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Breast Cancer

Breast cancer is life-threatening and the most frequently occurring cancer in women. One of the leading causes of death due to cancer in women, it has even surpassed lung cancer death counts. Triple assessment methodologies are commonly adopted for the screening of the cancer – clinical evaluation, imaging studies and needle biopsy. Breast carcinomas are seldom painful and nor do they cause any discomfort. Generally asymptomatic they are detected on a mammogram. For over three decades, extensive research on breast cancer has only helped in understanding the disease better and facilitating less toxic, targeted treatments. A series of molecular alternations occur at a cellular level leading to the uncontrolled growth of the epithelial cells of the breast.

Causes

  • Family history – This is the most widely identified probabilities of breast cancer. Risk factors are classified as follows:

    • 4 x more if mother and sister are affected

    • 5 x greater with either single, two or more first-degree relatives are diagnosed with breast cancer; in single first-degree relative the risk is even higher if the diagnosis is at < 50 years of age.

    • Breast cancer risks double if a relative is diagnosed with first-degree ovarian cancer and more so when the diagnosis is early i.e. < 50 years of age

    • Relatives who are male and are diagnosed with breast cancer

    • Mutations of the BRCA1 and BRCA2 gene

    • Risk quadruples with ataxia telangiectasia

    • Risk doubles with Ashkenazi Jewish descent

  • First pregnancy at a late age

  • Nulliparity

  • Early onset of menses

  • Late age menopause

  • Increased age is linked to sporadic breast cancer

  • Obesity – especially abdominal obesity

  • Dietary patterns

  • Sedentary lifestyle

  • Regular consumption of alcohol

  • Smoking

  • Radiation exposure to the chest area

Signs and symptoms

Overall indications may include:

  • Changes in size and shape of breasts

  • Skin dimpling, swelling, redness and thickening

  • Blood stained nipple discharges

  • Auxillary lump

  • Nipple inversion, ulceration and retraction

Diagnosis

  • Physical examination will reveal tethering of skin, inversion of nipple, dilated veins, ulceration, oedema, and the presence of Mammary Paget disease. Palpable lumps will be hard, irregular with focal nodularity, and breast asymmetry. A metastatic spread will indicate breathing difficulties with jaundice, bone pain and hypercalcaemia.

  • Screening for breast cancer:

    • Mammography will image the breast for the presence of cancer and detecting tumours.

    • Ultrasound or ultrasonography

    • MRI – can even monitor the response of the neoadjuvant chemotherapy

    • Nuclear imaging – uses three radiotracers Technetium-99m, 99mmTC-tetrofosmin and 99mmmethylene diphosphonate

  • PET-CT- the positron emission tomography is conducted to detect variations in metabolic activity, tumour receptor status and vascularization.

  • Biopsy – VACNB or the vacuum-assisted large-gauge core needle procedure is done with image guidance. Operational interventions are minimized at the same time providing an accurate diagnosis.

Treatment and medication

Staging of breast cancer is a very important step to arrive at a conclusive surgical approach for the abnormality. Surgery being the primary treatment, pharmacological treatments may include antimicrotubular therapy, alkylating therapy, administration of anthracyclines, antimetabolites, CDK inhibitors and such, which are generally adjuvant care.

Dr. Deepak and his team use the latest advancements in technology for the detection of breast cancer such as the digital mammography, which uses CAD or computer-aided design systems to identify abnormalities.

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