For the last 3 months, I am witnessing one of my patients battling breast cancer. A puritan, she has never touched a drop of alcohol or smoked or cigarette in her life, let alone drugs. A traditional homemaker, her family has been the cynosure of her eyes and the only real worry to plague her was what dishes need to be cooked for the dinner tonight. Why then is she going through this ordeal? I have no answer, nor do the 5 doctors she has visited in the past few months. It's because of a simple reason- breast cancer can happen to anyone. A battery of tests has been done to diagnose her breast cancer. It all started with her complaining of breast heaviness for a few days.
Identifying that you have breast cancer is the first and often most crucial step in this battle. See a Gynaecologist immediately if you notice any symptoms such as:
- Unusual lump in the breast
- Pain/heaviness in the breast
- Change in appearance of one or both the breast
- Change in feel, size or shape of the breast
- Abnormal discharge from the breast
- Changes in the nipple/areola appearance
If you have suspected breast cancer either due to the above symptoms or because of your routine mammogram you will be referred to a specialist for further tests and evaluation.
Early detection of Breast Cancer
Detecting cancer early and undergoing aggressive therapy goes a long way in reducing death due to breast cancer. Breast cancer that is found early and has not spread is easier to treat and overcome. Getting regular screening tests is the most reliable method to find breast cancer early, especially those at a higher risk of breast cancer.
Guidelines for Screening for Breast Cancer
Women between 40 and 44 have an option to start taking a screening mammogram every year. Women between 45 and 54 should get mammograms done every year.
All women should be familiar with how their breasts appear and feel. A periodic self-breast examination should be done to check for any lump, mass or nodule or any other changes in the nipple appearance and direction. Underarms also should be checked for any lymph node enlargement.
Look for any dimpling or changes in the shape or symmetry of your breasts by observing in the mirror. Use light pressure to feel lumps and firm pressure to explore deeper tissue. Squeeze each nipple to see a change in position or shape of the nipple.
It is better to wait for 3 -5 days after your period to examine your breasts
A hormonal change can cause a temporary thickening of your breast which settles after your period. Any changes in the breast tissue should be immediately reported to a healthcare provider.
Your physician will check both your breasts and lymph nodes in the armpit feeling for any lumps or other abnormalities. The complete examination will be done to understand the size, location and extent of mass or lump.
These tests will be done to study more about the suspicious area in the breast during screening or examination.
A mammogram is an x-ray of the breast. Screening mammograms are routinely done to detect breast cancer in women who have no apparent symptoms. A diagnostic mammogram is used after suspicious results are found on screening or after some signs of breast cancer alert the doctor. A diagnostic mammogram can help diagnose in case symptoms are indicative of the presence of cancer. A diagnostic mammogram is a more detailed x-ray using special techniques and involves more images of the breast tissue. This takes longer duration than a routine mammogram providing views from different angles and vantage points. In addition to catching small tumours, this mammogram can also find ductal carcinoma in situ which are abnormal cells lining the breast ducts and may become invasive cancer in some women.
The reliability of this mammogram depends upon the size of a tumour, the density of the breast tissue and skill of the radiologist. Sensitivity and specificity of Mammography in detecting breast cancer increases with increasing age.
This will be recommended if a suspicious area is felt on a breast examination or a screening mammogram. A breast ultrasound is a scan that uses penetrating sound waves that don’t affect or damage the tissue. Ultrasound uses waves to produce images of structures deep within the body. These high frequency sounds waves produce an image of the interior of the breasts showing any abnormality or lumps. This scan is used to determine whether a new breast lump is solid or fluid-filled.
Ultrasounds are useful when the lump is large enough to be felt and images can be used to evaluate the abnormality further. They also useful for differentiating whether the lump is solid, fluid-filled or a combination of both. Cysts are typically not cancerous; however, solid lumps are probably cancerous. Exact location, size and surrounding tissue can also be studied from this scan.
During this scan, a magnet connected to a computer transmits magnetic energy and radio waves through the breast tissue. It scans, making detailed pictures of the different areas of the breast. This scan helps distinguish normal and diseased tissues. An MRI is usually recommended if the initial examinations are not conclusive to assess the extent of the disease. Before the breast MRI, you will receive an injection of the dye for better analysis.
Once the imaging tests give a positive result, doctors typically process to more invasive procedures like a biopsy.
This is the only definitive way to come to a diagnosis of breast cancer. Here samples of breast tissue are taken for testing for the presence of cancerous cells. A biopsy is also useful for diagnosing a type of cancer cells, aggressiveness of cells and whether these cancer cells have hormone receptors or other receptors which can be useful in determining the type of treatment.
Staging of Breast Cancer
The extent of cancer and stage of cancer can be determined through following tests such as:
- Complete blood count
- Breast MRI
- Bone scan
- CT scan
- PET scan
Breast cancer stages or grades range from Grade 0 to Grade IV with 0 denoting that the cancer is non-invasive and contained within the milk ducts. Stage IV is also called as metastatic cancer, indicating that cancer has spread to other body parts. Waiting for the results of these scans and blood tests can be understandably difficult and worrisome.
However, here are few thoughts to keep in mind while awaiting results that only:
- Only twenty per cent tumours are cancerous.
- Most cancer tumours are highly treatable.
- Cancer treatment options are constantly improving
Speaking from my own experience, I can’t stress enough the necessity of the self-breast examination and an aggressive intervention for the best possible outcomes. The health of women in our life is often forgotten; don’t make that mistake.
Healthy Women, Healthy Nation