Breast cancer is a global disease. Though the majority of underlying causes and other features are usually uniform around the world, every region has its own uniqueness for that cancer. Breast cancer has ranked number one cancer among Indian females with age adjusted rate as high as 25.8 per 100,000 women and mortality 12.7 per 100,000 women. Mortality-to-incidence ratio was found to be as high as 66 in rural registries whereas as low as 8 in urban registries. Rising numbers of cases of breast cancer in India and especially increasing incidence of BC in younger age groups. Most of them have late presentation: due to Lack of awareness and Screening:
Better health awareness and availability of breast cancer screening programmes and treatment facilities would cause a favorable and positive clinical picture in the country.
- Know your risk
■ Talk to your family to learn about your family health history
■ Talk to your doctor about your personal risk of breast cancer
- Know general breast cancer risk
The main factors that influence your breast cancer risk are being a woman and getting older.
Other risk factors include—
- Changes in breast cancer-related genes (BRCA1 or BRCA2).
- Having your first menstrual period before age 12.
- Never giving birth, or being older when your first child is born.
- Starting menopause after age 55.
- Taking hormones to replace missing estrogen and progesterone in menopause for more than five years.
- Taking oral contraceptives (birth control pills).
- A personal history of breast cancer, dense breasts, or some other breast problems.
- A family history of breast cancer (parent, sibling, or child).
- Getting radiation therapy to the breast or chest.
- Being overweight, especially after menopause.
- Get screened
■ Ask your doctor which screening tests are right for you if you are at a higher risk
■ Have a mammogram every year starting at age 40 if you are at average risk
■ Have a clinical breast exam at least every 3 years starting at age 20, and every year starting at age 40
- Know what is normal for you
■ See your health care provider if you notice any of these breast changes:
- Lump, hard knot or thickening inside the breast or underarm area
- Swelling, warmth, redness or darkening of the breast
- Change in the size or shape of the breast
- Dimpling or puckering of the skin
- Itchy, scaly sore or rash on the nipple
- Pulling in of your nipple or other parts of the breast
- Nipple discharge that starts suddenly
- New pain in one spot that doesn’t go away
- Make healthy lifestyle choices
■ Maintain a healthy weight
■ Add exercise into your routine
■ Limit alcohol intake
■ Limit menopausal hormone use
■ Breastfeed, if you can
- WHAT CAN I DO TO REDUCE MY RISK OF BREAST CANCER?
Many factors can influence your breast cancer risk, and most women who develop breast cancer do not have any known risk factors or a history of the disease in their families. However, you can help lower your risk of breast cancer in the following ways—
Keep a healthy weight.
Exercise regularly (at least four hours a week).
Don’t drink alcohol, or limit alcoholic drinks to no more than one per day.
Avoid exposure to chemicals that can cause cancer (carcinogens).
Try to reduce your exposure to radiation during medical tests like mammograms, X-rays, CT scans, and PET scans.
If you are taking, or have been told to take, hormone replacement therapy or oral contraceptives (birth control pills), ask your doctor about the risks and find out if it is right for you.
Breastfeed your babies, if possible.
Breast Cancer: Treatment Options
In cancer care, doctors specializing in different areas of cancer treatment—such as surgery, radiation oncology, and medical oncology—work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others. Ask the doctor in charge of your treatment which health care professionals will be part of your treatment team and what they do. This can change over time as your health care needs change.
A treatment plan is a summary of your cancer and the planned cancer treatment. It is meant to give basic information about your medical history to any doctors who will care for you during your lifetime.
The biology and behavior of breast cancer affects the treatment plan. Some tumors are smaller but grow fast, while others are larger and grow slowly. Treatment options and recommendations are very personalized and depend on several factors, including:
- The tumor’s subtype, including hormone receptor status (ER, PR) and HER2 status
- Thestage of the tumor
- Genomic markers, such as Oncotype DX™ (if appropriate)
- The patient’s age, general health, menopausal status, and preferences
- The presence of known mutations in inherited breast cancer genes, such as BRCA1or BRCA2
Even though the breast cancer care team will specifically tailor the treatment for each patient and the breast cancer, there are some general steps for treating early-stage and locally advanced breast cancer.
For both DCIS and early-stage invasive breast cancer, doctors generally recommend surgery to remove the tumor. To make sure that the entire tumor is removed, the surgeon will also remove a small area of healthy tissue around the tumor. Although the goal of surgery is to remove all of the visible cancer, microscopic cells can be left behind, either in the breast or elsewhere. In some situations, this means that another surgery could be needed to remove remaining cancer cells.
For larger cancers, or those that are growing more quickly, doctors may recommend systemic treatment with chemotherapy or hormonal therapy before surgery, called neoadjuvant therapy. There may be several benefits to having other treatments before surgery:
- Women who may have needed a mastectomy could have breast-conserving surgery (lumpectomy) if the tumor shrinks before surgery.
- Surgery may be easier to perform.
- Your doctor may find out if certain treatments work well for the cancer.
- Women may also be able to try a new treatment through a clinical trial.
After surgery, the next step in managing early-stage breast cancer is to lower the risk of recurrence and to get rid of any remaining cancer cells. These cancer cells are undetectable but are believed to be responsible for recurrences of cancer as they can grow over time. Treatment given after surgery is called adjuvant therapy. Adjuvant therapies may include radiation therapy, chemotherapy, targeted therapy, and/or hormonal therapy (see below for more information on each of these treatments).
Whether adjuvant therapy is needed depends on the chance that any cancer cells remain in the breast or the body and the chance that a specific treatment will work to treat the cancer. Although adjuvant therapy lowers the risk of recurrence, it does not completely get rid of the risk.
Along with staging, other tools can help estimate prognosis and help you and your doctor make decisions about adjuvant therapy. This includes tests that can predict the risk of recurrence by testing your tumor tissue (such as Oncotype Dx™). Such tests may also help your doctor better understand the risks from the cancer and whether chemotherapy will help reduce those risks.
When surgery to remove the cancer is not possible, it is called inoperable. The doctor will then recommend treating the cancer in other ways. Chemotherapy, targeted therapy, radiation therapy, and/or hormonal therapy may be given to shrink the cancer.
For recurrent cancer, treatment options depend on how the cancer was first treated and the characteristics of the cancer mentioned above, such as ER, PR, and HER2.
Descriptions of the most common treatment options for early-stage and locally advanced breast cancer are listed below. Your care plan should also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. It is also important to check with your health insurance company before any treatment begins to make sure it is covered.
People older than 65 may benefit from having a geriatric assessment before planning treatment.
You might also want to get a second opinion. This can give you more information and help you feel more certain about the treatment plan you choose. If you aren’t sure where to go for a second opinion, ask your doctor for help.
Thinking about taking part in a clinical trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they are not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
Choosing to stop treatment or choosing no treatment at all
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons people might choose to not get cancer treatment, but it’s important to talk to your doctors and make that decision. Remember that even if you choose not to treat the cancer, you can still get
Help getting through breast cancer treatment
Your cancer care team will be your first source of information and support, but there are many places you can get more help if you need it. Hospital- or clinic-based support services are an important part of your care. These might include nurse or social work services, financial aid, nutritional advice, rehab, or spiritual help.