It is reported that every four minutes, an Indian woman is diagnosed with breast cancer and it accounts for 25% to 32% of female cancers across the country. Yet, there is a lack of awareness among Indian women about breast cancer. With Indian women putting their health and wellness on the backburner, timely diagnosis and treatment can get hampered. It’s time you gain knowledge about breast cancer and mastectomy. 

Things You Must Know About Breast Cancer

Breast cancer is the most common cancer of urban Indian women and the second most common in rural women. Owing to the lack of awareness of this disease and in absence of a breast cancer screening program, the majority of breast cancers are diagnosed at a relatively advanced stage. Breast cancer is a type of cancer that starts in the breast. Cancer starts when cells begin to grow out of control. Breast cancer cells usually form a tumour that can often be seen on an x-ray or felt as a lump. Take this quiz to find out if you are at the risk for breast cancer. Breast cancer occurs mostly in women, but men can get breast cancer, too. Learn more about breast cancer here:

1. Breast Screening Or Mammography

One of the best tools used to screen women to check for breast cancer is a mammogram. Women between the age of 40-44 should start getting annual breast cancer screening with mammograms. Women between the age of 45 – 54 are advised to do a mammogram once a year. Women over the age of 55 can continue yearly screening or switch to getting screened once every 2 years. And women less than 40 years should undergo an annual sono-mammogram instead of a mammogram for screening. 

2. Warning Signs Of Breast Cancer

Breast cancer comes with its own set of symptoms just like any other disease. The 5 signs that one can watch out for are:

  • A new lump in the breast or the underarm area
  • Thickening or swelling in parts of the breast
  • Redness or flaky skin around the nipple
  • Nipple discharge with blood
  • Pain in the nipple area

3. Types Of Breast Cancer And Its Symptoms

There are two categories of breast cancer that are invasive and non-invasive. Under these categories, there are 4 types of breast cancer.

  • Ductal Carcinoma In Situ (DCIS): This is a non-invasive condition where the cancer cells are only in the ducts in your breast and haven’t invaded the other parts of your breast
  • Lobular Carcinoma In Situ (LCIS): Similar to DCIS, here the cancer cells are confined to one part of the breast that is the milk-producing glands
  • Invasive Ductal Carcinoma (IDC): This is the most common type of breast cancer. It begins in the ducts and spreads to other parts of the breast. In this type, once cancer spreads outside to the tissue it will continue spreading across the body
  • Invasive Lobular Carcinoma (ILC): This first develops in the breast lobules and spreads across to the other tissues 

Inflammatory breast cancer is one type of cancer that is aggressive, however, it is only found in 1%-5% of all breast cancer cases. This causes the breasts to swell because the lymph nodes are blocked, not allowing the lymph vessels to drain. This is accompanied by breast discolouration, breast pain, skin dimpling and a change in nipple appearance. Metastatic breast cancer is a stage 4 breast cancer where it spreads to other parts of your body like bones, lungs or liver. It can be controlled by making dietary changes, lifestyle changes and regular exercise. Although not very common, men also get breast cancer just like women. They have the same tissues and although rare, are equally serious.

4. Common Treatment Options

Treatments generally depend on the type of cancer and the stage of cancer you are in, which will be diagnosed by the doctor. Most common treatments for breast cancer include surgery, chemotherapy, hormonal therapy, biological therapy, and radiation therapy. The most common treatment is surgery which involves removing the tumour and its nearby margins. These include lumpectomy, partial mastectomy, radical mastectomy and reconstruction.

Treatment of cancer depends upon the stage of the disease. For localized breast cancer, surgery remains an important part of the treatment. With newer techniques, it is not always necessary to remove the entire breast and lymph nodes. In small tumours, the breast can be conserved and a few lymph nodes may be removed and sent for testing. Some patients may additionally require chemotherapy. Other options include hormone treatment, targeted treatment depending on histology. Radiotherapy is offered to patients who undergo breast conservation or in those whose disease was locally advanced.

5. Steps To Prevent Breast Cancer

Small lifestyle changes impact our everyday health in great ways.

  • Limiting alcohol consumption
  • Avoiding smoking
  • Keeping your weight in check
  • Remaining physically active
  • Breastfeeding your child
  • Avoiding exposure to radiation and environmental pollution
  • Limited dose and duration of hormone therapy
  • Taking a Mediterranean diet involving a lot of fruits, vegetables, legumes, nuts and whole grains
  • Always self-examine oneself to look for lumps, bumps, discolouration, irritation or any other abnormality and visit the doctor at the earliest

11 Facts To Know About Mastectomy, By An Oncologist

A mastectomy is the removal of the entire breast or a part of it. It may also involve removing nearby tissues and lymph nodes. The type of mastectomy a woman needs depends on the stage and type of breast cancer, and her preference. Learn about mastectomy, its alternatives, breast reconstruction, risks, and recovery with expert advice.

TC46 connected with Dr Anil Heroor, Head-Surgical Oncology, Fortis Hospital, Mumbai to explain 11 vital points you need to know about mastectomy. Here he explains everything about the procedure, duration, alternatives, risks and follow-ups.

1. Reasons To Get A Mastectomy

A mastectomy is a surgery to remove a breast. This surgery is most often used to treat breast cancer. Sometimes other tissues near the breast, such as lymph nodes, are also removed in the surgery course. In some cases, a mastectomy is done to help prevent breast cancer in women with a high risk. A doctor will advise a mastectomy if:

  • The tumour in a breast is large
  • The tumour involves more than one area of the breast
  • Use of radiation therapy is not advised
  • The size of your breast may also help determine the type of mastectomy

2. Alternatives To A Mastectomy

If you’re at high risk of breast cancer and decide against mastectomy, you have other options, early detection and risk reduction.

  • Apart from medication, timely breast cancer screening through mammograms and MRI every year will be helpful
  • Surgery to remove the Ovaries (Prophylactic Oophorectomy) can reduce the risk of both breast and ovarian cancers. In women at high risk of breast cancer, Prophylactic Oophorectomy may reduce that risk by up to 50% if the procedure is done before age 50 when women are in a pre-menopausal state
  • Maintaining a healthy lifestyle, exercising most days of the week, limiting alcohol use, and avoiding hormone therapy during menopause may reduce the risk of breast cancer. Eating a healthy diet might decrease your risk of some types of cancer, as well as diabetes, heart disease and stroke

3. Go To A Reputed Hospital

Always go to a reputed hospital that has a centre for excellence for cancer treatment. You must understand that mastectomy is not the same for every patient. You should be able to discuss your fears and doubts with your doctor.

4. Different Types Of Mastectomy Procedures

The type of mastectomy you need depends on the stage and type of your breast cancer. The greater the spread of cancer cells, the more breast and nearby tissue the surgeon will remove. Partial mastectomy—known as a lumpectomy—removes cancer and a small area of normal breast tissue around it. A radical mastectomy removes the entire breast, including breast tissue, nipple, areola, skin, underarm lymph nodes, and the chest wall muscles under the breast. Talk with your surgeon about these as well as nipple-sparing mastectomy, simple mastectomy, a double mastectomy and a modified radical mastectomy.

5. Tests Before The Procedure And Duration Of Mastectomy

To determine if a mastectomy is advisable, you will undergo several imaging tests in the breast, including mammogram and possibly ultrasound as well as MRI. The operation takes about 90 minutes, and most people go home the following day. Hospital stays for mastectomy, on average, take 3 days or less. If you have a mastectomy and reconstruction simultaneously, you may be in the hospital a little longer. It can take 4 to 6 weeks to recover from a mastectomy. 

6. Tips To Prepare Yourself For A Mastectomy

  • Firstly, the procedure will be explained to you in detail by your doctor, and you can ask your questions
  • You will be asked to sign a consent form that permits you to do the procedure. Read the form carefully and ask questions if something is not clear
  • Give a proper medical history to your doctor. They will also give you a physical exam; this is to be sure you are in good health before the surgery. You may also have blood tests or other tests
  • You will be asked to not eat or drink anything (to fast) for about 8 to 12 hours before the surgery. Your surgeon will give you specific instructions
  • Stop taking Aspirin or other blood-thinning medication if you are on these medications
  • Talk to your doctor if you are pregnant or think you may be pregnant
  • Tell your doctor if you are sensitive to or allergic to any medicines, latex, tape, and anaesthesia medicines (local and general)
  • Tell your doctor about all the medicines you take. This includes both over the counter (OTC) and prescription medicines. It also contains vitamins, herbs, and other supplements
  • Tell your provider if you have a history of bleeding disorders
  • You may be given medicine to help you relax (a sedative) before the procedure

7. Possible Risks Factors

Some of the common risk factors include:

  • Short-term (temporary) breast swelling
  • Breast soreness
  • Hardness due to scar tissue that can form at the site of the cut (incision)
  • Wound infection or bleeding
  • Swelling (lymphedema) of the arm if lymph nodes are removed
  • Pain in the breast that has been removed (phantom breast pain)

 8. Recovery After Mastectomy

Your age, health and type of surgery factor into your recovery time. Recovery time for every patient is different and it is a gradual process. It will probably take some time before you’re feeling back to normal. It can take a few weeks to recover from mastectomy surgery and longer if you have had reconstruction. It’s essential to take the time you need to heal.

  • Take pain medication as needed
  • Take sponge baths until your doctor has removed your drains and/or sutures
  • Continue doing arm exercises each day
  • Have friends and family pitch in around the house

9. Some Signs Of Concern Post-Operation

Here are some complications that can occur post-operation:

  • Blood clots
  • Feeling tired and weak
  • Bleeding from the wound
  • Wound infection
  • Fluid collecting around the operation site (seroma)
  • Blood collecting around the operation site (haematoma)
  • Nerve pain
  • Shoulder stiffness

10. Follow-Up

Follow-up will be advised by your doctor depending on your post-operation recovery.  Generally, the post-operation treatment is decided 15 days post-surgery. Once done with the procedure, do not forget to go for your regular examinations. This may include regular breast exams and mammograms after a mastectomy if any breast tissue remains. A mastectomy greatly reduces the chances but does not eliminate the risk of breast cancer developing or recurring.

11. Most Women Are Candidates For Breast Reconstruction

Breast implants are one of the ways plastic surgeons can create a reconstructed breast after a mastectomy. No matter what point you are at during your treatment or what you’ve had done, most women are still candidates for breast reconstruction. But remember, all implants will eventually break, so there’s a finite lifespan to the implants. There are other options—such as special bras and prostheses—that can restore the appearance of a normal bust line under clothing. These options offer women the flexibility of having reconstruction in the future if they want it.

With all this knowledge you can make an informed decision about mastectomy and if you are still concerned about getting a mastectomy done, there is no harm in taking a second opinion. A second opinion can give you additional options that you hadn’t considered or it can reinforce your current decision. It may take time to process your feelings about mastectomy. Many women find comfort in talking with therapists, support groups, and friends and family about the emotional aspects of a mastectomy. And worry not, after your recovery period you can easily continue to do the things you love!