Ladies, Be wise… Healthwise…..

At a Glance:

“Why me? What next?” were the questions that troubled Lavanya in February 2010, when a biopsy that revealed a malignant tumor in her left breast. “The news was as hard as the tumor,” she recalls. Luckily for her, the tumor was detected early because she had been taking annual mammograms. The tumor could be cut away cleanly, and she didn’t have to lose her breast. Following surgery, as she regained consciousness, Lavanya was overjoyed to find her breast intact.

In her case the tumor had not spread and mastectomy a surgical removal of the breast was avoided. Had it been a decade ago, it might have been a different story.

As always, treatment for breast cancer depends on the stage at which it is detected and overall condition of the patient. Indeed, earlier, in a vast majority of cases, mastectomy was the only option. Today, in up to some 60 percent of patients, surgeons remove only the tumor with a surrounding bit, around a centimeter, of normal tissue and lymph nodes in the armpit. This is called “breast conservation surgery,” and patients like Lavanya are usually given radiation and chemotherapy after the operation to reduce any chances of cancer coming back. Today, after radiation therapy and a grueling course of chemotherapy, 46-year-old Lavanya is in perfect health.

Nothing waits – neither time nor cancer

In today’s era of stressful, competitive and hectic lifestyle, working women neglect their own health. She always cares for the whole family but when it comes to her own health, she takes a step back. You may have heard that women don’t have to worry so much about diseases because they naturally have good immunity, tolerance & patience.

Even though Soalpur based housewife Prashanthi was diagnosed with breast cancer 4 months back, she insisted on postponing treatment until summer holidays for the sake of her two school-going children. Another patient of mine, Lingamma from Hyderabad, postponed her treatment by 6 months for her son’s marriage. In both the patients, cancer progressed to an advanced stage. But they don’t understand that cancer is not going to wait or stop growing for you and me.

Prevention is always better than cure…

Our standard guideline suggests that women should undergo a mammogram at age 40 and should be made part of an annual health check-up. Since digital imaging is clearer, sharper and offers better magnification, fewer repeat procedures are needed. However, the equipment alone doesn’t suffice. We need experienced radiologists who can interpret the results more accurately. This will help us catch breast cancer at the earliest.

Regular self-examinations are important. We advise women to make self-examination of their breasts a regular habit. It is simply a matter of checking to see if there are any changes in the appearance of the breast such as to identify any lumps.

Why is this so important?

The incidence of breast cancer in urban India is rising. And recent studies show that the incidence of breast cancer has overtaken cervical cancer, cited as the most frequent cancer in Indian women. On an average one in 28 women in India will develop breast cancer during their lifetime. Due to rapid urbanization and westernization of lifestyles, there is a rising incidence of breast cancer in India.

Several factors can contribute to developing breast cancer. Some of these factors are lifestyle choices and some are biological characteristics.

Know your family history

Knowledge of which diseases run in your family, especially those that developed before age 50, can sometimes help determine which tests a woman may need, and when.

After Bhavana, a mother of two boys living in Himayathnagar, reached menopause at 40 years, I advised her to perform regular breast self-examinations, stressing that she had a higher risk of developing breast cancer because she had reached menopause at a comparatively early age with a positive family history of her mother with breast cancer. Two years ago, when she was 52, Bhavana detected a pea-sized mass in her breast and immediately reported it to her doctor. She was then diagnosed to have a malignant tumor.

Risk factors for breast cancer:

Family pre-disposition: If a family member has developed breast cancer in the past, or currently has breast cancer, women in that immediate family have a greater risk for breast cancer.

Age: With years passing by, the risk of breast cancer increases. Most cases of breast cancer are found in women over 40, though the number of younger women developing breast cancer is currently on the rise.

Reproductive and menstrual history: Women who experienced their first menstrual cycle before age 12, had their menopause after age 55, and/or never had children have increased risk.

Body weight: People who are obese or overweight face a greater chance of developing breast cancer than those who weigh normal.

Diet: A high-fat diet increases the risk of breast cancer. Fat triggers the hormone estrogen that fuels tumor growth. Eat a low-fat, nutritious diet. Fill your diet with plenty of fruits and vegetables.

Tobacco/Alcohol consumption: Smoking cigarettes and drinking alcohol increases the risk of cancer.

Signs of breast cancer:

• Painless lump in the breast
• Dimpling of skin over the breast
• Rash or ulcer over the nipple
• In-drawing of the nipple or inverted nipple
• Blood stained discharge through the nipple
• Lump or fullness in the armpit

If any of these changes are found during self-examination, then one should consult their doctor. Please remember that early detection increases chances of complete cure.

How does the doctor diagnose breast cancer?

When you see a doctor for a lump in the breast, he would examine your breast thoroughly. It may not always be possible for him to say what the lump is? He may run some tests to be sure about the character of the lump.

The tests commonly used are –

Fine Needle Aspiration Cytology (FNAC) or biopsy: This involves taking out a few cells from the lump with a thin needle and examining them under a microscope.

Mammography: This is a special type of X-ray of the breast to detect any abnormal growth in the breast. It allows the oncologist to assess the nature of the tumor in the affected breast and ascertain whether there is any abnormality in the other breast.

Other tests: The doctor may also ask for other tests like a chest X-ray, abdominal sonography, bone scan and PET scan. These are required to see if cancer has spread in the rest of the body.

What are the various treatment options?

The doctor chooses the treatment modality after many considerations like stage & pathology of cancer and your overall health status. Hence two patients in the same stage may receive different treatments. The available treatment options are:

• Surgery: There are several surgical procedures such as lumpectomy, mammaplasty, tissue expansion, lymph node dissection, & mastectomy. Lumpectomy is also called breast conversation surgery or partial mastectomy. The above surgeries in combination with breast reconstruction surgery can help women to improve the look of the breast.
• Radiotherapy can be given before or after surgery. The schedule or regimen for radiation therapy (radiotherapy) is determined, usually given daily for a set number of weeks.  Based on the extent of exposure required, there are partial breast irradiation, intensity-modulated radiation therapy.
• Systemic therapy: Early and locally-advanced breast cancer are treated with systemic therapy which is of 3 types: chemotherapy, hormonal therapy, and targeted therapy.
• Chemotherapy is the use of anticancer medicines to destroy cancer cells. A chemotherapy regimen consists of a specific number of cycles over a set period of time.

If you have any questions about your own treatment don’t be afraid to ask your doctor. It is always better that you make a list of your queries before you see the doctor. Treatment varies with stage, age, pathology, and other factors. Hence, do not compare your treatment with others. Ensure that you are thoroughly counseled regarding surgical options – chemotherapy, and radiotherapy. You can also get valuable advice and support from patient groups.

Exercise & healthy diet

Regular exercise gives more energy for the rest of your day. Plus, it fights stress, lowers the risk of a slew of diseases and boosts overall health. And it promotes weight loss. Healthy diet as per the diet pyramid is one of the important cornerstones of overall health. Square meal diet with plenty of green vegetables, sprouts and fruits with less oil, salt, sugar and spices is the key for good health. Please consume 3 – 4 liters of water every day.

At least 20 minutes of physical activity five days a week is recommended. Even small efforts like walking and gardening count. Muscle-strengthening exercises, Pranayama, Yoga, and Meditation can be beneficial in the long run.

Breast cancer is the most common cancer in women. Yet, the awareness about its nature, type, signs, symptoms, risk factors, action points is very limited. Staying aware may not prevent breast cancer completely but timely actions may lead to early detection, prompt treatments and complete cure. Regularly self-examine and undergo regular checkups when you are high risk. Do not overlook the signs of breast cancer or delay your visit to the gynecologist. Stay fit, act now & be healthy…

About Author –

Dr. Sachin Subash Marda, Consultant Oncologist (Cancer Specialist), Yashoda Hospitals, Hyderabad
Dr. Sachin Subash Marda specializes in breast cancer, head & neck cancer, gastrointestinal cancers, gynecological and urological cancers. He has a vast experience in several robotic surgeries, laparoscopic surgeries, day care oncological procedures and HIPEC.