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BREAST CANCER – AN OVERVIEW
Breast cancer is the commonest cancer in women worldwide. More than 2 million new cases of breast cancer are diagnosed every year. According to western figures, 1/8 of women will develop breast cancer in their lifetime.
With no exception, Breast cancer is the most common cancer in Sri Lankan women. Each year, about 4000 new cases of breast cancer are diagnosed in Sri Lanka. This figure may be much higher if not due to underreporting.
The incidence of breast cancer in Sri Lanka is increasing and is the leading cause of cancer death in Sri Lankan women. Unfortunately, The majority of breast cancer cases in Sri Lanka are diagnosed at a late stage, as a result of this, the survival rate for breast cancer in Sri Lanka is low.
Different types of breast cancers
The two main types of breast cancer are
- Invasive breast cancer
- Non-invasive breast cancer,
Invasive breast cancer
Invasive breast cancer is the most common type, accounting for approximately 80% of all breast cancer cases. There are two types of invasive breast cancers
- invasive ductal carcinoma
- invasive lobular carcinoma.
Ductal breast cancer is the most common type of breast cancer. It starts in the milk ducts and then spreads to the surrounding breast tissue. Lobular breast cancer starts in the milk-producing glands (lobules) and then spreads to the surrounding breast tissue. Breast cancer typically begins in the milk ducts or lobules of the breast, and then spreads to the surrounding tissues. The most common symptoms of invasive breast cancer include a lump in the breast, a change in the size or shape of the breast, and nipple discharge.
Non-invasive breast cancer
Non-invasive breast cancer, also known as in situ cancers accounts for approximately 20% of all breast cancer cases. Two types of invasive cancers are
- DCIS ( Ductal carcinoma in situ )
- LCIS (Lobular carcinoma insitu)
DCIS is a precancerous condition in which the cancer cells are confined to the milk ducts of the breast and have not spread to the surrounding tissues.
Inflammatory breast cancer (IBC) is the least common type of breast cancer, accounting for approximately 1% of all breast cancer cases. IBC is a rare and aggressive form of breast cancer that typically affects the skin of the breast. The most common symptoms of IBC include redness and swelling of the breast, nipple discharge, and a lump in the breast.
Risk factors for breast cancer
There are several risk factors associated with the development of breast cancer. While some of these factors are out of our control, there are some lifestyle choices we can make to help lower our risk.
- Gender: Women are 100 times more likely to develop breast cancer than men.
- Age: The risk of breast cancer increases with age.
- Family history: If you have a close relative (mother, sister, or daughter) who has had breast cancer, your risk is increased.
- Obesity: Being overweight or obese increases your risk of developing breast cancer.
- Alcohol consumption: Drinking alcohol increases your risk of developing breast cancer.
- Hormone replacement therapy: Taking hormone replacement therapy (HRT) increases your risk of breast cancer.
- Breast density: Women with dense breasts (more glandular and less fatty tissue) have a higher risk of developing breast cancer.
- Smoking: Smoking cigarettes increases your risk of developing breast cancer.
Making lifestyle choices that lower your risk of breast cancer, such as maintaining a healthy weight, exercising regularly, and limiting alcohol consumption, can go a long way in protecting your breasts. Additionally, getting regular mammograms and breast exams can help catch breast cancer early when it is most treatable.
Signs and symptoms of breast cancer
There are a number of signs and symptoms associated with breast cancer. These can include a lump in the breast, a change in the size or shape of the breast, a dimpling of the skin, a change in the nipple, and discharge from the nipple. Additionally, some women may present with a lump in the armpit. While these are all potential signs of breast cancer, it is important to remember that many of these can also be indicative of other conditions. Therefore, it is important to consult with a medical professional if you are experiencing any of these symptoms.
How to investigate breast cancer
If you have been diagnosed with breast cancer, your doctor will likely recommend some additional tests to determine the stage (extent) of your cancer. The stage of your cancer helps guide your treatment decisions.
Here are five ways to investigate breast cancer:
1. Clinical breast exam: During a clinical breast exam, your doctor will feel for lumps or other changes in your breasts.
2. Mammogram: A mammogram is an X-ray of the breast. Mammograms can often find breast cancer at an early stage.
3. Breast ultrasound: A breast ultrasound uses sound waves to create an image of the breast. Ultrasound can sometimes be used to determine whether a breast lump is a solid mass or a fluid-filled cyst.
4. Breast MRI: A breast MRI uses magnetic fields and radio waves to create a detailed image of the breast. MRI can sometimes be used to determine whether a breast lump is a solid mass or a fluid-filled cyst.
5. Biopsy: A biopsy is the removal of a small amount of tissue for examination under a microscope. There are several types of biopsies, including fine-needle aspiration, core needle biopsy, and surgical biopsy. Core biopsy is the best way to definitively diagnose breast cancer.
6. Treatment of breast cancer
There are number of treatment options available for breast cancer, These include surgery, radiotherapy, chemotherapy, and hormone therapy. The most appropriate treatment will depend on the individual case. Currently cancer management is multimodal, that means you will receive on or many of these treatment modalities.
Surgery is the most common treatment for breast cancer, and there are several different types of surgery that can be used depending on the individual case. The most common type of surgery is a lumpectomy, which involves removing the tumour and a small surrounding area of tissue. A mastectomy is another type of surgery that involves removing the entire breast.
Radiotherapy is another common treatment for breast cancer and involves using high-energy beams to destroy cancer cells. Radiotherapy can be given externally, or internally (brachytherapy).
Chemotherapy is a treatment that uses drugs to destroy cancer cells and is often used in combination with other treatments such as surgery or radiotherapy. Chemotherapy can be given orally, or intravenously.
Hormone therapy is a treatment that uses hormones to either prevent the growth of cancer cells or to kill them. Hormone therapy can be given in the form of tablets, injections, or implants.
7. Prognosis of breast cancer
The grade of breast cancer is a measure of how aggressive the cancer is. Grade 1 breast cancer is the least aggressive and grade 3 breast cancer is the most aggressive.
The hormone receptor status of breast cancer is a measure of whether the cancer is fuelled by the hormones estrogen and progesterone. Breast cancers that are estrogen and progesterone positive are more likely to respond to hormone therapy.
Age, family history, and personal history of breast cancer are all risk factors for the disease. However, they are not prognostic factors. This means that they cannot be used to predict how a woman will respond to treatment or how likely she is to survive.
The prognosis for breast cancer depends on many factors, including the stage of the cancer, the type of cancer, the grade of the cancer, the size of the tumour, the number of lymph nodes involved, and the patient’s age and general health.
The five-year survival rate for breast cancer is about 90%, and the ten-year survival rate is about 83%. However, these rates do not necessarily reflect the prognosis for an individual patient.
The prognosis for breast cancer is generally better when the cancer is caught early. For example, the five-year survival rate for stage 0 breast cancer is 100%, and the five-year survival rate for stage I breast cancer is 93%.
However, even when the cancer is caught early, the prognosis depends on other factors, such as the grade of the cancer. For example, the five-year survival rate for grade 3 breast cancer is 72%, while the five-year survival rate for grade 1 breast cancer is 98%.
In general, the prognosis for breast cancer is good, but it is important to remember that each individual case is different