Breast Cancer

The presence of any of the following conditions or criteria increases your chance of developing breast cancer:

• Age
  Incidence of breast cancer is found to be higher in women who are more than 45 years of age. Breast cancer incidence is extremely low below the age of 20 years and after 90 years.
• Sex
  Breast Cancer is more common in females. Incidence of the disease in males is negligibly low.
• Breast cancer in the family
  The chance of developing breast cancer increases if the individual’s mother, sister, or a first-degree relative has the disease. Breast cancer occurs more commonly in women with a family history of breast cancer than in the general population.
• Geographical factors
  Breast cancer occurs commonly in the Western world. In developing countries like India, the number of Breast Cancer cases is lower than in the Western world, but nevertheless, those are on the rise and need medical care and attention.
• Diet
  Because breast cancer so commonly affects women in the developed world, dietary factors may play a part in its causation. Excessive intake of alcohol is known to increase the risk of breast cancer. Research has shown that a high-fat is indirectly related to a higher incidence of breast cancers.
• History of irradiation exposure
  Women aged between 10 and 30 who were exposed to chest irradiation before have a higher chance of developing Breast Cancer.
• Previous history of breast disease
  If you previously suffered from any medical condition involving your breast, your risk of developing breast cancer is higher. The benign conditions of the breast having metastatic potential are moderate hyperplasia, atypical ductal or lobular hyperplasia, solitary papilloma of lactiferous sinus, and radial scar lesion.
• Genetic factors
  Mutations in tumour suppressor genes such as BRCA1, BRCA2, TP53, and CHEK2 lead to the development of breast cancer. Also, patients suffering from hereditary syndromes like Li Fraumeni syndrome, cowden's syndrome, HNPCC syndrome, Peutz-Jeghers syndrome, and Ataxia telangiectasia are prone to develop Breast Cancer.
• Hormonal factors (hyperestrogenism is the risk factor)
  Early menarche, late menopause, first full-term pregnancy > 30 years, nulliparity, obesity all are risk factors predisposing Breast Cancer.
• Hormone replacement therapy
  Patients in high-risk groups should take hormone replacement therapy with precaution as it is supposed to increase the risk of developing Breast Cancer. It has also been found that hormone replacement therapy worsens the symptoms of some benign breast conditions such as cysts and causes hindrance in their diagnosis.

Like many other malignancies, if we wait for significant symptoms to arise, the disease may already have advanced to a dangerous level. It is, therefore, important for females to stay acquainted and vigilant at all times and perform a self-breast exam every month or so.

Symptoms suggesting breast cancer:

• Lump in the breast: While most of the swellings and lumps in the breast are benign, patients must consult a healthcare professional to get it evaluated if they suspect a lump at any time.
• Blood or discharge from the nipple.
• Any change in the shape and configuration of the breast tissue.
• Indrawing of the nipple.

If you suspect experiencing any of the symptoms mentioned above while also having a risk factor for breast cancer, you should visit a Breast Cancer Centre immediately and undergo the necessary screening and other laboratory tests. Remember that "Prevention is better than cure."

Breast cancer staging according to TNM (tumour-node-metastasis) or UICC (Union Internationale Contre le Cancer) criteria was used more often before. Still, as we gain more knowledge of the biological variables that affect breast cancer prognosis, patients are classified according to the treatment they require.

• Group 1
  Very “low-risk” primary Breast Cancer. For example, screen-detected DCIS. Such cases are treated locally.
• Group 2
  “Low-risk” primary breast cancer: For example, lymph node-negative cancer with favourable histology. Locoregional with/without systemic treatment is assigned for such cases.
• Group 3
  “High-risk” primary breast cancer: Lymph node-positive or unfavourable histology cases. Locoregional with systemic treatment is required for such patients.
• Group 4
  Locally advanced breast cancer. Primary systemic treatment is required.
• Group 5
  Metastatic carcinoma. A primary systemic approach is required.

• Ductal carcinoma
  This is the most common type of Breast Cancer. It is the abnormal proliferation of cells inside a milk duct. It is not aggressive; the chances of spreading are low.
• Lobular carcinoma
  It is the second most common type of Breast Cancer. It is usually bilateral. It is further divided into subtypes, with the pleomorphic variant being the most aggressive one.
• Inflammatory carcinoma
  It is highly aggressive breast cancer, but it is rare. Patients present with painful swelling of the breast with cutaneous oedema. It happens due to obstruction of lymphatic vessels beneath the skin of the breast.

Because the prognosis of breast cancer is closely related to the stage at diagnosis, a population screening programme that detects tumours before they come to the patients’ notice reduces mortality from breast cancer. It has been found that breast cancer screening by mammography in women above the age of 50 will reduce cause-specific mortality by up to 30 per cent. Patients are encouraged to do a self-examination of the breasts every month and undergo a clinical breast examination every 1-3 years after 25 years of age. Specific imaging screening guidelines:

• Average-risk asymptomatic women Start screening at age 40 by undergoing an annual mammogram
• High-risk women Start screening at age 25 with an annual mammogram + MRI
• Asymptomatic women with previously treated breast cancer Annual mammogram is recommended.

There are no specific guidelines for lactating patients or patients with breast augmented surgery.

• Early age at first pregnancy
• Multiparity
• Breastfeeding
• Oophorectomy

Early age of first pregnancy, breastfeeding, and multiparity are protective factors Breast Cancer. This is due to a reduction in the overall number of ovulatory cycles, thereby reducing the duration of oestrogens action on the breast tissue

We provide the best Breast Cancer treatment in Navi Mumbai. We understand that the treatment of breast diseases, especially Breast Cancer, needs good doctor-patient communication. Patients are often anxious, and it is important to consider their decisions and inputs while determining the best treatment modality suited to their condition. In our Breast Cancer Centre, the care of Breast Cancer patients is undertaken as a joint venture between the surgeon, medical oncologist, radiotherapist and allied health professionals such as staff nurse specialists. This approach proves beneficial to alleviate the patient’s anxiety and ensure a better outcome. The goal of the Breast Cancer treatment in Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai is to limit its spread as little as possible — both locally and distant metastatic spread. Early breast cancer is usually treated with surgery with or without radiotherapy. If your breast cancer has spread to the adjacent lymph nodes, systemic therapy such as chemotherapy or hormone therapy is added. On the other hand, locally advanced or metastatic disease is locally treated by systemic therapy to palate symptoms, with surgery playing a much smaller role.

Surgery holds a major role in the management of Breast Cancer. Breast surgeries of many types are performed in Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai — such as segmental mastectomy, lumpectomy, partial mastectomy, wide local excision, and tylectomy. Depending upon the stage of Breast Cancer and associated factors, the healthcare team decides the breast surgery modality for the patient.

• Tylectomy Excision of lump
• Simple mastectomy Palpable extent of breast + nipple-areola complex + overlying skin
• Subcutaneous mastectomy Palpable extent of the breast without overlying skin
• Total mastectomy All breast tissue + nipple-areola complex + skin
• Extended simple mastectomy Simple mastectomy + removal of level 1 axillary lymph nodes
• Modified radical mastectomy entire breast tissue + nipple-areola complex + skin + axillary lymph nodes (levels 1 + 2 +3)
• Halsted’s radical mastectomy Entire breast tissue + nipple-areola complex skin + levels 1+2+3 axillary lymph nodes + pectoralis major and minor

According to statistics, breast cancer patients have an increased risk of recurrence and dissemination, so they need to be followed up for life. Yearly or two-yearly mammography of the treated and contralateral breast is recommended. Other than mammography, repeated measurements of tumour markers and other diagnostic imaging tests have no role.