Breast cancer is common. It usually occurs in women past the age of 40 years, though it has been seen to occur earlier as well. The incidence of breast cancer in India is reported to be 20 per 100,000 women. It occurs a decade earlier than in the Western women; the mean age of occurrence is about 42 years in India, as compared to 53 years in the white women.
Incidence of breast cancer is higher in the Western countries than it is in India. Different studies have shown the incidence there per 1,00,000 women as follows:
· USA 71.4
· Denmark 49.1
· Switzerland 70.6
· England 48.0
· Israel 55.5
· Yugoslavia 28.3
In Japan, the incidence is less than India, viz. 13.0/ 100,000 women.
Cause(s)
It is not known. The major known determinants of risk for breast cancer arc delayed age at first pregnancy, family history of breast cancer, giving of oestrogens, fibrocystic breast disease, and exposure to the ionizing radiation.
Symptoms
· A lump or nodule in the breast.
· As this lump grows, it gets attached to the skin of the breast.
· Lymph nodes become enlarged and papable in the axilla on the side of the disease.
Diagnosis
Routine: Physical examination of the patient and palpation of her breast to see whether the nodule is attached to the overlying skin, which it does in cases of cancer.
Blood: Hb, RBC, TLC, DLC may be normal.
Special: Taking out the lump of the breast surgically or if it is a big one, a part of it, and its histological examination, is necessary to establish a diagnosis. Biopsy can be taken under a local anaesthetic or a general one.
Fine needle aspiration biopsy has also been useful not only in differentiating cancer from non-cancer lesions, but it can also pin-point the exact histologic type of the cancer. The overall accuracy was found to be 84.2 per cent in a study, reported from PGI Chandigarh, in 1979.
Treatment
Surgery: If detected early, surgery may bring about a cure. The whole of the breast is removed including the underlying glands. The operation is called radical mastectomy. This is done in order to leave no doubt about recurrence of the cancer.
Radiation: If the cancer mass is of moderate size, then besides the above-stated surgery, radiation treatment is given to the patient in order to kill any remaining cancer cell. Radiation is given 4 to 5 times a week for 4 to 6 weeks. The side-effect of radiation is soreness or discomfort to the exposed area. Radiation is also given in case of recurrence of the disease.
Chemotherapy: In order to do away with exigency of recurrence, chemotherapy is given, besides the surgery and radiation, particularly in younger patients. In older patients, after menopause, the rapidity of growth of the cancer decreases, or the effect of recurrence are slow to appear. A single drug or a combination of them are suggested.
Side-effects include:
· Nausea
· Tiredness
· Partial hair loss
· Susceptibility to infection
Hormone Treatment: It is long known that removal of the ovaries, lessens the size of the breast cancer. The same result can be obtained if the adrenal glands are removed.
Nowadays, instead of doing the operation of removing the ovaries (oophorectomy), anti-hormone drugs like Timoxifen are given in selected patients who are known to respond to such a treatment. Not all patients respond to this treatment; prior testing can reveal which patient would respond.
Indian Studies
In a study reported from Tata Memorial Hospital in 1983, intensive multi-drug post-operative chemotherapy for high risk stage II breast cancer was given. 20 patients (15 premenopausal and 5 post-menopausal) with carcinoma of breast involving 4 or more ipsilateral axillary lymph nodes and primary lesions measuring more or equal to 3 cm by 3 cm received 6-monthly cycles of an intensive chemotherapy regime comprising Vincristine, Adriamycin, Cyclophosphamide, Methotrexate and 5-Flourouracil.
The surgery done was modified radical mastectomy with axillary glands removal. Post-operative radiation was not given and chemotherapy was instituted within the first 4 weeks of surgery. The treatment was well-tolerated except for marked hair loss and stomatitis. Fifteen patients (75 per cent) survived recurrence-free for 12 to 36 months with a median of 24 months. Two patients developed early recurrence in chest wall in 7th and 10th months of post-operative period. The other 3 patients developed distant organ and bone metastases in 14th, 17th, and 18th months after the surgery.
Prognosis
If the breast cancer recurs, after any or all modes of treatment, the chances of cure, are not bright. However, even such a patient can live for many years. An older patient may live up to her normal life span.
Early Detection
Signs & Symptoms
· A lump or nodule in the breast
Investigations
· Fine needle aspiration biopsy and its examination
· Taking out the lump and its histological examination