1.Risk Factors, Diet and Lifestyle
The exact cause of breast cancer is not known. It has not been understood why one woman develops breast cancer and another doesn’t; and when a woman develops breast cancer, it is hard to pinpoint an exact cause. However, breast cancer is always caused by a damage to the cell’s DNA.
The environmental and lifestyle factors can be modified. Few examples are:
First of all, the person diagnosed with breast cancer should undergo a gene test. Especially, family members who are below 50 years of age should go for a gene test.
If the gene test is positive, then all the family members should undergo genetic counselling and genetic testing. In such a case of strong family history, precautions that need to be taken include a mammography every year with adjunct ultrasound and a clinical breast examination (CBE) to be done once every 6 months to detect early breast cancer.
If the gene test is positive, they should undergo genetic counselling for more directed (focused) preventive measures such as prophylactic surgery, etc.
They should also incorporate lifestyle changes with a healthy diet and exercise.
Most menopausal symptoms are treated without HRT. However, in few cases, where the symptoms are extreme, HRT can be given for short time periods. Extended duration of HRT, for more than 5 years, increases the risk of breast cancer.
Bra or underwired bra does not cause breast cancer. It is a myth.
You need to eat nutritional foods that are palatable while experiencing side effects of chemo and radiation. There are many ways to keep your body healthy common symptoms and ways you can address them through your diet:
Fatigue: Fatigue is the most common side effect of cancer treatment. Many factors cause fatigue, and fatigue may even linger after breast cancer treatment is completed. Nausea, hot flashes, stress and depression may all contribute to fatigue. Not getting enough food and nutrients because of treatment side effects can add to your fatigue.
Getting these nutrients from foods rather than from supplements is ideal, however, if you aren’t eating very much because of treatment side effects, ask your doctor about taking multivitamins.
2. Diagnosis of Breast Cancer
Digital mammography with tomosynthesis is by far the most efficient way to diagnose breast cancer. The conventional analogue mammogram, which is found in most clinics, has only 29% sensitivity and is more painful. A digital mammogram is 30% more sensitive than an analogue mammogram, but with an adjunct tomosynthesis, the sensitivity is as high as 75-80%. By additionally performing an ultrasound, the sensitivity increases to nearly 90-95%. Therefore, the imaging of choice is a digital mammography with tomosynthesis along with an adjunct ultrasound.
This is a painless investigation because the compression of a digital mammography is digitized (done by the machine) and so, very even pressure is provided. Also, the paddles are so designed to give least amount of pressure to the patient.
A woman should undergo mammography when she is around 40 years, as is the recommendation everywhere, and continue to get a mammography done once every year after the age of 40.
If there is a strong family history, then the mammogram should be done annually and ultrasound and clinical examination should be done once in every 6 months. In India, most breast cancers happen at a very early age, around 40-45 years, and it is therefore considered ideal for a woman in India to undergo screening with an ultrasound after 35 years of age.
Yes, it can be done during your periods. But, it is probably better to do it after the periods are over as the breasts become less lumpy and are more amenable to good mammographic diagnosis.
A woman should do a self-breast examination every month and get herself examined clinically by a doctor who is trained to perform a breast examination.
CBE should be performed by a doctor or a trained personnel only. Women in their 20’s and 30’s should get CBE done at least once in 3 years. Women above 30 years of age should get CBE done once in a year.
If a lump is detected, an Ultrasound would be advisable to investigate further.
3. Benign or Non-Cancerous Breast Lesions
No, all lumps are not always cancerous. Only 5% to 10% of the lumps can be cancerous. A lump could be a fibroid, a cyst or just a normal breast tissue, which is very lumpy just before the menstrual periods.
Granulomatous mastitis is a very common finding. We see about 4-5 patients every month with granulomatous mastitis and it is a very challenging condition to treat; but in at least 90% of patients, we get excellent results with just medication.
Very rarely can a benign lesion become cancerous. A fibroid or a simple cyst never becomes cancerous. A papilloma (benign condition of the breast) is the only condition of the breast, which is known to be a.
Tuberculosis (Tb) of the breast is seen very rarely. Granulomatous mastitis mimics tuberculosis but it is not treated as Tb.
Tb diagnosis is made when there is a chronic abscess (pus collection) and the pus, which is removed with a needle, actually shows tuberculi bacilli in it.
A fibroid is a of the breast, that is, non-cancerous tumour of the breast, and is very similar to the fibroid found in the uterus. It is a very common occurrence among young and middle-aged women.
If the fibroid is small, then no further treatment will be required. If it is a complex fibroid, then a needle biopsy/vacuum assisted biopsy will be considered.
4. Breast Cancer and its Stages
Yes. Breast cancers are in fact classified based on anatomical origin of the cancer or on the basis of molecular origins of the cancer. The cancers can be low grade or high grade and since not all cancers are the same, the treatment and thefor each type of breast cancer differs from one another.
5. Preventive Oncology/ Risk Reduction
A change in lifestyle can go a long way in reducing your risk of having breast cancer. Some risk factors of cancer can be reduced. Avoid a sedentary lifestyle and get involved in physical activities. Make an effort to consume a healthy diet.
Be aware of the changes in your breast by doing a self-breast examination every month and go to a doctor for an annual check-up/mammography. If you are in the higher risk category, consider genetic testing or prophylactic surgery.
Prophylactic surgery is done is done in a few selective cases that have a very high chance of acquiring breast cancer in their lifetime (for example, women with BRCA1/BRCA2 gene mutations with familial history of breast cancer), that is more than 85-90% lifetime risk.
The surgery could be in the form of surgical removal of one or both the breasts with immediate reconstruction and removal of both the ovaries and the fallopian tubes (if advised) or it could be just mastectomies (surgical removal of breast) with immediate reconstruction.
Breast cancer can be treated alone or in combination by surgery, chemotherapy (administering drugs) and radiotherapy. Since no two breast cancers are similar, the treatment modality will not be uniform for all women and will depend on various factors like age, family history, characteristics of the lesion etc.
If breast cancer occurs, then there is 80% chance that your breast will not be removed.
No. For cancerous lumps, an open excision of the breast lump may be necessary.
When you are going through chemotherapy and/or radiation the body’s immune system is depressed and cannot fight infections as before.
You can eat bananas since they have a thick protective skin. Apples, pears washed well and skin peeled can also be consumed.
Homemade orange, sweet lime and watermelon are allowed if made with utmost hygiene.
It is generally advisable to avoid public places during treatment. Please refrain from going to the market or the movies.
7. Breast Surgery
The most common type of simple breast surgery is the breast conservation surgery (BCS), which does not require reconstruction. The patient comes in the morning and goes by evening. There are no drains required in the early stage of breast cancer and the surgery is virtually painless because an extremely good local anaesthesia is given which covers the pain for 24 hours.
Later the pain is dulled and is taken care of by just minor painkillers. The patient will require a day’s rest at home before she is back to her routine work. So, she can start going out within two to three days of the surgery.
Women, who require minor breast surgeries with breast conservation, can come in the morning, have the surgery and go home by evening. They can have liquids 4 hours after their surgery, and can start having their snacks in another 6 hours, and by evening they can have a normal regular meal.
There is virtually no pain and the size and shape of the breasts are maintained. The patient will require a day’s rest at home before she can go back to her routine work. On the third day after surgery, the patient can actually start moving out of the house for small errands and small walks, etc. The patient can have a bath very next morning and they can resume work in about 5-6 days. Some patients of ours have also started to work after third day of surgery.
As such, there are not many restrictions after a breast surgery apart from those of a regular surgery elsewhere in the body.
Some of the ‘Do’s’ are: eat healthy, exercise regularly, especially the shoulder exercises as prescribed to you, wear a full support bra at least for a month.
Few ‘Dont’s’ are: refrain from lifting heavy weights, you may not be allowed to take a bath for 2 days immediately post-surgery.
After a breast conservation surgery, which is the most common surgery, the sensations are always maintained.
The woman will not be able to breastfeed from the breast from where the lump was excised because the breast will undergo radiation after surgery. She can breast feed from the other breast.
There are recommended physiotherapy exercises to minimize the swelling. In addition, breast clinics may be equipped with an automated limb compression machine, which can provide transient relief to the swollen arm if used on a regular basis.
One of the main improvements in the field of breast surgery has been the fact that axilla (armpit) is dealt with very differently today. This is apart from the fact that we are able to save the breast.
To understand its importance, a little background knowledge may be useful. Once breast cancer occurs, it can spread from the breast tissue through and spread to structures called lymph nodes which are present in the axilla. For example, when one has tonsillitis, we can feel nodes in the neck. These nodes are the lymph nodes which are part of our immune system and are present in many parts of the body. These nodes are like check points which will try to prevent the disease from spreading to other parts of the body. So, there us a probability of the tumour in the breast spreading to the axillary nodes.
In the past, women not only had to undergo mutilating breast surgeries or total mastectomies but also had to endure mutilating radical surgeries to remove all the nodes from the axilla.
As of today, there has been a sea of change in the recommendations for handling the axilla. There have been major studies to identify even a single node in the axilla, which is known as a sentinel node or the node which is the watchman of the axilla. So if that node is not affected by the tumour, it may be safely understood that the rest of the nodes will not be affected by the tumour.
Therefore, we have a procedure named as the sentinel node biopsy which is done during the same surgery on the breast. If the node is diagnosed as negative, it would mean that it has no disease and so the rest of the nodes will not have to be removed. Thus, this saves the woman from extensive surgery.
Yes, reconstruction of breast during mastectomy is done keeping in mind shape, size, symmetry and minimal scarring.
Yes. Chemotherapy may be given before the surgery when the size of the tumour is quite big to be operated upon. This is know as Neo-adjuvant chemotherapy (NACT). Chemotherapy reduces the size of the tumour and thus makes it easy to operate and remove.
Hair loss is a possible side effect. In about 50-60% of the patients, there is complete hair loss. But in the rest of the patients there might be just thinning of the hair or partial hair loss. This is the only side effect that we have not really been able to combat. But the positive aspect of the side effect is that within three months, after completion of chemotherapy, the hair grows back thicker.
The only side effect of chemotherapy as of today is the hair loss. Earlier, the known side effects of chemotherapy were nausea, vomiting, reduction of blood counts, infections and hair loss. However, currently, chemotherapy has improved and is extremely safe and so, the side effects have reduced.
Nausea and vomiting are non-existent side effects in the present day scenario due to the availability of better drugs which combat vomiting. In the past, burning pain, prostration, feeling weak, etc., were all side effects of chemotherapy. Today, these symptoms do not exist, making women very comfortable.
There are a lot of myths about chemotherapy. Chemotherapy has improved leaps and bounds and the drugs are much easier to tolerate. They are better tolerated as the drugs are targeted (it only affects the cancer cells and not the normal cells).
Patients don’t need hospitalization for chemotherapy or Herceptin or hormone therapy. Internationally, it is recommended that chemotherapy be administered in a day care facility. Day care should be away from the major hospitals, which handle a lot of general elements such as infections, etc. Therefore, a stand-alone day care is probably one of the best ways to provide for chemotherapy because the risk of developing hospital-acquired infections is lesser. Proficient Day Care facilities will provide chemotherapy within 5 hours. Most of the regimes discussed here will require less than 5 hours.
Tamoxifen is an anti-drug taken twice a day and it helps to combat breast cancer which is hormone positive. The side effects of Tamoxifen are:
HER2 enriched breast cancer or HER2 positive breast cancer is a type of breast cancer. HER2 is another antigen or a special protein in the tumour cells and scientists have been able to find out antibodies against this antigen which is known as Herceptin.
Typically, the radiation regimes are given over 5 days, 15 days or 25 days. It takes only a few seconds to give radiotherapy. However, in a busy radiation department, the waiting time may be about 15 minutes to half an hour. The patient does not need hospitalization for radiation therapy. Radiation therapy today is extremely safe with no side effects.
There are no side effects of radiotherapy if done by well-trained radiologists.
11. Counselling and Support
The role of counselling and support groups is very important. Since the 1970s, there has been enough data and work by McGuire to suggest that support groups and counselling improve the survival as well as the effect of the treatment.
At Orchids, we have a very active support group of patients and breast cancer survivors. For more information, contact your clinician or staff at Orchids.
Caregivers can be parents, partners or spouses, adult children, friends or neighbors. Being a caregiver can be enriching and also a difficult experience for the giver and the receiver. Cancer can affect the quality of life of caregivers, causing psychological distress. Some caregivers set aside their own needs to help the other person. They may think it’s selfish to pay attention to their own wellbeing. But ignoring self-care can cause stress or burnout, which may trigger guilt, anger, resentment or depression. Patient and caregiver emotional distress is evident in each phase of illness, but is greater in some phases (diagnosis) than others (survivorship). An important first step is to assess the needs of family caregivers to assist them in reducing their emotional distress. The ultimate goal is for caregivers to continue to be effective caregivers without compromising their own health and wellbeing. At Orchids, we have counselors that offer counselling and engagement with patients and their caregivers, ensuring healthier patients and their caregivers.