case decisions make the most sense.

Q: What should women expect when they have a mammogram?

A: A woman who still menstruates should schedule the mammogram for one week after her

menstrual period begins, when the breasts will be the least tender. Women are asked to

avoid using deodorant and lotions on the day of the mammogram

A specially trained radiologic technologist will perform the mammogram.

The woman will be asked to undress from the waist up only and stand next to the x-ray machine. Two flat surfaces will compress one breast first, then the other for a few seconds.

Compression is necessary to produce the best pictures using the lowest amount of radiation possible.

Q: What is advanced breast cancer?

A: Breast cancer is considered advanced when it has spread from its original site to distant

areas of the body. Physicians will look at a number of factors to determine the stage of

breast cancer, including tumor size, lymph node involvement, and whether the cancer has

spread to other areas of the body. Once the stage of the disease is determined, there are

two different ways advanced breast cancer can be classified: locally advanced or

metastatic.

Q: What is locally advanced breast cancer?

A: The term locally advanced breast cancer indicates that the cancer is large (greater than

2 inches) or may have spread to other nearby tissue, such as underarm lymph nodes.

Locally advanced breast cancer is considered Stage III, and if it is operable, it is referred to

as Stage IIIA.

Q: What is metastatic breast cancer?

A: The term metastatic breast cancer[Stage 4] indicates that the cancer has spread from the breast

to other parts of the body such as bone, lung, liver, or brain.

Q: What are the treatments for breast cancer?

A: The basic treatment choices for breast cancer are surgery, radiation, chemotherapy, and

hormonal therapy, which may or may not be included in the treatment regimen, depending

on hormonal involvement in the growth of the tumor. Local treatments such as breast

surgery and radiation therapy are focused on the breast itself to remove or destroy the

cancer cells confined to the breast.

Systemic treatment such as chemotherapy aims to destroy the cancer cells that may have spread throughout the body.

Newer experimental treatments include biologically targeted therapies which currently, are

only available through clinical trials. A patient and his/her physician will choose thetreatment that is right for him/her, based on the location and extent of the cancer, patient’s age and preferences, and the risks and benefits of each treatment.

Surgery may be performed to remove the cancerous tumor, and may also be performed to allow for diagnostic testing of tumor tissue.

Radiation therapy uses penetrating beams of high-energy waves or streams of particles to kill and hinder the growth of cancer cells.

Chemotherapy may be used if it is believed the breast cancer will not respond to hormonal treatment. Chemotherapy is the use of drugs that target and destroy rapidly dividing cells, including cancer cells. It is frequently used in metastatic breast cancer and used in locally advanced breast cancer to shrink the tumor and make it operable.

Hormonal therapy can be used to slow the growth, spread, and recurrence of breast cancer. If the cancer is found to be of the type that may be sensitive to estrogen, hormonal treatment may be able to keep estrogen from helping the cancer cells to grow and divide. The presence of estrogen receptors (a message-carrying protein that may stimulate tumor growth) in the cancerous tumor is the best way to predict a woman’s response to hormonal treatment.

Biologically targeted therapy covers a range of new options that are to be added

to the family of cancer treatments. These therapies target specific features of cancer

cells to fight cancer. Since these therapies are specific, they are intended to have

less effect on normal cells, which may reduce the chance of possible side effects,

like those caused by current cancer treatments. Types of treatment include

monoclonal antibodies, which bind to proteins on the cancer cell surface to slow

down cancer cell growth; angiogenesis inhibitors, which are intended to prevent the

growth of new blood vessels and so cut off the supply of oxygen and nutrients to

cancer cells; and signal transduction inhibitors, which block the signals inside the

cancer cell that promote the cells to divide and, in turn, cause the cancer to grow.

How can we prevent Breast cancer?

Common to all women are daily lifestyle decisions that may affect breast cancer risk.

These day-to-day choices involve factors such as poor diet, insufficient physical activity, alcohol

use, and smoking. Besides possibly reducing breast cancer risk, lifestyle improvements

represent smart steps for a healthier life, since they can help prevent heart disease,

diabetes, and many other chronic, life-threatening conditions.

Decrease your daily fat intake – especially saturated or hydrogenated fats. Eat

leaner meats and limit red meat. Reducing your fat intake helps prevent other health

problems such as heart disease and stroke and may reduce your chance of

developing breast and colon cancers.

Increase fiber in your diet. Fiber is found in whole grains, vegetables, and fruits.

This type of diet is beneficial for your heart and can help prevent other cancers such

as colon cancer.

Eat fresh fruits and vegetables. In addition to their fiber content, fruits and

vegetables have antioxidant properties and micronutrients that may help prevent

some cancers.

Limit alcohol. Evidence suggests that a small increase in risk exists for women who

average two or more drinks per day (beer, wine, and distilled liquor).

Stay active. you can prevent many health problems by engaging in a moderate amount

of physical activity (such as taking a brisk, 30-minute walk) on most days of the week.

Strive to maintain the body weight recommended by a health professional, since excess fat

may stimulate estrogen production.

Don’t smoke. Although smoking doesn’t cause breast cancer, it can increase the

chance of blood clots, heart disease, and other cancers that may spread to the

breast.