Breast cancer is the most common type of cancer in the Pakistan. Most women diagnosed with breast cancer are over the age of 50, but younger women can also get breast cancer.
About 1 in 8 women are diagnosed with breast cancer during their lifetime. There’s a good chance of recovery if it’s detected at an early stage. In rare cases, men can also be diagnosed with breast cancer.
Symptoms of Breast Cancer
Breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.
Most breast lumps are not cancerous, but it’s always best to have them checked by a doctor.
You should also see a doctor if you notice any of these symptoms:
- A change in the size or shape of one or both breasts
- Discharge from either of your nipples, which may be streaked with blood
- A lump or swelling in either of your armpits
- Dimpling on the skin of your breasts
- A rash on or around your nipple
- A change in the appearance of your nipple, such as becoming sunken into your breast
Breast pain is not usually a symptom of breast cancer.
Causes of Breast Cancer
The exact causes of breast cancer are not fully understood. However, there are certain factors known to increase the risk of breast cancer.
These include:
- Age – the risk increases as you get older
- A family history of breast cancer
- A previous diagnosis of breast cancer
- A previous non-cancerous (benign) breast lump
- Being tall, overweight or obese
- Drinking alcohol
Diagnosing Breast Cancer
After examining your breasts, the doctor may refer you to a specialist breast cancer clinic for further tests. This might include breast screening (mammography) or taking a small sample of breast tissue to be examined under a microscope (a biopsy).
Types of Breast Cancer
There are several different types of breast cancer, which develop in different parts of the breast.
Breast cancer is often divided into either:
- Non-invasive Breast Cancer (carcinoma in situ) – found in the ducts of the breast (ductal carcinoma in situ, or DCIS) which has not spread into the breast tissue surrounding the ducts. Non-invasive breast cancer is usually found during a mammogram and rarely shows as a breast lump.
- Invasive Breast Cancer – where the cancer cells have spread through the lining of the ducts into the surrounding breast tissue. This is the most common type of breast cancer.
Other, less common types of breast cancer include:
- Invasive (and pre-invasive) lobular breast cancer
- Inflammatory breast cancer
- Paget’s disease of the breast
It’s possible for breast cancer to spread to other parts of the body, usually through the blood or the axillary lymph nodes. These are small lymphatic glands that filter bacteria and cells from the mammary gland.
If this happens, it’s known as secondary, or metastatic, breast cancer.
Breast Cancer Screening
Mammographic screening, where X-ray images of the breast are taken, is the most commonly available way of finding a change in your breast tissue (lesion) at an early stage.
However, you should be aware that a mammogram might fail to detect some breast cancers.
It might also increase your chances of having extra tests and interventions, including surgery, even if you’re not affected by breast cancer.
Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition.
As the risk of breast cancer increases with age, all women who are 50 to 70 years old are encouragerd for breast cancer screening every 3 years.
Treating Breast Cancer
If cancer is detected at an early stage, it can be treated before it spreads to other parts of the body.
Breast cancer is treated using a combination of:
- Surgery
- Chemotherapy
- Radiotherapy
Surgery is usually the first type of treatment you’ll have, followed by chemotherapy or radiotherapy or, in some cases, hormone or targeted treatments.
The type of surgery and the treatment you have afterwards will depend on the type of breast cancer you have. Your doctor should discuss the best treatment plan with you.
In a small proportion of women, breast cancer is discovered after it’s spread to other parts of the body (metastatic breast cancer).
Secondary cancer, also called advanced or metastatic cancer, is not curable, so the aim of treatment is to relieve symptoms.
Preventing Breast Cancer
As the causes of breast cancer are not fully understood, at the moment it’s not possible to know if it can be prevented.
If you have an increased risk of developing the condition, some treatments are available to reduce your risk.
Studies have looked at the link between breast cancer and diet. Although there are no definite conclusions, there are benefits for women who:
- Maintain a healthy weight
- Exercise regularly
- Have a low intake of saturated fat
- Do not drink alcohol
It’s been suggested that regular exercise can reduce your risk of breast cancer by almost as much as a third. Regular exercise and a healthy lifestyle can also improve the outlook for people affected by breast cancer.
If you’ve been through the menopause, it’s particularly important that you try to get to, and maintain, a healthy weight.
This is because being overweight or obese causes more oestrogen to be produced, which can increase the risk of breast cancer.
Surgery
There are 2 main types of breast cancer surgery:
- Breast-conserving surgery, where the cancerous lump (tumour) is removed
- Mastectomy, where the whole breast is removed
In many cases, a mastectomy can be followed by reconstructive surgery to try to recreate a breast.
Studies have shown that breast-conserving surgery followed by radiotherapy is as successful as total mastectomy at treating early-stage breast cancer.
Breast-Conserving Surgery
Breast-conserving surgery ranges from a lumpectomy or wide local excision, where the tumour and a little surrounding breast tissue is removed, to a partial mastectomy or quadrantectomy, where up to a quarter of the breast is removed.
If you have breast-conserving surgery, the amount of breast tissue that is removed will depend on:
- The type of cancer you have
- The size of the tumour and where it is in your breast
- The amount of surrounding tissue that needs to be removed
- The size of your breasts
Your surgeon will always remove an area of healthy breast tissue around the tumour, which will be tested for traces of cancer.
If there’s no cancer present in the healthy tissue, there’s less chance that the cancer will return.
If cancer cells are found in the surrounding tissue, more tissue may need to be removed from your breast.
After having breast-conserving surgery, you’ll usually be offered radiotherapy to destroy any remaining cancer cells.
Mastectomy
A mastectomy is the removal of all the breast tissue, including the nipple.
If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, where your breast is removed, along with a sentinel lymph node biopsy.
If the cancer has spread to your lymph nodes, you’ll probably need more extensive removal (clearance) of lymph nodes from the area under your arm (axilla).
Reconstruction
Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast.
Reconstruction can be done at the same time as a mastectomy (immediate reconstruction), or it can be done later (delayed reconstruction).
It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast.
Lymph node surgery
To find out if the cancer has spread, a procedure called a sentinel lymph node biopsy may be done.
The sentinel lymph nodes are the first lymph nodes that the cancer cells reach if they spread. They’re part of the lymph nodes under your arms (axillary lymph nodes).
The position of the sentinel lymph nodes varies, so they’re identified using a combination of a radioisotope and a blue dye.
The sentinel lymph nodes are examined in the laboratory to see if there are any cancer cells present. This provides a good indicator of whether the cancer has spread.
If there are cancer cells in the sentinel nodes, you may need further surgery to remove more lymph nodes from under your arm.