Every October, your timelines are painted pink with people and organisations generating awareness about breast cancer in the country and the world. However, even with all the talk about the disease, how is it that women are still getting diagnosed in the later stages of the illness?
According to the National Institute of Cancer Prevention and Research, for every two women diagnosed with breast cancer in India, one woman dies of it. It is also the number one cancer to affect women.
Talking exclusively to POPxo, Dr Nanda Rajneesh, Breast and Obesity Surgeon at Sakra World Hospital said, "Worldwide CA breast incidence is 11.5% of all cancers equivocal to lung CA. In India, 28% of women have breast cancer. Every woman has a 2-3% risk of developing breast cancer, which rises to 8-10% for those with a family history of cancer. According to 2018 statistics, the western world has about 70% of breast cancers detected in the early stage and 10% in metastatic stage. In India, only 20% are detected in the early stage, while 50% are locally advanced and 25% are metastatic at diagnosis. Regarding mortality, a huge disparity can be seen. Out of the 26% incidence of CA, breast mortality in India is 12% compared to 6% in the USA and this is due to early screening and detection."
The statistics speak for themselves and the main reason for this disparity between India's numbers and USA's is that there still isn't enough awareness about the illness and hence, it usually gets detected too late. So this breast cancer awareness month, we're here to break down the treatment options for breast cancer and how can one prevent it.
According to Dr Dilip Kumar Kar, Surgical Oncologist at BR Life Kalinga Hospital the treatment options are basically three - surgery, chemotherapy, and radiation therapy. Talking to POPxo, he said, "Surgery is the main treatment for stage I breast cancer. These cancers can be treated with the procedures like Lumpectomy for the removal of a smaller tumour. Mastectomy (removing the entire breast) is the removal of a limited number of lymph nodes (sentinel node biopsy) and removal of several lymph nodes (axillary lymph node dissection). In chemotherapy, the drugs are used to destroy fast-growing cancer cells. When cancer has a higher risk of spreading to another part of the body or has the risk of reoccurrence chemotherapy is suggested. Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells. This also lowers the chance of cancer coming back in the breast. External beam radiation of the whole breast is commonly used after a lumpectomy to lower the risk of reoccurrence of breast cancer."
There are also other forms of treatment available in India, and we'll break them down for you.
This type of treatment actually strengthens your body's immune system and equips it to fight cancer better. While chemotherapy directly fights the cancer cells, biological therapy strengthens the body's system to fight it itself.
The sentinel node biopsy is a process that eliminates a partial number of lymph nodes to decide whether cancer has spread to your lymph nodes. The surgeon will discuss the role of eliminating the lymph nodes which will get the lymph drainage from the patient's growth.
Hormone therapy uses drugs to avoid hormones, particularly estrogen, to enhance the development of breast cancer cells. It is usually prescribed after surgery but can be used before it as well. It is a neoadjustive therapy and can last up to five years. The side effects can be hot flashes and vaginal dryness.
Targeted drugs are designed to attack the exact abnormality in the cancer cell. These can include Pertuzumab, Lapatinib, Ado-trastuzumab. These can be used after chemotherapy and radiation as the doctor sees the best course of action to fight the cancer cells once and for all.
Typically, breast reconstruction takes place during or soon after mastectomy and even sometimes lumpectomy. During reconstruction, only the part where the breast cancer has started to grow in a place where the mastectomy missed is removed.
Some women with cancer in one breast may decide to get both the breasts, even the healthy one removed (contralateral prophylactic mastectomy). This is done if they have a higher chance of getting breast cancer in the other too as a part of their genetic disposition or if they have a strong family history.
Dr Rajneesh says, "There is a trend of lifestyle-related disorders in the world now. Colon cancer, lung and breast cancers are among the lifestyle cancers. Smoking, obesity, lack of exercise, sedentary lifestyle, chemical and preservative ingestion, consumption of more and more processed foods lead to these. We can prevent it by adopting a healthy lifestyle and a proper awareness of breastfeeding, breast examination, and breast care. It is important to seek immediate medical care when minor symptoms are noticed in the prevention of breast cancer. Awareness about the available diagnostic and treatment options are also crucial."
Because it is a lifestyle disease, some of the changes in daily life can help one prevent breast cancer.
Keeping weight in check is essential to prevent many diseases including heart, cholesterol etc. Being overweight can increase the risk of many types of cancers including breast, especially after menopause.
A sendatory lifestyle can again lead to being at the risk of lifelong illnesses. Women who are physically active for at least 30 minutes in a day are at a lower risk of breast cancer. Regular exercise also ties in with keeping the weight in check and together they can help one prevent breast cancer.
A well balanced and nutritious diet can also reduce the risk of breast cancer. Eating fruits and incorporating different vegetables into your diet can go a long way. Studies say that a high intake of alcohol also needs to be curbed in order to prevent breast cancer.
Breastfeeding for a total of one year or more (combined for all children) reduces the risk of breast cancer. Apart from that, it also has great health benefits for the child.
Smokers and non-smokers alike know the harmful effects of smoking and increasing your risk of heart desease, stroke, and at least fifteen types of cancers- including breast cancer.
Women who have a strong family history of breast cancer need to take special steps to protect themselves. One may be at a higher risk if one's mother or sister developed breast or ovarian cancer, or even if males developed prostate cancer.
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Dr Dilip Kumar Kar says breast self-examination is the key to prevention in India. Talking to us, he said, "Breast self-examination is the best way of prevention in India. Breast self-exam is an important way through which one can detect early signs of breast cancer. It is a technique which is convenient, free of cost and can be conducted by women of all age groups. In India, Sonography is more cost-effective than Mammography, any small nodule/lump in a woman should be evaluated by Sonography and FNAC (Fine Needle Aspiration Cytology) without any delay. The home test is nothing but, educating people on “how to do breast self-examination at home. This should be done 7 days after the menstrual cycle, especially after the age of 30."
Dr Rajneesh says, "Breast cancer home test is a major part in primary prevention. It has the ability to detect 60% of the lumps. Every woman should do Self-Breast Examination on a monthly basis. Women after 40s should do an annual mammography test which helps in detection of small lumps and cancers in early stages."
Step One: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. You should try and see if your breasts are their usual size, shape and colour and if they are both evenly shaped without any distortion or swelling. If you see puckering, dimpling or bulging of the skin or if a nipple has changed position or has become inverted then bring it to a doctor's attention.
Step Two: Raise your arms and look for the same changes.
Step Three: While looking into the mirror also keep an eye for any signs of fluid coming out of one or both nipples. This is usually watery, milky, or a yellow fluid or could even be bloody.
Step Four: Feel your breasts while lying down and use the opposite hand for each breast (right hand for left breast and left for the right one.) Use a firm, smooth touch with the first few fingers, keeping them flat and together. Use a circular motion too, about the size of a coin. Cover your entire breast from top to bottom- from the collarbone to the top of your abdomen and from your armpit to your cleavage.
Step Five: Lastly, feel your breasts while you are standing or sitting. Many women like to do this step in the shower as they find it to be the easiest way to feel their breasts. Cover the entire breast and use the same circular motions and firm motions used in step four.
Dr Rajneesh again stresses the importance of a self-examination saying, "Breast cancer is curable by early identification and it can be done at home. A simple self-breast examination can be done every month which helps in identifying lumps, discharge, etc. helping pts seek medical attention in early stages. It enables to cure with minimal suffering and better longevity."
What is mastectomy and what are the types?
Mastectomy is the removal of the breast tissue completely from the chest wall. It is one of the surgical procedures for women with breast cancer. With a mastectomy, the recurring of breast cancer is contained.
Based on the types of cancer, here are the different types of mastectomy:
Simple Mastectomy: It includes the removal of the entire breast, including the nipple, but excluding the lymph nodes and muscle tissues.
Modified Radical Mastectomy: It is a variation of the total mastectomy, which includes removal of the entire breast including the lymph nodes under the arm.
Mastectomy with Immediate Reconstruction: In this process, both the mastectomy and reconstructive surgery of the breast takes place at the same time. It usually involves breast cancer surgeon, oncology treatment team, and a plastic surgeon to reconstruct the breast.
Subcutaneous Mastectomy with Implant Reconstruction: The pathological breast tissue is removed through the lower incision from the prepectoral space and implanted with silicone in the retropectoral space through the axillary approach.
How painful is it?
Doctor Rajneesh: "Mastectomy is surgery on the chest wall, a superficial part of the body. Pain is less if surgery is done by an expert with good skills and knowledge. When remove the breast from the chest wall, we also remove facia on pectoral muscle. During this course, if you damage the muscle fibres, pain can become very severe. Placement of the drain can cause little pain which cannot be avoided. With good coverage of painkillers, the patient can be very active and take care of themselves."
How do women deal with no breasts post-surgery?
Doctor Rajneesh: "As far as the physical appearance is concerned, they can use local removable silicone implants. Sometimes they opt either for immediate or late reconstruction."
What are the alternatives to mastectomy?
Doctor Rajneesh: "As such breast oncosurgeons are trained in oncoplastic breast surgery. When indicated, after mastectomy they can perform immediate or delayed reconstruction that can give a feeling of normalcy."
Does having no breasts affect the physical intimacy of a woman with her partner?
Doctor Rajneesh: "The relationship between partners changes given the course of such diseases. They tend to care for the need of the patients which eventually brings them closer. Physical intimacy may be affected during treatment but not once it’s over."
So this breast cancer awareness month, let's take a pledge and take better care of our boobs, cause they deserve it!
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