Breast cancer doctors and breast cancer specialists answer questions about the reasons for breast cancer, causes, symptoms, diagnosis, treatment, and prevention.
Breast cancer is one of the leading causes of cancer among women and the most common cancer among women in India. Early detection and prompt treatment can help improve survival chances and quality of life.
It is often a misconception that breast cancer is a cancer of older woman. There are thousands of cases of breast cancer among women below the age of 40 diagnosed every year.
One of the vital aspects to detect breast cancer is breast self-examination, which is the key to early diagnosis, especially during the reproductive years. While it is frequently discussed, so few of us know how to conduct a self-exam on our breast.
On the SHEROES app for women, we often feature health experts and specialists who provide answers on various aspects of women’s health, and we asked some of the best breast cancer doctors in India to offer advice on breast cancer awareness.
In the first event, Dr Uma Dangi, Consultant Medical Oncologist at Fortis Mulund, Mumbai and Fortis Vashi, Navi Mumbai, enlightened us on the importance of breast cancer screening.
In the second event, breast cancer specialists, Dr Anita Ramesh, Professor & HOD, Medical Oncology, Saveetha Medical College, Chennai and Dr Manasi Shah, Medical Oncologist, HCG Centre, Ahmedabad discussed breast cancer among younger women.
Breast Cancer Doctors And Specialists Answer Breast Cancer Questions
In this article, we have compiled the answers to the breast cancer questions from SHEROES users from these two events on the SHEROES app for women.
Breast Cancer Screening & Diagnosis
When should I begin breast cancer screening? What are the breast cancer tests we can get for breast cancer diagnosis?
The most accurate breast screening technique for breast cancer detection is a combination of these methods:
- Self-breast examination
- Mammogram, X-ray and USG
- Doctor’s examination
- Breast tissue biopsy
Screening depends on the risk of breast cancer. A self-breast examination should start as early as the age of 20 years every month.
A clinical check-up with a doctor once a year after the age of 40 is recommended. Mammography is recommended once the clinician suspects a lump depending on the age.
For definitive diagnosis a biopsy of the lump is necessary. It is done under local anaesthesia with or without sonography guidance. A small piece of the breast tissue is taken with the help of a wide bore needle and sent for testing under the microscope.
It is a safe procedure in trained hands. There may be some pain post-procedure which can be managed with simple pain killers. Tests may be advised prior to biopsy and you will be advised to stop taking blood thinners to reduce the risk of bleeding.
How accurate is breast cancer screening with breast cancer mammogram and breast cancer ultrasound? What is the right age for getting mammography done?
Mammography is an X-ray of the breast. It is not recommended before the age of 40 years unless advised by a physician.
Mammography once in two years should be done after the age of 40 to 45 years of age as a part of screening for breast cancer. The accuracy of breast cancer mammogram and breast cancer ultrasound depends on age and breast density.
The sensitivity according to age is 52% for mammography and 72% for an ultrasound. The specificity according to age is 88% for ultrasound and 73% for mammography.
Breast Cancer Self-Exam
How to detect breast cancer lumps during breast cancer self-exam?
Self-examination of the breast is very important for early detection of breast cancer. It should be done once a month 5 to 7 days after the start of your periods.
Examine both of your breasts (self, as well as a physician check-up). The self-breast examination is done with the flat part of the fingers and not with the tips. There are several videos available which can show how it can be done.
Alternatively, you can consult a doctor and learn how to do self-breast examination so you will be able to detect any changes once you understand what is normal.
Get a regular breast cancer screening with mammogram and ultrasound after the age of 40. Sometimes in young women, a breast cancer MRI may be recommended.
All lumps in the breast are not cancerous. Young women often have lumps called fibroadenomas which are non-cancerous lumps. The treatment and risk depend on size.
If small, it can be followed up with monthly self-examination and clinical check-up once a year initially and then less frequently if stable. Large lumps may need surgical removal.
Talk to your daughters and teach them the importance of self-breast examination. Educate your female friends and other members of your family and community.
Breast Cancer Signs & Symptoms
Is breast cancer painful? Are breast pain and breast tenderness some of the early-stage breast cancer symptoms?
Breast cancer lumps can be painful as well as painless. Many early breast cancer lumps are painless, but early-stage breast cancer symptoms can include pain, lumps or nipple discharge.
Breast pain can be a symptom of benign breast disease, fibrocystic lumps associated with hormonal changes, breast engorgement associated with pregnancy or other hormonal changes, as well as breast cancer.
What are some of the early-stage breast cancer symptoms in females?
In breast cancer, lumps or swelling in the breast is the most common symptom and they are usually hard and start off as a painless swelling. Even if this swelling is painless, one should not ignore it.
Any painless lump or swelling in the breast requires a clinical check-up. Other symptoms include discharge from the nipple, changes in the nipple area like skin cracking or discolouration or inverted nipples.
Subtle changes like change in the shape or contour of the breast can also occur. In advanced stages the skin over the breast also changes, appearing like the skin of an orange.
I get a painful sensation in my breast just before my periods. It feels hard and lumpy and it goes away after my periods. Should I be worried?
This is a common symptom in many women. You may have a fibrocystic disease. This does not increase the risk of breast cancer. However, if you notice any lumps it is recommended to get examined by a doctor.
What is inflammatory breast cancer? What are the first signs of inflammatory breast cancer?
Inflammatory breast cancer is a locally advanced form of breast cancer in which the entire skin of the breast is involved leading to redness and appearance of orange like skin.
Change in the colour of the skin of breasts, changes where one breast feels much bigger in size than the other and heavier, orange peel appearance of the breast skin, changes in the nipple are all signs of inflammatory breast cancer.
What is a breast cyst? Can a breast cyst turn cancerous?
A breast cyst is a small fluid bubble and it cannot become cancerous.
Breast Cancer Genes
If I have a family history of breast cancer, am I more likely to get it? How can I find out if I have the breast cancer gene? Is there any blood screening available for breast cancer risk factors?
About 5 to 10% of breast cancers are hereditary. If you have a strong family history of breast cancer, the risk of it being hereditary is higher.
There are certain genes associated with hereditary breast cancer. In order to know your risk of developing breast cancer, these genes can be detected by a blood test called a germline panel for hereditary breast and ovarian cancer.
It is recommended that you meet a genetic counsellor in your area if available to discuss the implications of getting these tests done.
If a genetic counsellor is not available, you can meet a breast cancer specialist or medical oncologist in your area and discuss the same with them.
The breast cancer specialist may recommend a CT scan or USG guided biopsy or other investigations like PET CT scan.
What is the HER2 breast cancer test?
HER2 is a protein found on the surface of breast cells and in some breast cancers it can be over-expressed (HER2 positive). The HER2 test is done on the breast tissue biopsy specimen.
If positive, you may need anti-HER2 or hormone therapy and can plan for surgery, chemotherapy, or radiation based on the breast cancer stage.
Reasons For Breast Cancer
How does breast cancer start? How is breast cancer caused?
Cancer can occur in any part of the body. Increased exposure to estrogen can lead to increased risk of breast cancer as some breast cancers are dependent on estrogen for their growth.
The increase in breast cancer incidence is suspected to be due to lifestyle and environmental changes, however, the exact epidemiologic reasons are unknown.
We do know that some of the risk factors and reasons for breast cancer include genetic or familial factors, smoking, obesity, drinking excessive alcohol, and reduced physical activity. By avoiding these risk factors one can reduce the risk of developing breast cancer.
Obesity is one of the primary causes of breast cancer. A sedentary lifestyle with increased fatty and fast food leads to obesity and increases the risk of breast cancer. Any factors that increase your exposure to estrogen can be triggers for breast cancer.
Some of them include:
- Early start of periods (early menarche)
- Taking hormone pills with high estrogen content
- Never being pregnant
- Late pregnancy and late age of first child-bearing
- Having a single child
- Decreased breastfeeding or not breastfeeding
- Late menopause
- Long-term use of hormone replacement therapy during menopause
Breastfeeding reduces the exposure of estrogen and thus reduces the risk of breast cancer. In a study by the Collaborative Group on Hormonal Factors in Breast Cancer, researchers found that for every 12 months a woman breastfed, her risk of breast cancer decreased by 4.3%.
Women who have not had children or who had their first child after the age of 30 to 35 have a slightly higher risk of breast cancer. Although advanced age is associated with increased breast cancer risk, there is no specific breast cancer age as we also see younger women with breast cancer.
Contrary to popular opinion, wearing any type of bra or wearing a bra at night is NOT associated with increased risk of breast cancer.
Breast Cancer Prevention
What precautions can I take to prevent breast cancer?
Although the risk for breast cancer can never be made zero, one can certainly adopt a healthy lifestyle to reduce the risk.
Lifestyle changes such as avoiding habits like smoking and excessive alcohol intake, regular exercise, healthy eating, and weight reduction can definitely reduce the risk of breast cancer.
Here are some proactive lifestyle changes you can take:
- Avoid excessive alcohol and smoking
- Have your first child before the age of 35 years
- Breastfeed your child for the recommended duration
- Avoid exogenous estrogen or progesterone hormones
- Avoid hormone replacement therapy during menopause
- Eat a healthy diet and maintain ideal body weight
- Exercise daily, at least 150 minutes of moderate-intensity exercise a week
Other precautions include breast self-examination and a yearly mammogram for early detection of cancer.
- Perform self-breast examinations periodically
- Screening mammosonogram once every 2 years after the age of 40
- See a doctor in case of any breast lump, skin changes, nipple changes, a lump in the armpit.
Breast Cancer Diet
Is there any breast cancer diet for breast cancer patients? What are the best breast cancer-fighting foods to include in a breast cancer prevention diet?
Any food in moderation is fine. The key is to eat healthy nutritious food to avoid being overweight or obese since obesity is associated with an increased risk of developing breast cancer.
Some studies do suggest that diets high in fruits and vegetables and low in red and processed meats might lower the risk of breast cancer.
Is Breast Cancer Curable?
What is the cure for breast cancer? Is surgery the only option for breast cancer treatment? Is breast reconstruction required in all cases?
Most cancers can be cured if detected early. Breast cancer treatment usually involves surgery, chemotherapy and/or radiation. For localised breast cancer, surgery is one of the necessary modalities of treatment.
However, with newer advances, it is possible to conserve the breast and only sample the axillary lymph nodes. Advances in breast reconstruction surgery have made it possible to preserve a woman’s cosmetic appearance.
Late detection of breast cancer is a problem. This is mainly because women tend to neglect their own health sometimes. As the initial lump is painless, it may be ignored.
Lack of awareness and shyness to come forward with a symptom can also be the reason. It is important to consult a doctor if one sees any of the signs of breast cancer mentioned above.
There are no herbal or ayurvedic remedies for breast cancer. Currently, there are no breast cancer vaccines, but breast cancer research on new breast cancer treatment options always gives one hope.
Breast Cancer Treatment In India
What is the breast cancer treatment cost in India? Where can one get the best breast cancer treatment in India? Which is the best breast cancer hospital in India?
Breast cancer treatment is covered by all government schemes is free if done in government hospitals. In self-paying patients, it can cost INR 4 to 5 lakhs. Anti-HER2 therapy has an additional cost.
Will breast cancer treatment affect my ability to conceive a baby?
Chemotherapy can interfere with fertility and impair one’s ability to have children. It is recommended to avoid pregnancy for at least 5 years after the diagnosis of breast cancer.
You can consider IVF or embryo preservation to preserve your fertility if you plan to have a baby later.
Male Breast Cancer
Can men get breast cancer? What causes male breast cancer in men? What are the signs of breast cancer in males? How can we detect male breast cancer symptoms of breast cancer in men?
Yes, breast cancer can occur in males and the sign and symptoms are similar to those in females, but it can spread more rapidly. If you see these early signs consult with a breast cancer specialist and do a genetic test.
Genetic testing for the breast cancer gene is recommended in all-male breast cancers since a genetic mutation in BRCA1/2 is associated with increased risk of breast cancer in males.
About the author:
Dr Michelle Frank is a Doctor of Medicine by degree and certified by the Educational Commission For Foreign Medical Graduates. She is currently the Director of Women’s Health for the all-women platform, SHEROES.
She coordinates women’s health on three platforms, SHEROES Health, Babygogo and Maya. Most of her work is centred around menstrual health, reproductive health, sexual health and general wellbeing for women.
When she is not answering medical queries, she is adding content to the growing world of Women’s Health on the internet. In her spare time, she enjoys classic rock music, sketching and reading anything she can get her hands on.