Breast Cancer ! What all you need to know

Dr Ashwini Sirapanasetty Karache *

Breast cancer arises in the lining cells (epithelium) of the ducts (85%) or lobules (15%) in the glandular tissue of the breast. Initially, the cancerous growth is confined to the duct or lobule (“in situ”) where it generally causes no symptoms and has minimal potential for spread (metastasis).

Over time, these in situ (stage 0) cancers may progress and invade the surrounding breast tissue (invasive breast cancer) then spread to the nearby lymph nodes (regional metastasis) or to other organs in the body (distant metastasis).

If a woman dies from breast cancer, it is because of widespread metastasis. Breast cancer treatment can be highly effective, especially when the disease is identified early.

Treatment of breast cancer often consists of a combination of surgical removal, radiation therapy and medication (hormonal therapy, chemotherapy and/or targeted biological therapy) to treat the microscopic cancer that has spread from the breast tumour through the blood. Such treatment, which can prevent cancer growth and spread, thereby saves lives.

How breastfeeding & pregnancy give protection against breast cancer ?

The human breast goes through remarkable changes during a woman’s lifetime. During puberty increased levels of oestrogen and progesterone causes the breasts to enlarge. This is due to the development of the mammary glands and increased fatty tissue. The breast contains 15–20 units called lobes, the lobes of the breast drain into lactiferous ducts which lead to the nipple. Each lobe of the breast is made up of 20–40 lobules, and each lobule consists of 10–100 hollow cavities called alveoli.

The alveoli are lined with epithelium which synthesises the protein and lipid components of breast milk. Elevated hormone levels during pregnancy causes the ductal system to expands and the alveolar epithelium and the breast increases in size.

When breastfeeding stops there is a regression in the breast tissue but there is no substantial reduction of the mammary glands. The lobules in the breast involute as a woman ages with reduction in number of alveoli. Over time there is a replacement of the mammary glands with fatty tissue.

High BMI-Obesity associated with breast cancer ?

Fat tissue (also called adipose tissue) produces excess amounts of estrogen, high levels of which have been associated with increased risks of breast, endometrial, ovarian, and some other cancers. Obesity often have increased blood levels of insulin and insulin-like growth factor-1 (IGF-1). High levels of insulin and IGF-1 may promote the development of colon, kidney, prostate, and endometrial cancers.

The positive association between BMI and breast cancer risk in post menopausal women was speculated to result from the higher level of estrogen derived from the aromatization of androstenedione within the larger fat reserves of women of higher BMI.

The negative relationship between higher BMI and breast cancer risk in premenopausal women probably came from a protective effect of increased weight in the early premenopausal years, which is a predictor of longer anovulatory cycles and a lower level of progesterone and estrogen

Mammogram – For screening & for diagnostic purpose !

A mammogram is an X-ray image of your breasts. It can be used either for breast cancer screening or for diagnostic purposes, such as to investigate symptoms or unusual findings on another imaging test. During a mammogram, your breasts are compressed between two firm surfaces to spread out the breast tissue.

Then an X-ray captures black-and-white images that are displayed on a computer screen and examined for signs of cancer. Mammograms play a key role in breast cancer screening. They can detect breast cancer before it causes signs and symptoms. Mammograms have been shown to reduce the risk of dying of breast cancer. American Cancer Society recommends

o Women with age 40 to 44 years should have the option to start annual breast cancer screening with mammograms.
o Women with age 45 to 54 years should undergo mammograms every year.
o Women who are 55 and older can choose to get mammograms every 2 years, or can continue yearly screening.
o Screening mammograms should be continued if a woman is in good health and is expected to live 10 more years or longer.

Breast self-examination

A breast self-exam is a check-up a woman does at home to look for changes or problems in the breast tissue. Many women feel that doing this is important to their health. The best time to do a monthly breast self-exam is about 3 to 5 days after your period starts.

Do it at the same time every month. Your breasts are not as tender or lumpy at this time in your monthly cycle. If you have gone through menopause, do your exam on the same day every month. Begin by lying on your back. It is easier to examine all breast tissue if you are lying down.

o Place your right hand behind your head. With the middle fingers of your left hand, gently yet firmly press down using small motions to examine the entire right breast.
o Next, sit or stand. Feel your armpit, because breast tissue goes into that area.
o Gently squeeze the nipple, checking for discharge. Repeat the process on the left breast.
o Make sure that you are covering all of the breast tissue.

Next, stand in front of a mirror with your arms by your side.

o Look at your breasts directly and in the mirror. Look for changes in skin texture, such as dimpling, puckering, indentations, or skin that looks like an orange peel.
o Also note the shape and outline of each breast.
o Check to see if the nipple turns inward.
o Do the same with your arms raised above your head.

Your goal is to get used to the feel of your breasts. This will help you to find anything new or different. If you do, contact your provider right away.

Stigma around femininity!

Social Burden & Acceptance for Breast Cancer Patients & Survival still remain troublesome. Most of the women who all are suffering through such kind of diseases like breast Cancer or Cervical Cancer, they do undergo a lot of gender discrimination & societal pressure (in terms of–to be in a certain size & shape because of which their sexuality always get questioned).

In this revolutionary era, we as a society need to expand our horizon & shall dwindle the boundaries of discrimination. It’s high time for the society to surrender & break this misogynist “Gender Specific Attitude” because any issue or health issue of women’s body should not be considered on the basis of gender or body image.

It is supposed to be considered as a human health issue . This will not just lead to an empowerment of women but empowerment of every individual/gender of the society.