Breast Cancer: Understanding causes, precautions, & why regular screening is recommended

Hyderabad: Breast cancer is the leading cause of cancer among women in the country, followed by cervical cancer. According to the National Cancer Registry Program report by the National Centre for Disease Informatics and Research, they accounted for 39.4% of all cancer cases in women in India in 2020.

To know better about the disease and how to protect ourselves from it, NewsMeter spoke to Padma Shri awardee Dr. P. Raghuram, director and consultant surgeon at KIMS-USHALAKSHMI center for breast cancer, and Dr. K Sreekanth, senior consultant and surgical oncologist at Yashoda Hospital.

90,000 women die of breast cancer each year

Breast cancer has surpassed cervical cancer in our country to become the most frequent cancer affecting women in India. As a result, approximately 1.78 lakh new instances of breast cancer are detected each year. That is, one person is diagnosed with breast cancer every four minutes in our country, and one in every two women who were diagnosed with it lost their life.

In other words, about 90,000 people die from breast cancer per year. So, every 8 minutes, someone dies from breast cancer.

Has breast cancer become an epidemic in India?

Dr. Raghuram said, "Late detection is one of the main reasons for the fatality rate due to breast cancer. Furthermore, breast cancer is a taboo subject, and there is a lack of a robust, coordinated screening programme for breast cancer. More than 60% have progressed to the advanced phases."

He added, "When women come to the latter stages, their chances of survival are pretty slim, regardless of the medication or treatment they receive. That's absolutely different, if not radically opposite, in the UK, where more than 80% of women present in the early stages. As a result, their chances of survival are much improved. That is the one thing that stands out."

How can women be alert?

"Eighty per cent of the lumps found are benign, but there is only one way to determine if a lump is malignant or benign. Triple assessment," the doctor said.

What is Triple assessment?

The doctor explained, "Triple assessment means clinical breast examination by a specialist, mammogram, or ultrasound scan, which is breast imaging. The third is an ultrasound-guided core needle biopsy of that breast lump if the woman has a lesion. So, with this triple assessment, which can be done without putting the woman under the knife or having an operation, one can get a precise diagnosis."

At what age do we need to start regular screening? Are any age groups under more prominent risk?

People believe that older people are more likely to develop breast cancer. Dr. Raghuram said, "It is another myth. Although breast cancer indeed becomes more common as one gets older, in our country, 87% of the population is under 50. As a result, the peak incidence of breast cancer is also among 40 to 50 years old."

What are the leading causes of breast cancer? How much of it is genetic, and how much is due to social and environmental conditions?

"Many people believe that family history is the most significant risk factor. It isn't. My mother or grandmother's breast cancer does not endanger my children," explained Dr. Raghuram.

"There are a few cases where we need to be vigilant, where abnormalities in the BRCA1 and BRCA2 genes are possible. Those are if someone is diagnosed with breast cancer before the age of 40 and if there are two or more immediate family members diagnosed with breast cancer. Suppose the immediate family has a history of breast and ovarian cancer, or there is a history of male breast cancer," he said.

Dr. Raghuram added, "These are the individuals who require genetic counseling. However, the belief that family history is the most significant is incorrect. Only a small number of people would need this genetic test. To be precise, about 5% of the cases are hereditary."

He continued, "Another myth is that men don't get breast cancer. Though it is scarce, there is a possibility."

Coming to testing and regular screening, for the past 40 years, it has been advised for people with genetic risk to get screened every six months, as having a mammogram frequently is not advisable. They can alternate between a mammogram and an MRI scan, he said and added that getting tested once in two years or yearly is advisable for people without any genetic risk.

Another common myth is that mammograms are not safe or cause pain, but that is not the case. If the radiographer is skilled, it is not painful, and the radiation exposure is equal to that of a dental X-ray, the doctor clarified.

What about accessibility? Triple testing, genetic mutation, and other information are readily available to urban women. What about women in semi-urban or rural areas?

The next best way to check for abnormalities is a clinical breast examination (CBE), which trained healthcare workers can perform. Additionally, awareness needs to be brought about for checking certain signs.

Any painless lump in the breast, recent drawing in of the nipple, blood-stained discharge from the nipple, or recent excoriation of the skin overlying the nipple or areola region, are signs women need to look out for.

It has been reported that urban women are more at risk of breast cancer than their rural counterparts.

Dr. Sreekanth explained, "This can be due to the modern lifestyle, abnormal BMI, alcohol intake, or even having their first child in their 30s. Women who breastfeed for a more extended period are at less risk of getting breast cancer."

When asked how we can predict breast cancer at an early stage, he added, "Avoiding breast cancer should be the priority, considering the main reason for the disease being hormonal changes, lifestyle changes should be made as much as possible. It doesn't eliminate the risk but can potentially reduce the risk."

Dr. Raghuram said screening is the only way to fight breast cancer. "Early detection can cure the disease completely. But urbanization has become inevitable, so we must concentrate on regular screenings and self-examination. A self-breast examination is the most competent method to detect any malignancy at its early stages. Being an intimate part, only the person can see any changes first," he said and added, "Do not ignore any changes."

Some general guidelines to follow when inspecting your breasts

· The week following your period is usually the best time to undertake a self-exam.

· Make use of your finger pads. For the exam, use the pads of your three middle fingers rather than the tips. If you have trouble feeling with your finger pads, try another sensitive region of your hand, such as your palm or the backs of your fingers.

· Use various pressure levels. The idea is to feel different depths of the breast by applying varying pressure levels to all breast tissue. Light pressure should be used to feel the tissue nearest to the skin, medium pressure for a bit deeper feeling, and hard pressure for the tissue closer to the chest and ribs. Before moving on to the next area, use each pressure level. Consult your doctor or nurse if you're unsure how hard to press.

· Take your time. Allow yourself plenty of time. Examining your breasts thoroughly may take many minutes.

· Stick to a pattern. Examine your entire breast using a thorough approach. Consider the face of a clock or the slices of a pie across your breast. Examine the area near your collarbone first, then move your fingers toward your nipple. Then, with your fingertips, proceed to the next section.