Breast cancer occurs in women at any age after puberty but with increasing rates in later life. In 2020, 2.3 million women were diagnosed with breast cancer and 685000 deaths were reported globally as per the World Health Organization (WHO). As of the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past 5 years, making it the world’s most prevalent cancer. For over a decade now, J&K has witnessed an unprecedented rise in cancer cases. Rising Kashmir health correspondent Mansoor Peer in a chat with Dr. Vikas Roashan, Senior Consultant at American Oncology Institute (AOI) Acharya Shri Chander College of Medical Sciences (ASCOMS) Jammu, talks about causes, symptoms, screening, treatment and impact of breast cancer.

Edited Excerpts!

Tell us about breast cancer and how it affects a woman?

Breast cancer is the most common cancer in women in India, after cervical cancer. It is an uncontrolled growth of tumour cells in the breast tissue. Breast cancer is primarily seen in women, but it can also occur in men (specific type) in rare cases.

How is breast cancer affecting women?

The global burden of breast cancer is expected to cross 2 million by 2030, with a growing proportion from developing countries. Though age-standardized incidence rates in India are lower than in the United Kingdom (UK) (25.8 versus 95 per 100,000), mortality rates are nearly as high (12.7 versus 17.1 per 100,000, respectively) as those of the UK.

In addition, breast cancer incidence rates within India display a 3–4-fold variation across the country, with the highest rates observed in the Northeast and major metropolitan cities such as Mumbai and New Delhi.

Reasons for this variation include differences in demographic (education), reproductive (age at first child and number of children), obesity and lifestyle factors (tobacco smoking, alcohol use).

If a woman is detected with breast cancer, how long does it take to get treated?

Breast cancer treatment involves surgery, chemotherapy, radiotherapy, treatment gets completed usually in 4 to 6 months, and hormonal treatment is usually 5 to 10 years.

There has been a rise in breast cancer cases in Kashmir as 300 cases are reported annually. Why are cases going up?

In recent years, breast cancer rates have increased incredibly quickly among women aged 65-69. Incidence probably increased because of screening that is started in age more than 50 years. Other factors that lead to a rise in breast cancer are changing lifestyle, history of hormone replacement therapy, smoking, obesity, increased life expectancy, and nulliparous women.

What is the treatment available in Jammu and Kashmir?

All state-of-the-art treatment modalities are now available in Jammu and Kashmir.

Is the treatment effective if the disease is identified early?

If detected early, breast tumors are curable with treatment, which is why screening and breast self-examination play a vital role in breast cancer management.

Are there any known viral or bacterial infections linked to the development of breast cancer?

No, there is no bacterial and viral infection associated with breast cancer. 

How important is awareness to diagnose it at the appropriate time?

If appropriately taught about signs and symptoms of breast cancer, I think women can detect early cancer, which subsequently gives good outcomes with multimodality treatment.

Moreover, we can even train females in villages to identify any lump or mass which can be sent to the physician for further management. Initially, it was an issue that treatment is very costly, but now treatment is covered under the Ayushman card in all J&K hospitals.

When to consult a doctor?

If you experience swelling or a shift in the breast, see a doctor immediately. It is recommended that women who have no symptoms of breast cancer should also undergo regular screening.

The goal of breast screening is to detect breast cancer at the earliest when the treatment is known to show the best results. Mammograms are commonly recommended for imaging patients over 40 years of age.

In younger patients, MRI breast is advised as breast tissue is thick and mammography is challenging to find cancer.

Ignoring breast cancer can lead to metastatic disease, which leads to severe life-threatening conditions. One of the biggest reasons for high breast cancer death is late diagnosis and treatment.

How to do a breast cancer self-exam?

There are a few steps to follow for breast self-examination that include:

Stand before a mirror and look at both breasts

Check for anything unusual, such as nipple retraction, redness, puckering, dimpling or scaling of the skin. Look for nipple discharge and note the colour and report to your doctor.

Press your hands firmly on your hips and lean slightly toward your mirror and look for any change in the normal shape of your breasts.

Looking in the mirror, raise your arms and rest your hands behind your head. This allows you to see the underside of your breasts.

Place your left hand on your waist, roll your shoulder forward, reach into your underarm area, and check for enlarged lymph nodes (small glands that fill with fluid when you have an infection).

An enlarged node would feel like a corn kernel or a bean. Also, check the area above and below the collar bone. Then, repeat on the right side.

Raise your left arm. Use the pads of three or four fingers of your right hand to examine your left breast.

Use three levels of pressure (light, medium, firm) while moving in a circular motion. Feel the breast in circles, lines, or wedged fashion.

How is Breast cancer treated?

There are many ways and treatment options available for breast cancer including breast cancer surgery. Operations used to treat breast cancer include:

Breast lumpectomy:

During a lumpectomy, the surgeon removes the tumor and a small margin of surrounding healthy tissue.

Mastectomy: 

Mastectomy is a procedure performed to remove all your breast tissue. Mastectomy can be followed by breast reconstruction surgery to restore the appearance of the breast.

Modified radical mastectomy: 

In this procedure, the entire breast is removed – including the skin, breast tissue, areola, and nipple – along with most of your underarm lymph nodes. However, the chest muscles are left intact.

Breast conservation surgery: 

This is a procedure to remove cancer while leaving as much normal breast tissue as possible. In many cases, some surrounding healthy tissue and lymph nodes are also removed.

Radiation Therapy:

It uses high-powered energy beams, such as X-rays and protons to kill cancer cells.

It’s given to destroy any cancer cells that may have been left in the breast and surrounding area after surgery. You may hear this called adjuvant Radiotherapy.

Radiotherapy is given using Linear Accelerator

External beam radiotherapy

• This is the most common type of Radiotherapy used to treat primary breast cancer.

• X-rays are delivered by a machine that directs a beam of radiation at the breast.

• The x-rays do not make you radioactive, so you can safely mix with other people, including children, when you leave the treatment room.

Intensity-modulated radiotherapy (IMRT)

• IMRT is another way of giving external beam radiotherapy.

• The intensity of Radiotherapy can be varied, allowing different amounts of radiation to be given to different areas. The risk of side effects is lower with IMRT because healthy tissue in the area gets a lower dose of radiation.

• IMRT is not available in all radiotherapy treatment centres.

Volumetric modulated arc therapy (VMAT)

• This is a type of IMRT. The radiotherapy machine rotates around the area being treated, continuously changing the shape and intensity of the radiation beam

• Chemotherapy: Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells.

• Immunotherapy: Uses the body’s own immune system to fight cancer

Symptoms

• A lump or mass in the breast that looks distinct from the surrounding tissue
• Change is the shape, size, or appearance of the breast
• Changes in the skin over the breast, for example, dimpling
• Breast pain
• Inverted or pulling-in of the nipple
• Scaling, peeling, or flaking skin over the breast, particularly in the dark area around the nipple
• Discharge from the nipple
• Bleeding from the nipple
• Redness or pitting of the skin of the breast, resembling the skin of the orange

Breast cancer screening

Tests are used to screen various kinds of cancer when a person has no symptoms. Mammography is the most common screening procedure for breast cancer. In addition, magnetic resonance imaging (MRI) can be used to screen people at high risk of breast cancer and young patients. Apart from these, Breast Inspection, Thermography, Tissue Sampling, etc., are also used for screening.

What are the factors that increase the risk of breast cancer?

Factors that increase the risk of breast cancer include:

• Family history of breast and ovarian cancer
• Inherited genes that increase risk- BRCA1 and BRCA2 gene mutations
• In those females where periods start at a younger age
• Beginning menopause at an older age
• Late or no pregnancy
• History of benign breast disease
• Postmenopausal hormone therapy
• History of oral birth control pills intake
• Being overweight or obese
• Alcohol and tobacco consumption