Daily Times

Breast cancer may be a devastating disease but it is potentially curable. Although in majority of cases with breast cancer, it is difficult to tell what exactly triggered the beginning of cancer, certain factors have been identified which can make a woman more prone to develop breast cancer than others. The older we grow the higher the chances of developing breast cancer.

Exposure to estrogen: Estrogen is a hormone which is normally produced in females and takes part in reproductive function. Women who are overexposed to estrogen due to early periods, late menopause or late childbirth, may be at a relatively increased risk of breast cancer. Post-menopausal women who take hormone replacement therapy have also been shown to have an increased chance of breast cancer. Once a woman stops taking hormone replacement therapy, her risk of developing breast cancer decreases.

Obesity: Women who gain weight especially with increased waist girth, around the age of menopause, may have increased chance of breast cancer and breast cancer related death.

Inherited risk: Some women inherit changes in breast cancer genes which are called BRCA 1 and BRAC 2 genes. These women are at a much higher risk of developing breast cancer, which may be at a young age.

How to prevent breast cancer?

Exercise: In order to try to improve our health, exercise at least half an hour to one hour every day would help prevent not only breast cancer but also many other diseases.

Diet: Taking a diet that is based on plants such asraw vegetables, fruits, nutsand grains can help prevent the risk of cancer. You should also avoid sugary drinks,processed and fried foods.

Breast-feeding has been shown to be helpful in keeping the estrogen levels low.Avoid taking over the counter hormone tablets. If you have to take these tablets, you must discuss with your doctor first.

How does breast cancer present? The first symptom of breast cancer for many women is a lump in the breast. If you spot a lump, see your doctor straight away, You need to know that 9 out of 10 breast lumps (90%) are not cancer, so please do not be afraid to see the doctor, who can decide if any tests are required or not.

The following signs that could be due to breast cancer:

n A lump or thickening in an area of the breast

n A change in the size or shape of breast

n Dimpling of the skin or the skin over the breast becomes like orange peel

n A change in the shape of nipple, particularly if it turns in, sinks into the breast or becomes irregular in shape

n A blood-stained discharge from the nipple

n An eczema like rash or ulcer over the breast

n A swelling or lump in armpit

After examination your doctor may decide to do mammogram or ultrasound of the breast. If needed, further tests like a biopsy or needle test of the lump are arranged. In case a diagnosis of breast cancer is made, the patient is referred to a cancer specialist.

Treatment of breast cancer: Depending on the stage at presentation, several treatment modalities are used for breast cancer patient.

Surgery: Surgery plays an important role during therapy for patients presenting with localized disease. These days if a woman is diagnosed with an early stage disease, it is very likely that she will not have mastectomy. Instead breast conservation is done frequently in these cases, meaning that only a portion of the breast which has the tumor and little bit of normal tissue around is excised. This operation has very good cosmetic results and also does not compromise the survival.

1. Radiotherapy: Some patients require radiotherapy to the chest wall. It is usually given after a patient has had surgery and chemotherapy. Radiotherapy is also a very effective modality for pain control in patient with bone metastases and in cases with local recurrence.

2. Chemotherapy: By the time a patient presents with a lump in the breast, the cancer cells are likely to have travelled to other parts of the body. While surgery and radiotherapy provide local control, chemotherapy takes care of tumor cells wherever they are in the body. Therefore, in most cases, either before or after surgery the patients are given chemotherapy.

3. Hormone therapy: Patients who have hormone receptor positive tumor are given hormone therapy for at least five years or more.

4. Targeted therapy: In 25 to 30 per cent of breast cancer patients, the tumor is reported to be HER-2 positive. These patients benefit for anti-HER-2 antibody.

5. New therapies: Several trials are looking at improving outcome for patients with breast cancer. As the results of these trials are announced, we try to incorporate these results in our patient care.

Overall, the ten-year survival rate for all types of breast cancer has improved significantly by 25 to 30 per cent present over the last two decades. This improvement is because of better understanding of the disease, earlier disease detection and improvement in treatment of breast cancer.

The writer is a consultant medical oncologist at SKMCH&RC

Published in Daily Times, October 27^th 2018.