Power of Pink

ACCORDING to the latest survey of the Indian Council of Medical Research, the most common malignancy among women in the country—and esp...

ACCORDING to the latest survey of the Indian Council of Medical Research, the most common malignancy among women in the country—and especially in the metros—is breast cancer. While the increased reporting could be an offshoot of the celebrity-propped ‘pink ribbon’ campaign—Kylie Minogue is only the latest star to be diagnosed with the cancer—it certainly helps to demystify the disease.

How common is breast cancer?
Let’s put it this way: It’s the most common cancer among women, three times more prevalent than all gynaecological cancers taken together. But more than that, men can get breast cancer too: It’s a heterogeneous disease that has more to do with unregulated cell growth than gender. ‘‘The first visible sign of breast cancer is often a lump or swelling that keeps on increasing in size, thereby affecting tissues and organs around,’’ says Dr Sameer Kaul, senior oncologist and surgeon at Indraprastha Apollo, New Delhi.

Are there any specific conditions that increase the risk?
Since breast cancer is not communicable, risk factors obviously come into play. Dr Kaul says a woman would be considered more at risk if:
• She reached puberty early (prior to 12 years) or menopause late (post 50)
• She gets pregnant late in life, or never conceives. Pregnancies prior to the age of 26 are deemed to be a protective factor
• Her immediate family—mother, sisters, daughters—has a history of breast cancer
• She goes in for a diet high in saturated fats, particularly animal fat
• She is a heavy drinker
• She is obese

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What are the symptoms?
Since early diagnosis is one of the most potent weapons in the fight against the big C, watch out for:
• A discreet lump in the breast, which grows slowly yet painlessly
• Veins on the skin of one breast become more prominent
• Bloody discharge from a nipple
•A nipple wound that doesn’t heal
• A nipple that retracts
However, not every lump in the breast is a sign of cancer: 80 per cent are benign. Also, there may not be any manifestation in the early stages of breast cancer. If you’re in the high-risk group in any way, a screening mammogram is advised every year.

	DO THE GENES FIT?
Genetic mutations for breast cancer are a hot topic, with 3 to 10 per cent of breast cancers being attributed to changes either in the BRCA1 or BRCA2 genes. Either of these could be inherited from either parent. Gene tests may be particularly worthwhile if there’s an exceptionally strong family history of breast cancer.

When in doubt…
Check it out. A breast self-examination should be conducted at the same time every month, a week before and a week after the menstrual cycle. Don’t hurry through it. Use the palm of the right hand to check the left breast and vice versa, go around in concentric circles or in a zigzag manner. Always stand in front of a mirror during the examination.

If anything feels suspicious, sign up for a mammogram. An ultrasound or a FNAC—fine needle aspiration cytology—are alternatives.

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The next course of action if the clinical diagnosis is positive…
The next step is to choose from the gamut of alternative treatments. Your oncologist is the best guide, but Dr Kaul lists the basic options:

• If detected in the first stage (when the tumour is less than 2 cm in size and hasn’t spread beyond the breast) or second stage (the tumour is between 2 to 5 cm and has spread to the lymph nodes under the arm, or is larger than 5 cm, but hasn’t spread), surgery, followed by chemotherapy and radiation, is usually the best option. Following primary treatment, hormonal tablets might be prescribed for the next seven years. Stage one detection allows for a 90 per cent chance of survival; 80 per cent for the second stage

• Stage three (when the tumour’s larger than 5 cm and has spread to lymph nodes) calls for neoadjuvant therapy to reduce the size of the tumour. This is followed by chemo-therapy and surgery, backed by further rounds of chemo and radiation. The chances of survival decrease to 60 and 40 per cent in the late stages.

Is losing a breast unavoidable?
Nowadays, doctors prefer conservative breast surgery, rather than the removal of an entire breast. ‘‘Surgery just removes the cancerous tissues and the normal tissue around it. This is confirmed by a microscopic examination, so that no affected cells remain in the body,’’ says Dr Kaul.