Breast Cancer Awareness: Early Detection Saves Lives
Introduction
Even as the world observes Breast Cancer Awareness month in October, it is now the commonest cancer among Indian women. Unfortunately the number of Indian women dying of breast cancer has increased over the decades.
According to data from Indian Council of Medical Research, more than 50% of breast cancers are detected late in our country. One of the key points that makes a difference to prognosis is early detection of breast cancer.
Early detection saves lives. It also saves breasts as if detected early, a lady does not have to lose her entire breast. Only the tumour can be removed and the lady’s breast saved, if tumour is detected early.
Several reasons such as lack of awareness about self-assessment, cultural barriers, reluctance to share problems with male doctors and ignorance contribute to this alarming rate. Women also tend to put themselves last on the list and this attitude also is responsible for the delay in diagnosis. Breast cancer is often painless and this also is responsible for women reaching out for help quite late.
When does one need to see a doctor?
Broadly speaking there are two reasons for you to go to your doctor:
When does one need to see a doctor?
Broadly speaking there are two reasons for you to go to your doctor:
1. If you have breast symptoms
2. Routine breast check up (Breast Screening)
Breast Symptoms:
Let us look at the symptoms that women present with to a doctor. As one would expect, most of the symptoms are not due to cancer and your doctor will reassure you by examining your breasts and sometimes by performing certain breast investigations. I have tried to present this in a Question and Answers form to make it easily readable.
1. Why is my right breast different from my left breast!
Breasts vary from person to person. In fact a lady may have breasts that are asymmetrical. For example: One may be larger than the other. One may feel harder than the other. One may have a nipple larger than the other. One nipple may be indrawn when compared to the other. As long as they have been asymmetrical since teenage, and show no change, it is likely that the variation is normal for you. If there is a new change, that is a cause for concern.
2. I suffer from breast pain!
Breast pain or Mastalgia is a very common symptom, and is often due to hormonal variations in our body. This is most likely the case, if this is in both breasts, is generalised in the entire breast, is cyclical and severe just before menstrual periods, and often goes away when the period ends. In fact 99% of women who present with breast pain do not have a worrying diagnosis. Non-cyclical breast pain, or pain in a single breast or at a single point in the breast also tends to be hormonal or due to noncancerous causes such as an infected cyst for example. However at times breast cancer may present with breast pain or as a painful lump. If you have breast pain that is bothering you, it is best to see your doctor, who will then organize the appropriate investigation, as required.
3. I can feel a lump in my breast!
Most breast lumps that the ladies present with are not cancers. In fact more than 80% of these are likely to be benign. There are a number of things such as cysts, some non-cancerous tumours and some infections that can present as a lump. In fact very commonly normal lumpy breasts can be perceived by the patient as a worrisome lump.
2. Routine breast check up (Breast Screening)
Breast Symptoms:
Let us look at the symptoms that women present with to a doctor. As one would expect, most of the symptoms are not due to cancer and your doctor will reassure you by examining your breasts and sometimes by performing certain breast investigations. I have tried to present this in a Question and Answers form to make it easily readable.
1. Why is my right breast different from my left breast!
Breasts vary from person to person. In fact a lady may have breasts that are asymmetrical. For example: One may be larger than the other. One may feel harder than the other. One may have a nipple larger than the other. One nipple may be indrawn when compared to the other. As long as they have been asymmetrical since teenage, and show no change, it is likely that the variation is normal for you. If there is a new change, that is a cause for concern.
2. I suffer from breast pain!
Breast pain or Mastalgia is a very common symptom, and is often due to hormonal variations in our body. This is most likely the case, if this is in both breasts, is generalised in the entire breast, is cyclical and severe just before menstrual periods, and often goes away when the period ends. In fact 99% of women who present with breast pain do not have a worrying diagnosis. Non-cyclical breast pain, or pain in a single breast or at a single point in the breast also tends to be hormonal or due to noncancerous causes such as an infected cyst for example. However at times breast cancer may present with breast pain or as a painful lump. If you have breast pain that is bothering you, it is best to see your doctor, who will then organize the appropriate investigation, as required.
3. I can feel a lump in my breast!
Most breast lumps that the ladies present with are not cancers. In fact more than 80% of these are likely to be benign. There are a number of things such as cysts, some non-cancerous tumours and some infections that can present as a lump. In fact very commonly normal lumpy breasts can be perceived by the patient as a worrisome lump.
However a percentage of lumps in the breast will be cancers, and hence a check up with mammography and breast ultrasound would be appropriate, depending on your age and symptoms. Most importantly a new breast lump must be investigated to rule out breast cancer. Sometimes women do not consider a painless lump worrying. However breast cancer can present as a painless lump, so please go to your doctor if you feel a painless lump.
4. I can see liquid coming out of my nipple!
Nipple discharge is mostly innocent, and may be due to reasons such as pregnancy, recent breastfeeding, hormonal reasons, some medications, infection and sometimes noncancerous tumours. However at times it may be due to a cancerous tumour, and hence a thorough breast examination, mammography and breast ultrasound, as required, need to be performed. So, please see your doctor immediately if the discharge is spontaneous, i.e. discharge that is seen without compression of the breasts by yourself.
5. My nipple is going inwards!
Nipple becoming indrawn or inverted should be taken seriously. Although there are noncancerous causes for a nipple becoming indrawn, one should not presume so unless all investigations have been performed. If your nipples have always faced inwards, ie if that is the case since childhood, that is normal for you. However if nipple inversion is new, please see your doctor immediately.
6. My nipple is becoming red and I notice flaking of the skin over the nipple!
Eczema could cause these findings of the nipple. However breast cancer can be associated with similar nipple changes. So if the nipple changes do not resolve with treatment for eczema or infection, please do go back to your doctor. You may need further tests to rule out the presence of breast cancer.
7. My breast is swollen and red!
Swelling and redness are usually signs of infection. Please see a doctor who can assess this and treat you with antibiotics. If not treated on time this can result in an abscess which may need a procedure to drain it. So see your doctor early and hopefully you will not need any interventional procedure or surgery.
You need to beware of a rare type of breast cancer that mimics infection. You may need a breast ultrasound, mammography and biopsy, if this is suspected. So please be wary of presumed infection that does not go away! Do go to your doctor if the redness does not go away after the initial treatment.
8. I am a man! Should I worry about my breasts?
Although breast tissue does not develop into large breasts during teenage in a man, there is some breast tissue in the male chest. Hence men are susceptible to breast problems, including breast cancer! However breast cancer in men is not as common as in women. Any lump or pain in the breasts in men should be investigated as we would do in women.
9. There is a lump in my armpit which is sometimes painful!
Accessory breast tissue is seen in the axilla of many women. This is normal breast tissue that is seen in the armpit and behaves similarly to the breasts. ie they can be painful just like breasts may be painful cyclically. This is often present since puberty and may become more prominent in pregnancy and childbirth.
Sometimes lymph nodes can swell up in the armpit and may present as lump in the armpit. This may be an indicator of cancer or infection in the breast. So, do consult your doctor if there is a new lump in the armpit.
10. Should I worry about my breasts?
Please don’t! It is very common to have symptoms such as breast lump, nipple discharge, breast pain. Most of the time, breast symptoms are due to entirely benign (not cancer) reasons. As a doctor, I do not want you to be scared of your breasts or your doctor! I would like you to enjoy good breast health, and I would urge you to be breast aware! This means I would like you to keep an eye on your breasts, and take medical help sooner rather than later, when you see a change in your breasts or when you have a breast symptom!
Breast Screening:
Now let us look at the routine breast check up that doctors advise women to undergo. This may feel like a chore, but it has proven to save lives. Let me try to answer some of the questions you may have on breast check up.
1 What is Breast Screening?
“Breast Screening” involves mammography of both breasts performed periodically to keep an eye on the breasts in women who do not suffer from any breast symptom. In some cases breast ultrasound may also be required.
Some hospitals such as ours have a “Breast check up” facility for women who would like a regular check up. In our hospital, the “Breast check up” includes mammography of both breasts by female radiographers, breast ultrasound by female radiologist and breast examination by a female surgeon. We have kept the price of this very reasonable to encourage women to have their breasts checked.
2 Why is Breast Screening important?
The aim of Breast Screening is to detect any significant abnormality in the breast as early as possible. For example a breast lump may be picked up by the mammogram even when the lump is not yet felt by the lady’s or doctor’s hands. It is also an opportunity to educate women about Breast Health, so that they can understand when to seek help in the future.
3 When shouldI start Breast Screening?
Mammographic check up for women with no symptoms is usually done above the age of 40 years, but could be performed at a lower age, for example at the age of 35, if there is a strong family history. The Breast Imaging Society, India (BISI) recommends annual breast screening from the age of 40 years. If you think you may be at high risk due to family history, do discuss this with your doctor, who would be able to advise you when to start screening.
4 What if I cannot afford Breast Screening?
We appreciate that this may be unaffordable for some women in our country, but we are keen to help these women. Hence as part of BK Roy Foundation’s charity initiative, we make free mammography available for women below poverty line, in our hospital. We request women to contact us with proof of the same, such as a BPL card, so that mammography, which is a vital part of this check up, could be made free for these women. In the absence of a BPL card, please contact us to see if we may be able to help. Other hospitals may have similar schemes, so contact your nearest hospital to check this out.
5 Why Breast Screening?
Breast Cancer has become the commonest cancer amongst Indian women. The rate of rise of Breast cancer in India is so alarming, that if we do not act now, the cancer burden may become unmanageable in the next twenty years. Early detection of breast cancer by breast screening has given women in the developed countries reduced death rate as well as a better quality of life. Sadly in our country, breast cancer is detected late, and so the death rate from breast cancer is high. For example, although there are more breast cancers diagnosed in the US, the number of patients dying from Breast cancer in India is far higher than the number of patients dying in The USA. Early detection is one of the effective keys to reducing death rate and improving quality of life for our breast cancer patients.
6 Do men need Breast Screening?
Breast cancer can affect men, although the chances of this are far less when compared to women. Routine breast screening with mammograms is not therefore advised. However if there is a very strong family history of cancer or a genetic mutation, men may be offered clinical examination, counseling, breast ultrasound, and in some cases mammography too. Please contact your doctor if you have any queries.
7 I am not yet 40, but would like to take care of my breasts. How do I go about it?
To start with you can be breast aware! “Breast Awareness” means knowing what is normal for you and when to seek help. We expect that from your mid twenties onwards you should know how your breasts look and feel in general. If there are changes other than what is expected due to physiological changes such as pregnancy, breast feeding or aging, you should contact your doctor.
Or you could go one step further and perform “Breast Self-examination”. This means you perform a systematic examination of your breasts every month with your own fingers. Best to perform the examination at a fixed time in relationship with your menstrual periods, such as always prior to or always after your periods, as breasts can feel different before and after periods. Women who don’t have periods can examine on a particular date each month. Any new change which is not explained by normal physiological changes such as pregnancy, breast feeding or aging, should prompt you to see your doctor.
“Breast awareness” and “Breast self examination” are life long practices, and should be continued even after breast screening starts at the age of 40 years.
Summary:
· It is very common to have symptoms such as breast lump, nipple discharge, breast pain.
· Most of the time, breast symptoms are due to entirely benign (not cancer) reasons. For example 99% of women who present with breast pain do not have a worrying diagnosis.
· It is important to see your doctor if you have any symptoms that are worrying you.
· A small proportion of women with breast symptoms will be diagnosed with breast cancer.
· Breast cancer can be treated very effectively if detected early. Hence do see your doctor sooner rather than later.
· A new lump in the breast, dimpling of breast skin, watery or blood stained liquid coming out of the nipple spontaneously and nipple inversion are some of the signs that must alert you to go to a doctor soon.
· Healthy lifestyle, regular exercise, avoiding smoking and alcohol, reduce risk of breast cancer.
· Being breast aware and looking for change is the key for early detection of subtle changes.
· You may in fact check your own breasts systematically once every month to look for any changs.
· Above the age of 40 years , a yearly check up with mammograms (and breast ultrasound, if required) is advised. This is to detect cancers before they can be felt by hands.
· A visit to the doctor is more likely to reassure you that all is well. In the unlikely event of there being a small cancer in the breast, early detection will save lives as well as breasts. If detected early, the entire breast need not be removed, and the lady can have breast conservation surgery.
· Breast cancer is the commonest cancer amongst women in India. But this is a cancer with multiple treatment options medically available.
4. I can see liquid coming out of my nipple!
Nipple discharge is mostly innocent, and may be due to reasons such as pregnancy, recent breastfeeding, hormonal reasons, some medications, infection and sometimes noncancerous tumours. However at times it may be due to a cancerous tumour, and hence a thorough breast examination, mammography and breast ultrasound, as required, need to be performed. So, please see your doctor immediately if the discharge is spontaneous, i.e. discharge that is seen without compression of the breasts by yourself.
5. My nipple is going inwards!
Nipple becoming indrawn or inverted should be taken seriously. Although there are noncancerous causes for a nipple becoming indrawn, one should not presume so unless all investigations have been performed. If your nipples have always faced inwards, ie if that is the case since childhood, that is normal for you. However if nipple inversion is new, please see your doctor immediately.
6. My nipple is becoming red and I notice flaking of the skin over the nipple!
Eczema could cause these findings of the nipple. However breast cancer can be associated with similar nipple changes. So if the nipple changes do not resolve with treatment for eczema or infection, please do go back to your doctor. You may need further tests to rule out the presence of breast cancer.
7. My breast is swollen and red!
Swelling and redness are usually signs of infection. Please see a doctor who can assess this and treat you with antibiotics. If not treated on time this can result in an abscess which may need a procedure to drain it. So see your doctor early and hopefully you will not need any interventional procedure or surgery.
You need to beware of a rare type of breast cancer that mimics infection. You may need a breast ultrasound, mammography and biopsy, if this is suspected. So please be wary of presumed infection that does not go away! Do go to your doctor if the redness does not go away after the initial treatment.
8. I am a man! Should I worry about my breasts?
Although breast tissue does not develop into large breasts during teenage in a man, there is some breast tissue in the male chest. Hence men are susceptible to breast problems, including breast cancer! However breast cancer in men is not as common as in women. Any lump or pain in the breasts in men should be investigated as we would do in women.
9. There is a lump in my armpit which is sometimes painful!
Accessory breast tissue is seen in the axilla of many women. This is normal breast tissue that is seen in the armpit and behaves similarly to the breasts. ie they can be painful just like breasts may be painful cyclically. This is often present since puberty and may become more prominent in pregnancy and childbirth.
Sometimes lymph nodes can swell up in the armpit and may present as lump in the armpit. This may be an indicator of cancer or infection in the breast. So, do consult your doctor if there is a new lump in the armpit.
10. Should I worry about my breasts?
Please don’t! It is very common to have symptoms such as breast lump, nipple discharge, breast pain. Most of the time, breast symptoms are due to entirely benign (not cancer) reasons. As a doctor, I do not want you to be scared of your breasts or your doctor! I would like you to enjoy good breast health, and I would urge you to be breast aware! This means I would like you to keep an eye on your breasts, and take medical help sooner rather than later, when you see a change in your breasts or when you have a breast symptom!
Breast Screening:
Now let us look at the routine breast check up that doctors advise women to undergo. This may feel like a chore, but it has proven to save lives. Let me try to answer some of the questions you may have on breast check up.
1 What is Breast Screening?
“Breast Screening” involves mammography of both breasts performed periodically to keep an eye on the breasts in women who do not suffer from any breast symptom. In some cases breast ultrasound may also be required.
Some hospitals such as ours have a “Breast check up” facility for women who would like a regular check up. In our hospital, the “Breast check up” includes mammography of both breasts by female radiographers, breast ultrasound by female radiologist and breast examination by a female surgeon. We have kept the price of this very reasonable to encourage women to have their breasts checked.
2 Why is Breast Screening important?
The aim of Breast Screening is to detect any significant abnormality in the breast as early as possible. For example a breast lump may be picked up by the mammogram even when the lump is not yet felt by the lady’s or doctor’s hands. It is also an opportunity to educate women about Breast Health, so that they can understand when to seek help in the future.
3 When shouldI start Breast Screening?
Mammographic check up for women with no symptoms is usually done above the age of 40 years, but could be performed at a lower age, for example at the age of 35, if there is a strong family history. The Breast Imaging Society, India (BISI) recommends annual breast screening from the age of 40 years. If you think you may be at high risk due to family history, do discuss this with your doctor, who would be able to advise you when to start screening.
4 What if I cannot afford Breast Screening?
We appreciate that this may be unaffordable for some women in our country, but we are keen to help these women. Hence as part of BK Roy Foundation’s charity initiative, we make free mammography available for women below poverty line, in our hospital. We request women to contact us with proof of the same, such as a BPL card, so that mammography, which is a vital part of this check up, could be made free for these women. In the absence of a BPL card, please contact us to see if we may be able to help. Other hospitals may have similar schemes, so contact your nearest hospital to check this out.
5 Why Breast Screening?
Breast Cancer has become the commonest cancer amongst Indian women. The rate of rise of Breast cancer in India is so alarming, that if we do not act now, the cancer burden may become unmanageable in the next twenty years. Early detection of breast cancer by breast screening has given women in the developed countries reduced death rate as well as a better quality of life. Sadly in our country, breast cancer is detected late, and so the death rate from breast cancer is high. For example, although there are more breast cancers diagnosed in the US, the number of patients dying from Breast cancer in India is far higher than the number of patients dying in The USA. Early detection is one of the effective keys to reducing death rate and improving quality of life for our breast cancer patients.
6 Do men need Breast Screening?
Breast cancer can affect men, although the chances of this are far less when compared to women. Routine breast screening with mammograms is not therefore advised. However if there is a very strong family history of cancer or a genetic mutation, men may be offered clinical examination, counseling, breast ultrasound, and in some cases mammography too. Please contact your doctor if you have any queries.
7 I am not yet 40, but would like to take care of my breasts. How do I go about it?
To start with you can be breast aware! “Breast Awareness” means knowing what is normal for you and when to seek help. We expect that from your mid twenties onwards you should know how your breasts look and feel in general. If there are changes other than what is expected due to physiological changes such as pregnancy, breast feeding or aging, you should contact your doctor.
Or you could go one step further and perform “Breast Self-examination”. This means you perform a systematic examination of your breasts every month with your own fingers. Best to perform the examination at a fixed time in relationship with your menstrual periods, such as always prior to or always after your periods, as breasts can feel different before and after periods. Women who don’t have periods can examine on a particular date each month. Any new change which is not explained by normal physiological changes such as pregnancy, breast feeding or aging, should prompt you to see your doctor.
“Breast awareness” and “Breast self examination” are life long practices, and should be continued even after breast screening starts at the age of 40 years.
Summary:
· It is very common to have symptoms such as breast lump, nipple discharge, breast pain.
· Most of the time, breast symptoms are due to entirely benign (not cancer) reasons. For example 99% of women who present with breast pain do not have a worrying diagnosis.
· It is important to see your doctor if you have any symptoms that are worrying you.
· A small proportion of women with breast symptoms will be diagnosed with breast cancer.
· Breast cancer can be treated very effectively if detected early. Hence do see your doctor sooner rather than later.
· A new lump in the breast, dimpling of breast skin, watery or blood stained liquid coming out of the nipple spontaneously and nipple inversion are some of the signs that must alert you to go to a doctor soon.
· Healthy lifestyle, regular exercise, avoiding smoking and alcohol, reduce risk of breast cancer.
· Being breast aware and looking for change is the key for early detection of subtle changes.
· You may in fact check your own breasts systematically once every month to look for any changs.
· Above the age of 40 years , a yearly check up with mammograms (and breast ultrasound, if required) is advised. This is to detect cancers before they can be felt by hands.
· A visit to the doctor is more likely to reassure you that all is well. In the unlikely event of there being a small cancer in the breast, early detection will save lives as well as breasts. If detected early, the entire breast need not be removed, and the lady can have breast conservation surgery.
· Breast cancer is the commonest cancer amongst women in India. But this is a cancer with multiple treatment options medically available.
