Breast cancer is the most common cancer and the fifth leading cause of cancer-related deaths worldwide, according to GLOBOCAN 2020 data. The incidence and mortality rates for both sexes are notably high in Asia, at 45.4% and 50.5%, respectively. In India, breast cancer is the most common cancer among women, and its prevalence is expected to increase by 2025. In Nagaland, it ranks as the second most common cancer and the second leading cause of cancer-related deaths in women. Despite this, the screening rates for women aged 30-49 in the state remain alarmingly low, at just 0.3%.
Today, both men and women can be diagnosed with breast cancer, although the majority of cases are still found in women.
Causes and risk factors of breast cancer
The most common cause of breast cancer is prolonged exposure to hormones like estrogen and progesterone, which stimulate breast cells to grow. Long-term exposure, such as through prolonged menstrual cycles, increases the risk. Early menarche (before age 10) and late menopause (after age 54) are factors that increase the number of menstrual cycles, thus increasing the risk. Other risk factors include the use of oral contraceptive pills (OCPs), not breastfeeding, obesity, lack of exercise, smoking, alcohol use, late childbirth (after age 35), and genetic mutations.
Genetic mutations, like BRCA, are abnormal DNA changes that can be inherited. The BRCA mutation is strongly linked to breast cancer and can also cause ovarian, prostate, and pancreatic cancers. Public figures like Angelina Jolie and Manisha Koirala have brought attention to this mutation; Jolie opted for preventive surgeries, while Koirala was treated for Stage IV ovarian cancer and remains cancer-free.
Signs and symptoms of breast cancer: The most common symptom of breast cancer is a lump in the breast. Other associated symptoms may include skin changes in the breast, pain in the breast, nipple discharge, nipple edema, swelling in the axillary (armpit) region, skin dimpling, and nipple retraction. However, the earliest sign and symptom of breast cancer is typically a lump in the breast, which is why monthly self-breast examinations are recommended. If the disease spreads to other parts of the body, it will manifest as symptoms related to the affected organ.
Diagnosis: Cancer is always confirmed with a biopsy. Not all breast lumps are cancerous; some lumps, such as fibroadenomas, are benign and often occur in younger individuals. To determine the stage of the disease, imaging or scanning is done. Mammography is recommended for those over 40 years old, while ultrasound of the breast is suggested for those under 40.
Types of breast cancer: Breast cancer has different types. There are hormone receptors, that is Estrogen Receptor (ER) or Progesterone Receptor (PR) and protein reception (Her 2 neu). A person diagnosed with breast cancer have be either hormone positive, or protein positive or positive for both or negative for all three (which is also known as ‘Triple-negative breast cancer’).
Staging and treatment of breast cancer: Stage I breast cancer is confined to the breast. Stage II cancer may have spread to nearby lymph nodes. Stage III cancer has spread to nearby tissues and lymph nodes. Stage IV cancer has spread to other organs like the lungs, liver, or bones.
Local treatment includes surgery and radiation therapy. Radiation involves directing X-rays to cancer cells using machines like linear accelerators. Systemic therapy includes chemotherapy, targeted therapy, and hormonal therapy. For Stages I and II, surgery is the main treatment. This can be breast-conserving surgery (removing only the lump) followed by radiation, or mastectomy (removing the whole breast), typically without radiation. Chemotherapy may be needed based on the patient’s risk score.
Stage III requires a combination of surgery, chemotherapy, and radiation therapy. Stage IV treatment is mainly palliative, focusing on controlling the disease with chemotherapy, immunotherapy, and sometimes radiation or surgery. The prognosis is generally poor.
Hormonal and targeted therapies are used as needed for all stages based on cancer type.
Survival: Survival for Stage I breast ranges around 90-98%, Stage II is 80%, Stage III is 50% and Stage IV is 20-30%. As the Stage increases, the survival decreases.
Screening: The earlier the stage, the better is the survival and chances of cure. The only way to find it in the early stages is to screen for it. Screening assessment include breast self-examination every month, examination by a clinician/oncologist and mammography after the age of 40 years of age.
(Dr. Vishala Varghese, Radiation oncologist, CIHSR)