Breast cancer is the most common cancer in females worldwide representing almost 25% of all cancers in women. Even though it is 100 times more common in women, men are also at risk of harboring breast cancer. It is responsible for approximately 15% of all cancer-related deaths in women.
A staggering number of women are susceptible to this form of cancer and unfortunately, the incidence in developing countries is on the rise in recent times. One in every 29 females develops breast cancer in India.
It is the second most common cancer among women in India and accounts for 7% of the global burden of breast cancer and one-fifth of all cancers among women in India.
Epidemiological studies have shown that the global burden of BC is expected to cross almost 2 million by the year 2030. The incidence of breast cancer is approximately three times higher in urban areas compared to rural areas.
The age-standardized incidence rates vary between 9 and 32 per 100,000 women. An increasing trend in the incidence rates of breast cancer has been reported from the various registries of the National Cancer Registry Project.
Breast cancer is emerging as a major concern in female populations of the Kashmir Valley with its incidence showing an increasing trend.
According to the latest figures revealed by the Regional Cancer Center at the Sheri Kashmir Institute of Medical Sciences (SKIMS) Soura, a total of 4,737 cancer cases were reported in the year 2021, up from 3,840 cases of cancer in 2020.
Experts say that lung cancer is more common in men due to smoking, poor diet, lack of physical activity, and other things, while breast cancer is more common in females.
According to the Regional Cancer Center, breast cancer is not limited to married women only but is becoming more common among unmarried young women. Breast cancer occurs in 0.5 to 1% of men as well, according to the experts.
Signs and symptoms of breast cancer
Some warning signs of breast cancer are
New lump in the breast or underarm (armpit).
Thickening or swelling of part of the breast.
Irritation or dimpling of breast skin.
Redness or flaky skin in the nipple area or the breast.
Pulling in the nipple or pain in the nipple area.
Nipple discharge other than breast milk, including blood.
Any change in the size or shape of the breast.
Pain in any area of the breast.
Risk factors of Breast Cancer
Getting older. The risk for breast cancer increases with age. Most breast cancers are diagnosed after age of 50.
Genetic mutations. Women who have inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2, are at higher risk of breast and ovarian cancer.
Reproductive history. Starting menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.
Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
Family history of breast or ovarian cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who has had breast or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (for instance; treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.
Hormonal therapy or oral contraceptives: Oral contraceptives develop a higher threat of breast cancer, but only very slightly. Once a woman puts an end to oral contraceptives, the risk moderately decreases over the next 10 years as compared to that for other women of the same age. Women having hormonal therapy after menopause, for a few or many years, are on the verge of developing breast cancer. Further, there has not been an increase in the risk if estrogen is taken alone.
Being overweight or having obesity after menopause. Older women who are overweight or have obesity have a higher risk of getting breast cancer than those at a normal weight.
Reproductive history. Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk.
Drinking alcohol. Studies show that a woman’s risk for breast cancer increases with the more alcohol she consumes.
Breast cancer detection and diagnosis
Various screening techniques are used to detect and diagnose breast cancer. Some of them are mentioned here:
Breast self-examination: Self-examination is a simple and entirely safe method of detecting changes in your breasts. It is important to do this regularly to be aware of your ‘normal’ breasts and therefore to detect changes at an early stage. Early detection nearly always leads to less invasive treatments and better outcomes as cancer can be treated sooner. An individual should have familiarity with breast size, texture, cyclic changes, etc. The altered features in breast cancer include the formation of a lump in the breast, armpits with swollen lymph nodes, bloody or transparent fluid from the nipple, nipple inversion, presence of scales on the nipple, and nipple associated with pain, discomfort, or pain, etc. There can be a change in skin texture, attributed to the inflammation. Similarly, metastatic breast cancer is also associated with weight loss, bone strain, difficulty in taking a breath, loss of appetite, headaches, neurological pain or numbness, etc.
Mammogram: Mammography is a type of x-ray examination used to examine the breasts. This type of imaging involves exposing the breasts to a small amount of ionizing radiation to obtain pictures of the inside of the breasts
Breast ultrasound: Breast ultrasound uses sound waves to create pictures of the inside of the breasts. Breast ultrasound can capture images of areas of the breast that may be difficult to see with mammography. It can also help to determine whether a breast lump is a solid mass or a cyst.
Breast MRI: During breast MRI, a powerful magnetic field, radio frequency pulses and a computer will be used to produce detailed pictures of the inside of the breasts. MRI helps evaluate breast lumps that are not visible with mammography or ultrasound, particularly in women with dense breast tissue.
PET/CT: This type of nuclear imaging combines PET scans and CT scans to provide images that pinpoint the anatomic location of abnormal metabolic activity within the breasts. It can detect breast cancer, determine if it has spread, assess the effectiveness of a treatment plan, and determine if cancer has returned after treatment.
Scintimammography: This imaging test, also known as nuclear medicine breast imaging, may be used to investigate a breast abnormality that has been discovered on mammography. The procedure is noninvasive and involves the injection of a radiotracer or drug that emits radioactivity, into the patient. Because the radiotracer accumulates differently in different kinds of tissue, it can help physicians determine whether cancer could be present, thus helping determine whether a biopsy or additional follow-up is necessary. While it is not a primary screening tool and does not replace mammography, some physicians have used it as an additional tool in women who are at elevated risk for breast cancer but cannot undergo MRI screening.
Biopsy: If these tests do not clearly show that the lump is benign, a biopsy may be necessary. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. There are different types of biopsies, classified by the technique and/or size of the needle used to collect the tissue sample.
Fine needle aspiration biopsy: This type of biopsy uses a thin needle to remove a small sample of cells.
Core needle biopsy: This type of biopsy uses a wider needle to remove a larger sample of tissue. This is usually the preferred biopsy technique. If a tumor is identified, the cancer biomarkers, such as hormone receptor status (ER, PR) and HER2 status, will be tested to help guide treatment options. Local anesthesia, which is medication to block pain, is used to lessen the patient’s discomfort during the procedure.
Surgical biopsy: This type of biopsy removes the largest amount of tissue. Because surgery is best done after a cancer diagnosis has been made, a surgical biopsy is usually not the recommended way to diagnose breast cancer. Most often, non-surgical core needle biopsies are recommended to diagnose breast cancer to limit the amount of tissue removed. Since many people who are recommended to undergo breast biopsy are not diagnosed with cancer, using a needle biopsy for diagnosis reduces the number of people who have surgery unnecessarily.
Image-guided biopsy: During this procedure, a needle is guided to the location of the mass or calcifications with the help of an imaging technique, such as mammography, ultrasound, or MRI. These are usually core needle biopsies, but they can also be fine needle aspiration biopsies.
Sentinel lymph node biopsy. When cancer spreads through the lymphatic system, the lymph node or group of lymph nodes cancer reaches first is called the “sentinel” lymph node. In breast cancer, these are usually the lymph nodes under the arms called the axillary lymph nodes. The sentinel lymph node biopsy procedure is a way to find out if there is cancer in the lymph nodes near the breast.
Taking the above into consideration, one can have an awareness regarding breast cancer and thus can help in the prevention or early detection of the disease. Breast cancer is a threatening disease that needs to get attention from everyone, so that we may win the battle against this dreadful disease.
Dr Manzoor Ahmad Mir, Senior Assistant Professor, Coordinator/Head, Department of Bioresources, School of Biological Sciences, University of Kashmir and can be reached at: [email protected].
