Breast Cancer: All You Need to Know
In India, breast cancer is the most widespread form of cancer among women, with incident rates as high as 25.8 women per 100,000 and mortality rates of 12.7 per 100,000 women, says Ministry of Health, Government of India. It further adds that by 2020, India may have 17,97,900 women suffering from breast cancer. The survival rates of breast cancer patients in India is also low at 66% when compared to 90% in the US and Australia. The findings come from the latest study Global Surveillance of Trends in Cancer Survival 2000-14 (CONCORD-3).
CONCORD 3 is led by London School of Hygiene and Tropical Medicine and refers to the global program of worldwide surveillance of cancer survival.
The high incidents of occurrence and lower survival rates are primarily due to a lack of awareness about breast cancer and the treatments available. Compared to the western countries where breast screening is a part of normal healthcare routine, the same is missing for a large majority of Indian women. According to cancer specialists, of the patients diagnosed with breast cancer in India, 50-60% die due to late diagnosis, low awareness of symptoms of breast cancer, lack of diagnostic centers in tier 2 and 3 cities, and high costs of treatment.
It is estimated that one in eight women runs the risk of getting diagnosed with breast cancer in her life. In India, breast cancer is more common in urban women as compared to their rural counterparts.
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Causes of Breast Cancer
It is not possible to pinpoint the exact cause why a woman would suffer from breast cancer. There are no known specific causes that can be attributed specifically to cause breast cancer. But, it is undoubtedly caused by damage to the DNA of the cells in the body. It is therefore likely that a seemingly healthy woman with no signs or symptoms may suffer the disease.
What are then the most common causes of breast cancer?
There are some known risk factors, that increase the likelihood of some women suffering from breast cancer. These include a family history of breast cancer, age, genes, lifestyle, and the surrounding environment. However, it cannot be said with absolute certainty that women with high-risk factors will develop breast cancer, as there are many women with these risk factors who never suffered breast cancer.
With age, above 50 years, women become more susceptible to developing breast cancer. Genetic factors such as being taller, early puberty, high breast density, and late menopause are also known to increase the risk. The other lifestyle-related or environmental factors that increase chances of developing breast cancer include lack of physical activity, no or low breastfeeding, alcohol consumption, hormone replacement therapy treatments, intake of contraceptive pills, pregnancy, and obesity. The myths that breast cancer is caused by caffeine, deodorants, microwaves, mobile phones, and meeting/touching a cancer patient, are just that –myths.
What can be done to mitigate breast cancer risk factors?
While family history, genetics, and age are beyond human or medical control, the other factors can be mitigated to reduce the risk of developing breast cancer. Regular physical activity, such as walking, cycling, gardening, or simply playing around with children, is known to reduce the risk of breast cancer, especially after menopause.
- Breastfeeding your children for longer durations significantly reduces the risk of breast cancer as it alters the hormonal balance of the body and delays the return of periods. It is recommended that an infant be exclusively breastfed for the initial six months. Women who breastfeed their children for a year or longer, reduce their risk of developing breast cancer significantly.
- Higher alcohol consumption increases risks of breast cancer. Therefore, if you cannot completely give up drinking, limit the amount of alcohol you consume per day.
- Menopausal treatments such as hormone replacement therapy make you more vulnerable to breast cancer during the period of the treatment. The longer the period of treatment, higher the risk. Intake of contraceptive pills slightly increases the risk. However, the risk gets mitigated within a few years of stopping the intake.
- Women who bear children are less likely to develop breast cancer in the long run. It may be noted the age at which you have children also affects the risk. The earlier you start your family at a younger age, lesser the risk of breast cancer.
- Weight gain is also known to manifest risk of developing breast cancer in three ways. If you gain weight after 18 years of age, your risk of developing breast cancer after menopause is higher. If you gained weight before menopause, your risk of developing breast cancer after menopause is slightly reduced. And, if you gain weight or become obese after menopause, your risk increases manifold.
Breast Cancer Types
Breast cancers are differentiated based on the specific cells of the breast that get affected. The most common type being carcinomas or tumors that start in the epithelial cells (lining the organs and tissues) of the body. These are known as breast adenocarcinoma and are known to start in the milk ducts or milk-producing glands. It is possible that a single breast tumor may be a combination of different types, while in rare cases, cancer may not form a lump or tumor at all!
What are the different types of breast cancer?
Depending on the extent to which cancer has spread, cancers are classified as in situ (localised or limited to the breast) or invasive/infiltrating (cancer has spread to surrounding tissue). In the in situ category, the cancer cells do not spread to the adjoining tissue, lobes, or ducts. Instead, they remain confined to a certain part of the breast. Invasive cancers, on the other hand, break through the breast tissues and spread to other tissues and organs of the body through blood vessels and lymph vessels.
The in situ cancers are further classified as ductal carcinoma in situ (DCIS) also known an intra-ductal carcinoma, and lobular carcinoma in situ (LCIS) also known as lobular neoplasia. The invasive/infiltrating cancers are those that spread to surrounding breast tissue. They are of various types, the most common being invasive ductal carcinoma and invasive lobular carcinoma.
Ductal carcinoma in situ (DCIS) is the earliest form of breast cancer and shows up on mammogram during breast screening. Lobular carcinoma in situ (LCIS) is actually not breast cancer. It refers to the condition where the cells lining the lobe undergo changes, thereby increasing the risk of developing breast cancer. Most women with LCIS do not get breast cancer. However, they still need to undergo regular breast examinations and mammogram screenings.
About 80% invasive (cancers that spread to other parts) ductal carcinoma start in the duct of the breast while 10% of invasive lobular carcinoma start in the lobes of the breast. They are difficult to diagnose with a mammogram due to the way they grow. Therefore, an MRI scan may be needed to detect them.
Apart from these, there are certain types of breast cancers which are less common, constituting only about 1 to 5% of all breast cancer types. These include inflammatory breast cancer, paget disease, phyllodes tumor, and angiosarcoma.
The inflammatory breast cancer is invasive in nature and due to growth of cancer cells in the lymph vessels, the breast inflames and becomes swollen. The paget disease of the nipple may have in situ (limited) or invasive (spreading) cancer. It begins in the ducts and then spreads to the skin of the nipple and areola. The skin of the nipple becomes red and scaly as in eczema. Phyllodes tumors develop in the connective tissue around the breast, while angiosarcoma cancers develop in the cells that line up the blood and lymph vessels.
Depending on the genes and proteins involved, genomic research suggests that 60% of breast cancers are estrogen positive, 20% are HER2 positive, and the remaining 20% are triple negative. When doctors test the cancer cells for diagnosis and treatment purposes, they check if the cells have certain proteins (called receptors) for estrogen hormone or a protein called HER2. Depending on the receptor type found in the cancer cells, the doctors classify these cancers as either estrogen positive or HER2 positive. If there are no receptors, the cancer is termed triple negative breast cancer.
Different Stages of Breast Cancer
When someone is diagnosed with breast cancer, it is important to ascertain the staging of cancer to understand the spread and progress of the disease. This helps decide the way forward on containing or eliminating cancer as well as to determine the course of the treatment.
What are the different stages of breast cancer?
There are many ways to detect the stage of cancer, including, physical exams, X-ray, biopsy, bone scan, blood tests etc.
Depending on the size of the tumor in the breast and spread of the cancer cells to the lymph nodes, various stages of cancer are defined. These are usually expressed as a number on a scale of 0 (zero) to IV (four). The lowest numbered stage (0) denotes the earliest detection of development with cancer cells confined to a limited area. This means that the cancer is in its earliest stage and has not spread. As the number of the stage progresses, the size of the tumor increases with an increased spread to the neighboring tissue and lymph nodes.
Stage 0 – This stage marks the beginning of the development of cancer cells and that cancer has been diagnosed early. In this stage, the cancer is still ‘in situ’ (still present in original place) with neither the cancer cells nor the abnormal non-cancerous cells having yet broken through the surrounding tissue to spread to other parts of the breast or neighboring lymph nodes.
Stage I – This stage describes the invasive stage, where cancer cells start breaking through the surrounding tissue. In Stage I, the cancer cells just begin to invade the outer tissue lining the duct or lobule. The invading cancer at this stage is small in size. Stage I is further divided in to Stage IA and Stage IB.
In Stage IA, the cancer is invasive with the tumor size measuring about 2 mm. However, cancer has not yet spread out of the breast and lymph nodes are also not involved.
Stage IB refers to the invasive breast cancer where two scenarios are possible. First, there is no tumor in the breast, but cancer cells in small groups of size ranging between 0.2 mm and 2 mm are seen in the lymph nodes. Second, the tumor in the breast is smaller than 2 cm with a group of cancer cells of size ranging between 0.2 mm and 2mm are found in the lymph nodes.
Stage II: In Stage II, cancer has grown further, spread to other locations, or a combination of both. Stage II is also divided into two sub-categories namely Stage IIA and Stage IIB.
In Stage IIA, there is no tumor in the breast but cancer measuring 2 mm or more is found in the lymph nodes located under the arms (called axillary lymph nodes) or those located near the breastbone. Alternatively, the tumor is about 2 cm or less and has spread to axillary lymph nodes. The third case in Stage IIA refers to the tumor measuring more than 2 cm but lesser than 5 cm and not yet spread to axillary lymph nodes.
Stage IIB refers to invasive cancer where the tumor becomes the size of a lime or walnut, measuring anywhere between 2 and 5 cm, with small cancer cell groups found in lymph nodes. Alternatively, the tumor measures between 2 and 5 cm with cancer spreading to 1-3 axillary lymph nodes or to those lymph nodes located near the breastbone. The third alternative is where the tumor measures more than 5 cm but cancer has not spread to lymph nodes.
Stage III: Stage III is considered advanced stage, making it difficult to fight the disease. But, the consolation is that cancer has not yet spread to other organs or bones. Stage III is further divided into IIIA, IIIB, and IIIC categories.
In Stage IIIA, either the tumor is found in the breast with cancer cell groups spreading to 4-9 axillary lymph nodes or those located near the breastbone, or tumor is over 5 cm with cancer cell groups spreading to lymph nodes, or a tumor larger than 5 cm with cancer cells spreading to 1-3 axillary lymph nodes or those near the breastbone.
In Stage IIIB, the tumor can be any size with cancer cells spreading to the chest wall and/skin of the breast, causing swelling or ulcer. Cancer has spread to up to 9 lymph nodes or to those lymph nodes situated near the breastbone. Stage IIIB cancer is inflammatory cancer with the skin of the breast becoming red, breast feels warm and gets swollen, and the cancer cells spread to the lymph nodes as well as in the skin.
In Stage IIIC, there may be no cancer in the breast, the tumor may be any size, spreading to the chest wall and/or skin of the breast, and the cancer cells spread to more than 10 axillary lymph nodes and/or spread to lymph nodes near the breastbone.
Stage IV: Stage IV is usually considered the advanced stage or the ‘metastatic’ stage, meaning spread beyond its place of origin. The cancer has now spread beyond the lymph nodes and the breast to other organs of the body such as lungs, bones, brain, liver, or skin, making it extremely difficult to fight.
Is there any other method to determine the stage of cancer?
Apart from the numeric staging system, the various stages of cancer are also described in the TNM staging system. The TNM (Tumor, Node, Metastatic) methodology of cancer staging is more popular in clinical trials. The T stage is categorised further into T1, T2, T3, and T4, based on the size of the tumor and the extent of spread of cancer to the surrounding breast tissue. The higher the T number, the larger the size of the tumor and greater its spread. The N stage signifies the spread of cancer to the lymph nodes. N1, N2, N3 categories represent the number of affected lymph nodes and cancer spread to them. The M stage denotes metastasis and reveals if cancer has reached other body parts or not.
How do various stages of cancer help determine survival rates?
Earlier, patients were required to undergo extensive scans for diagnosis, irrespective of the stage of cancer. But, with new standards of diagnosis and treatment, and partly also due to early detection, extensive testing is no longer required. Depending on the stage of cancer, the expected survival rate of the patient is determined. This 5-year survival rate, however, is only an estimate, with people going on to live longer than expected. The lower the stage, the better the chances of living longer. According to National Cancer Institute, USA, Stage 0 and Stage I have 100% 5-year survival rates, with Stage II at 93%, Stage III at 72%, and Stage IV at 22%.
Breast Cancer Treatment
Genetic, lifestyle-related, and environmental factors are known to increase risk of breast cancer. Once breast cancer diagnosis is received, the next step is treatment. The treatment and overall recovery plan is formulated based on the stage of the cancer, age, medical history, and general health of the patient.
What treatment options are available to breast cancer patients?
With the advances in technology and pharmaceuticals, it is now possible to get life-saving treatments for breast cancer. Compared to the treatment options available two decades ago, there is now a menu list of possible treatments available, that one can choose from. However, it is advisable to seek a second opinion from an expert or a plastic surgeon and speak to women who have been in similar situations.
The most common treatments for breast cancer are:
Lumpectomy: This is a surgical procedure where the tumor, cancerous cells, along with some healthy surrounding tissue is removed from the breast. The procedure is also called breast-conserving surgery as a majority of the breast remains.
Mastectomy: In this type of treatment of breast cancer, the entire breast is removed. However, options of skin-sparing and nipple-sparing mastectomy are now available due to technological advances in mastectomy techniques. In some patients, mastectomy may be needed later in life even when lumpectomy along with radiation therapy was conducted.
Radiotherapy: Cancerous cells are destroyed using precise amounts of high energy X-rays. The most common form of radiation therapy involves an external machine that produces external beams. However, it may also be done using a radioactive material (brachytherapy) inside the body. Radiation therapy is used for several weeks after patients have undergone a surgical procedure. Radiotherapy is practiced by a specialist radiation oncologist.
Chemotherapy: The tumor is destroyed using specific medicines, that arrest the growth and multiplication of cancerous cells. These medicines can either be administered through an intravenous (IV) tube or through oral pills and capsules. Chemotherapy is suggested only depending on the stage of the cancer and the chances of its success. It is possible that at times chemotherapy may precede surgery. This is done with a view to shrink the tumor to a smaller size making it easier to operate upon.
Hormone therapy: This therapy is recommended when the tumors grow with the availability of estrogen or progesterone hormones, with a view to block their growth and prevent the return. The medicines administered stop production of estrogen in the body and block these hormones from attaching to the cancer cells. This therapy, also called endocrine therapy, can help shrink and control cancer when it has already spread to other parts of the body. It often accompanies surgery and chemotherapy.
Targeted therapy: As the name suggests, this therapy specifically targets the afflicted genes, proteins, or tissues. With the advances in technology, it has become possible to zoom in and determine the exact target tumors to not only arrest the growth of cancerous cells, but also reduce the damage to surrounding health tissue.
Combination therapy: With the spread of cancer to other organs and parts of the body, the treatment required becomes more elaborate and aggressive. Therefore, to eliminate the cancerous cells, a combination of chemotherapy, hormone therapy, and targeted therapy, in addition to surgery may be recommended. This is at times also called ‘adjuvant’ therapy.
Complementary therapy: In addition to the conventional treatments, many patients are now also opting for holistic treatment to eliminate toxins and emotional issues that accompany the disease. Patients are exploring dietary changes, use of essential oils, alternative medical practices such as acupuncture, to complement the ongoing treatments. While complementary therapies may not cure the patient, they help them cope up with the conventional treatments and improve quality of life.
Bone-modifying drugs: In instances where cancer has not spread to other parts of the body, bone-modifying drugs such as bisphosphonates can help prevent recurrence of cancer. But, if cancer has become metastatic, that is it has spread to the bones, further bone destruction can be arrested using high dose drugs. These drugs also help strengthen the remaining bones.
Clinical trials: When standard medication fails, you can opt for clinical trial to test new techniques/drugs/therapies. These trials help gauge effectiveness and benefits of the new drugs. However, the percentage of patients participating in clinical trials is miniscule.
Supportive (palliative) care: Special medical care that provides relief from pain and other symptoms to complement the ongoing treatment is called supportive or palliative care. It is used alongside surgical procedures, chemotherapy, and radiation to support patients and their families through the course of the treatment.
Are there any side-effects of breast cancer treatments?
Since treatments for breast cancer include the use of strong medicines, it is possible that the patient may suffer from side effects such as recurrence of breast cancer, hair loss, nausea, fatigue, infection, hot flashes, night sweat, vaginal dryness, bone thinning, blood clots, etc. Some of the rare side effects include early menopause, infertility, damage to nerves, heart, kidneys, and blood cell cancer.
Breast Cancer Symptoms
The earlier breast cancer is detected, the greater the chances of eliminating it. Therefore, it is important that one knows the symptoms of the disease and conducts a regular check.
What are the symptoms of breast cancer besides a lump?
The most common symptoms of breast cancer that should not be ignored include change in the size or shape of the breast, a lump, thickening of some area of the breast, unexplained change in skin texture such as dimpling (like an orange skin), eczema-like rashes or redness on the skin or around the nipple, the nipple looks different or becomes pulled in, clear, red, brown, or yellow liquid discharge from nipple even without squeezing, persistent pain in the breast or arm pit that does not go away after the next period, a new lump that survives the period, a swelling in the armpit or around collar bone, bloating, bleeding between periods, blood in urine or stool.
Pain is often associated with something going wrong in the body. It is possible that you feel a pain or a lump in the breast due to normal breast changes or a non-cancerous (benign) condition. But, rarely is breast pain the lone symptom of breast cancer. It may be due to many other factors such as changes in hormone levels due to menstruation, intake of birth control pills, treatments for infertility, cysts in the breasts, uncomfortable bra, large/heavy breasts, and stress.
Breast cancer does not show any symptoms in the early stages. And, although lumps in breasts are associated with breast cancer, often these lumps are non-cancerous. The lumps in the breast may occur due to numerous reasons such as infection, cysts, tumor (non-cancerous), or damaged tissue in the breast. But, if you feel new, painless, a lump that is hard and has irregular edges, immediately visit your doctor, as this is more likely to be cancerous.
The symptoms of breast cancer that manifest later are nipple retraction or inversion towards inside, one breast enlarges, dimpling of breast skin, pain in the vagina, unexplained weight loss, enlarged lymph nodes in armpits, and breasts with visible veins.
Most women diagnosed with breast cancer may not show any of the above-mentioned symptoms. However, these symptoms may point towards the development of the disease. Regular screenings and mammogram tests are useful in early detection of breast cancer even before symptoms begin to appear.
Breast cancer self-examination
Now that you are aware of the common symptoms of breast cancer, it is essential that you monitor your breasts regularly to take note of any changes and seek prompt medical assistance. Get aware of your breasts and how they look and feel in a normal state. While ‘normal’ may mean different for different women, it helps to understand what your breasts generally look and feel in terms of size, contours, color, texture, etc. When you are aware of your breasts, you can better gauge any changes or abnormalities that may occur.
Can you test for breast cancer at home?
According to Johns Hopkins Medical Center in the US, forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important. It is possible to conduct a preliminary check at home. It is called breast self-exam (BSE) and helps you check for any changes to the breasts, such as thickening of the tissues, change in skin texture and color, fluid discharge, or any lumps. It is best to do breast self-exam at home every month after your periods. This is because the breasts are less tender then. Pregnant women or those with irregular periods can choose a specific day each month for a breast self-exam.
If you notice anything unusual report to your doctor. In most cases, these symptoms may not point to breast cancer, but early detection makes it easier to eliminate the disease. Remember, breast self-exam is not an alternative to clinical screening or mammogram and it only helps your doctor to understand the changes that may have occurred.
How do you conduct a breast self-exam at home?
You can follow a five-step procedure to examine your breasts at home:
Step 1: In this step, you observe any unusual changes to the breasts. To do this step, keep your shoulders straight with arms on your hips. Now, look at the breasts in the mirror. What should you look for? Look at the breasts and notice the shape, size, and color. The breasts should be evenly shaped, of usual size and color. Don’t panic if the breasts are unequal in size. Most women’s breasts are unequal. Look for visual distortion such as discoloration or swelling of the breasts. Notice anything that looks unusual such as rashes on the breast skin, bulging of the skin, or dimpling of the skin. Check also if the nipples have changed their position, show signs of peeling, have any sores, or have become inverted, that is turned towards inside. Take note of any redness, soreness, or eczema type rashes on the breasts. Press down your hands on your hips such that the muscles under your breasts tighten. Observe the breasts for all of the above while turning from one side to the other to examine each breast completely. Now, bend down a little towards the mirror such that the breasts fall forward. Tighten your chest muscles and observe any changes. Clasp your hands behind your head, turn from one side to the other and observe the outer periphery of the breasts. You may need to lift the breasts with your hand to check this.
Step 2: Remove your hands from the hips and raise them. Now look for the same changes as described in step 1 above.
Step 3: Looking into the mirror, see if there is any liquid oozing out from one or both nipples. The liquid or discharge could be white, milky, transparent, yellow, or red. Also, check if there is any blood oozing out from either or both nipples. To check the nipples, using your thumb and forefinger, pull the surrounding tissue outward and look for any discharge.
Step 4: Lie down on your back, place a small pillow under the right shoulder, and place your right arm behind your head. Using your left hand feel the right breast. Use a few finger pads keeping the fingers flat to firmly touch the breast. You may use a lotion to make the movements smoother and easier. Feel the breast with circular motion covering the entire breast from top to bottom and from left to right. Begin from the outer edge of the breast and move it in a complete circle. Now, move your fingers slightly inwards and repeat the circle. Repeat this circular movement till you reach the nipple. A similar circular pattern can be followed from nipple moving outwards in bigger circles till the entire breast is covered. Now, move your finger pads firmly from the collarbone to the top of the abdomen, and then from the armpit to the cleavage. Make sure you cover the entire breast. Then move your fingers vertically from top to bottom in rows. Place your fingers on the top of the nipple and gently press inwards. Notice if it moves easily.
What should you feel when touching the breasts? You need to feel the tissue from the front to the back of the breasts. You may have to alter the pressure that you exert while feeling the tissue. For instance, you should apply light pressure for skin just underneath, medium pressure for tissue in the middle and slightly higher pressure for the tissue inside. Repeat the above movements for the other breast, too.
Step 5: You can either sit or stand for this step where you again need to feel the breasts. Repeat the steps described above. Many women find it comfortable to move the finger pads on wet skin. So, you can do this step, in a shower.
Video Courtesy: Discovery Limited
What are the likely results of self-exam?
It is possible that you may feel a lump or a thickened tissue in the breast or the underarm, an area of the breast that looks different from the remaining part, visible changes to the shape or size of one or both the breasts, a marble-like area beneath the skin, changes to skin texture, discoloration of the skin, change to the nipple (scaly, dimpled, sore), clear or bloody discharge from the nipple.
If you observe any of the above changes, seek medical advice. It may not be cancer as these symptoms get manifested due to other reasons such as infections, as well. However, speaking to your doctor will help eliminate the chances of cancer.
Can you rely solely on the breast self-exam that you are cancer free?
Even before you can feel the tumor through a breast self-exam, a mammogram is able to detect them. So, for early detection of cancer, screening is the key. However, breast-self exam proves helpful in noticing any changes to the breasts and therefore seeking early medical intervention.
Breast Cancer Diagnosis
Doctors make use of numerous tests to diagnose breast cancer. Tests are also conducted to detect if the cancer is still localized in the breast or lymph nodes or has spread to other parts of the body. Finally, doctors conduct tests to determine the course of treatment.
In order to determine the diagnosis of breast cancer, the following tests, or a combination thereof, may be used:
Imaging tests: These tests are done to learn more about the area under scrutiny as revealed by the preliminary screening.
Diagnostic mammography: The first imaging test is diagnostic mammography which is similar to a screening mammogram, just that it takes more pictures. It is used when a new lump or nipple discharge is detected.
Ultrasound: Using a sound wave, an image is created of the breast tissue. An ultrasound is particularly useful in distinguishing between a solid mass or cyst filled with fluid. The solid mass has a greater probability of being cancerous, whereas cyst is generally non-cancerous.
Magnetic Resonance Imaging (MRI): Instead of X-rays, MRIs use magnetic fields to produce images. A breast MRI is used to check the extent of spread of cancer in the breast or to check the other breast for the possibility of cancer. MRI is also used before surgery to understand the success of chemotherapy in shrinking the tumor. In addition to a mammogram, MRI is recommended as a screening method for women with high risk to breast cancer.
Digital Tomosynthesis: This technique is used to take multiple X-ray images of a stationary, compressed, breast. Images are taken from different angles, so they can be viewed individually or as an animation, providing 3D view of the breast under examination. It provides better information when compared with a standard mammogram.
Biopsy: Biopsy is considered the most definitive test that accurately establishes the presence of cancer. A small amount of tissue is removed and examined under the microscope by a pathologist. According to the technique used and the size of the needle used, a biopsy is classified as follows:
Fine needle aspiration biopsy: A thin needle is used to remove a small sample of the tissue or cells.
Core needle biopsy: The needle size used is bigger and a larger sample of tissue is removed for analysis. This is a preferred method to establish if the abnormality is cancer. The procedure involves administering local anesthesia to the patient to block pain and reduce patient discomfort.
Surgical biopsy: This technique is used to remove the largest amount of tissue. However, this is not a recommended technique as surgery is usually performed after cancer has been diagnosed.
Image-guided biopsy: In this technique, a needle is guided to the abnormality with the help of an imaging technique. Ultrasound, MRI, or mammography may be used. A small meta-clip, usually of a non-interfering meta such as titanium, may be put in the breast to mark the location of the biopsy. This is done to help locate the place easily should another sample of tissue be needed for further tests.
Sentinel lymph node biopsy: This method is used to understand if cancer has reached the lymph nodes, that are located near the breast, or not.
Vacuum-assisted biopsy: A special needle is attached to a vacuum device and samples of breast tissue are taken for examination purposes
Wire-guided excision biopsy: Using this technique a thin wire is placed in the abnormal area of breast tissue in order to mark the area for removal with surgery.
Once the biopsy is done, the biopsy sample is analyzed to understand the features and extent of cancer, thereby providing guidance on the treatment to undertake.
Tumor Features: The features of the tumor are examined under a microscope with a view to understanding if the tumor is localized (in situ) or has become invasive (spread to other parts).
ER and PR: Testing for ER and PR (estrogen receptor and protein receptor) is conducted to assess the risk of recurrence of cancer. Depending on the results of these tests, further course of treatment is decided.
HER2: Another test may be conducted for HER2 to determine the drugs needed to target HER2 receptor.
Grade: A biopsy is useful in understanding the grade of the tumor, which means how different the cancerous cells or tumor looks from the healthy cells. It also helps determine the rate at which the tumor is growing – whether it is a fast-growing tumor or slow-growing. If upon examination, the tumor is called low-grade or differentiated, it means it looks similar to the healthy cells and contains cells of different groupings. However, if the cancer tissue looks vastly different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The grades are also numbered as 1, 2, and 3. Grade 1 refers to well differentiated, grade 2 moderately differentiated, and grade 3 is poorly differentiated.
Blood tests: Doctors prescribe several types of blood tests that may be needed before or after surgery. Usually, blood tests are used for complete blood count, blood chemistry, hepatitis test, etc.
There are other laboratory tests that are recommended on the basis of genes, proteins, and other factors as ascertained from the tumor, to help find out the subtype of cancer and eventually the course of further treatment.
Once the diagnostic tests are completed, the doctor reviews all the results and arrives at the diagnosis if it indeed is cancer. This is called staging. Depending on the stage of cancer, the doctor may recommend some more imaging tests such as chest x-ray, CT scan, bone scan, etc.
In addition to the above-described tests, there are some genomic tests that may be recommended to understand the risk of recurrence of cancer years after diagnosis. These tests are also helpful in predicting if a certain treatment can prevent recurrence of cancer. Therefore, it helps eliminate treatment options that are unlikely to benefit the patient. Some of the tests under this category include oncotype DX, breast cancer index, mammaprint, and PAM50.
It has been established by studies that urban Indian women are more vulnerable towards developing breast cancer due to changing lifestyles and other environmental factors. But, with the knowledge about the disease and awareness about their breast health, they can prevent the disease from progressing to higher stages. Early detection is the key to fighting breast cancer and increasing the chances of survival. Being proactive, regularly monitoring their breast condition and making certain lifestyle changes such as holistic diet and regular exercise can help fight and eliminate the disease before it strikes roots.
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