The ListExpert Talk: Breast Surgeon Dr Soumya Holla & Oncologist Dr Uma Dangi...

Expert Talk: Breast Surgeon Dr Soumya Holla & Oncologist Dr Uma Dangi List Things You Must Know About Breast Cancer

It is reported that in 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 this disease and prevent it with advice from doctors.

The Breast Cancer Awareness Month, marked in countries across the world every October, helps to increase attention and support the awareness, early detection and treatment, as well as palliative care of this disease. Today, we highlight the importance of creating awareness about breast cancer with two experts, Dr Soumya S Holla, Consultant Breast Surgeon at Motherhood Hospital in Bangalore & Dr Uma Dangi, Consultant Medical Oncology at Hiranandani Hospital in Mumbai.

1. When should you start getting breast screening or mammography?

Dr Holla says, “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 mammogram for screening. Women should be familiar with the benefits of screening, its limitations and potential harms linked to breast cancer. If women are aware of a family history of breast cancer, it would be better if they get screened regularly as well. They will require MRIs along with mammograms.”

“Breast cancer incidence is increasing in India. In 2018, more than 1.5 lakh women were diagnosed with breast cancer. The risk of this disease increases with age and a family history of cancer. Screening can help detect it at an early stage when it can be cured. Depending upon the risk, certain tests are advised. It is recommended that women who are at standard risk for breast cancer should start Self Breast Examination (SBE) by the age of 30 years. This should be done once every month at the same time. For women who are menstruating, the ideal time for SBE is seven days after the start of the period. Clinical Breast Examination (CBE) is an examination conducted by a trained nurse or a doctor. This is recommended once every 3 years after the age of 30 years, and once a year after the age of 40 years. Mammography is recommended once in one to two years after the age of 45 years. More frequent or additional tests may be advised depending on family history and genetic testing”, states Dr Dangi.

2. What are the 5 warning signs of breast cancer?

Dr Holla explains, “Breast cancer comes with its own set of symptoms just like any other disease. The five signs that one can watch out for are:

  • A new lump in the breast or in 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”

According to Dr Dangi, “The most common symptom of breast cancer is the presence of a lump. Most importantly, the lump is painless in its early stages and hence many times gets ignored. A painless lump in the breast is a very important sign of breast cancer. In addition, other symptoms include changes in the shape or contour of the breast, bleeding or discharge from the nipple, and change in the nipple and areolar region without any lump, which includes retraction of the nipple. In very advanced stages, the skin of the breast may get involved leading to redness and appearance of orange-like skin, also called Inflammatory Breast Cancer.”

3. What are the 4 types of breast cancer? What are the signs, symptoms and causes?

“Advances in science have led to the identification of different subtypes of breast cancer. Simply put, all breast cancers are not the same. DCIS is a pre-invasive stage of breast cancer. Other histologies include Invasive Ductal Carcinoma, Invasive Lobular Carcinoma, and Phyllodes Tumour. In addition, some breast cancers are hormone-positive, some are HER2 positive, some triple positive and some triple negative. These markers are important in deciding the future treatment of breast cancer”, says Dr Dangi.

Dr Holla explains, “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 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. What are some common breast cancer treatments?

Dr Holla says, “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.”

To add to the point, Dr Dangi says, “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 whom the disease was locally advanced.”

5. What are some steps you can adopt to prevent breast cancer?

“Small lifestyle changes impact our everyday health in great ways. A few things that can be done are limiting alcohol consumption, avoiding smoking, keeping your weight in check, remaining physically active, breastfeeding your child, avoiding exposure to radiation and environmental pollution, and limited dose and duration of hormone therapy. Research has also shown that women who follow the Mediterranean diet including olive oil and nuts into their diet have a lesser chance of dealing with breast cancer. The Mediterranean diet involves a lot of fruits, vegetables, legumes, nuts and whole grains. There is no proof that wearing or not wearing bras cause cancer and one can always self-examine oneself to look for lumps, bumps, discolouration, irritation or any other abnormality and visit the doctor at the earliest”, advises Dr Holla.

Dr Dangi states, “Although the presence of certain unmodifiable risk factors such as female gender, age, genetic make-up and family history cannot completely reduce the risk of breast cancer to zero, there are modifiable risk factors for breast cancer which can be tackled to definitely reduce the risk. Obesity and physical inactivity are two of the most important risk factors for breast cancer. Controlling weight by regular physical activity has been shown to reduce the risk of breast cancer occurrence as well as recurrence in clinical trials. Eating healthy food and avoiding harmful habits like smoking and excessive alcohol intake also help reduce the risk. Continuing a healthy lifestyle and self-examinations can certainly help reduce the risk of developing this disease.”

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