Breast cancer begins when a cell within the breast undergoes a mutation and starts to multiply at an uncontrolled rate. With over many breast cancer diagnoses each year in India, new and advanced treatments have fortunately elevated the disease's five-year survival rate to approximately 90%.
Every individual, irrespective of biological sex, possesses some amount of breast tissue. The breast rests atop the pectoral (chest) muscles and is primarily composed of fatty tissue and connective tissue, which determine its shape. Breasts also contain small, bean-shaped organs called lymph nodes, which are vital for transporting immune cells and eliminating waste. In women, specialised glands known as lobules produce milk. These lobules connect to the nipple via small channels called ducts.
Breast cancer results from the uncontrolled growth and multiplication of breast tissue cells. While it predominantly affects women, it can also occur in men. Your prognosis and treatment options are determined by several key factors:
The origin point of the cancer within the breast.
Whether the cancer is invasive or non-invasive.
The molecular receptor status of the cancer cells.
Although breast cancer can originate in various tissue types, most cases are categorised as either:
Cancer that begins in the ducts.
Cancer that begins in the lobule glands.
Both ductal and lobular carcinomas are further classified based on whether they have spread to the surrounding tissue:
This is an early stage of cancer that remains confined within the ducts. It is often detected during routine screening. If it spreads to surrounding tissue, it becomes invasive ductal carcinoma, which is the most commonly diagnosed form of breast cancer.
This is less common and is not strictly classified as cancer, but it indicates a higher risk for developing breast cancer later. If it spreads to other tissue or lymph nodes within the breast, it is considered invasive lobular carcinoma.
Receptors are molecules produced on the surface of cancer cells. They are capable of binding with specific proteins and hormones in the patient's body, a process termed 'recognition'. Researchers have identified certain receptors that accelerate the growth and spread of the disease. Interrupting this recognition process with targeted medications can slow or stop the cancer's progression.
The three main receptor subtypes, which significantly influence prognosis and treatment, are:
Indicates much higher than normal levels of the HER2 protein, which promotes cell growth and multiplication.
Recognises the hormones oestrogen and progesterone.
Does not recognise HER2, oestrogen, or progesterone. Lacking a molecular receptor to target, this is often the most challenging subtype to treat.
Though less frequent, thousands of men are diagnosed with breast cancer. The average age at diagnosis for men is 67, compared to 62 for women. The five-year survival rate is slightly lower for men, often because the cancer is typically more advanced when diagnosed—tumours are larger, and the cancer is more likely to have spread to regional lymph nodes. This is often attributed to a general lack of awareness and the absence of widespread screening for the disease in men.
Factors that increase a man's chance of developing breast cancer include:
Mutations in the BRCA1 and BRCA2 genes, which normally suppress tumours, are present in 8%-15% of male breast cancer patients.
The risk doubles for men with a parent, sibling, or child who has had the disease.
The risk increases as men get older.
Increased body weight is a risk factor.
Enlarged breasts caused by hormone imbalance or specific medications.
Often as a result of treatment for a different cancer.
Breast cancer symptoms vary greatly from person to person, and there is no fixed definition of how a lump or mass should feel. The most important step is to become familiar with your breasts so you know what is normal for you and to inform your doctor immediately if you notice any changes. While self-exams are important, many breast cancers are detected via regular screening mammograms before symptoms become apparent.
A lump or mass in the breast.
A lump or mass in the armpit.
Changes to the breast skin, such as redness and thickening, which can result in a texture resembling an orange peel.
Dimpling or puckering on the breast surface.
Discharge from the nipple.
Scaliness on the nipple, sometimes extending to the areola.
Changes to the nipple, including turning inward, pulling to one side, or changing direction.
An ulcer on the breast or nipple, occasionally extending to the areola.
Swelling of the breast.
It is important to note that these symptoms do not definitively mean breast cancer, but they must be discussed with your doctor as they may signal other health issues.
If you experience symptoms, notice changes in your breasts, or have an abnormal screening result, your doctor will need to conduct a thorough investigation to reach a definitive diagnosis.
The diagnostic process typically begins with a breast exam, where your doctor manually checks your breasts and armpits for lumps or abnormalities. If breast cancer is suspected, imaging tests will be ordered for a closer look:
X-ray pictures of the breasts are taken from different angles to look for signs of cancer.
A device uses high-energy sound waves to create a picture (sonogram) of the tissue.
Occasionally, more specialised examinations like an MRI may be used.
If imaging reveals a suspicious mass or skin thickening, a tissue sample is required for a definitive diagnosis. This process, called a biopsy, involves retrieving and examining the tissue under a microscope.
Once a patient is diagnosed, the cancer cells will be analysed to determine the disease's molecular receptor subtype. Understanding this subtype is crucial for developing a comprehensive, personalised treatment plan.
Breast cancer treatment is highly individualised and depends on the cancer type, stage, hormone receptor status, and the patient's overall health. Treatment is primarily delivered through surgery, often combined with chemotherapy, radiation therapy, or both, and may also include targeted therapy, hormone therapy, and immunotherapy.
Surgery is often the first step in treatment. In some cases, chemotherapy or targeted therapy may be given beforehand (neoadjuvant) to shrink the tumour and lymph nodes, making the procedure easier.
The two main types of breast surgery are:
The tumour and a small margin of surrounding healthy tissue are removed. This may be an option for early-stage, smaller tumours and is typically followed by radiation therapy.
The entire breast, including the nipple and areola, is removed. There are various types, and reconstruction can often be performed simultaneously. In high-risk cases (e.g., due to a BRCA mutation), a double mastectomy may be recommended to prevent new cancer development.
This focuses on checking or removing the lymph nodes in the armpit to see if the cancer has spread:
A special dye or radioactive tracer locates the sentinel node (the first node to which cancer would likely spread), which is then removed and tested for cancer.
If cancer is found in the lymph nodes, several nodes under the arm may be removed to help prevent further spread.
Surgery Side Effects may include: Pain or swelling in the chest, scarring and potential change in chest shape, numbness or tingling from nerve damage, and lymphedema (arm swelling) if lymph nodes are removed.
Chemotherapy uses powerful drugs to kill cancer cells, control their growth, or alleviate symptoms. It can be administered as pills, injections, or intravenously (IV), usually in cycles over several months.
Used to shrink larger tumours.
Helps reduce the risk of the cancer returning.
Chemotherapy is often recommended for larger or aggressive tumours, cancer that has spread to lymph nodes, or HER2-positive or triple-negative cancers.
Chemotherapy Side Effects may include: Fatigue, hair loss, nausea or vomiting, increased risk of infection, mouth sores, and temporary or long-term fertility issues.
Radiation therapy uses powerful, focused energy beams to kill cancer cells, precisely targeting the tumour while minimising damage to healthy tissue. It can be used alone or combined with other therapies, either before surgery to shrink tumours or after surgery to destroy any remaining cancer cells. After a lumpectomy, patients often receive three to four weeks of daily radiation; a mastectomy or lymph node involvement may require six weeks.
3D conformal radiation therapy, Intensity-Modulated Radiation Therapy (IMRT), Volumetric Arc Therapy (VMAT), Accelerated Partial Breast Irradiation (APBI), Stereotactic Body Radiation Therapy, and Stereotactic Radiosurgery. SSCHRC breast radiation oncologists are dedicated exclusively to breast cancer care.
Radiation Therapy Side Effects may include: Skin redness or peeling in the treatment area, fatigue, chest wall discomfort, and rarely, long-term risk of damage to nearby organs like the lungs or heart.
Targeted therapies interfere with the specific molecules or genes that cancer cells need to survive, multiply, and spread. They have become a significant tool, particularly for subtypes that historically had a poor prognosis.
Given for hormone receptor-positive breast cancer, this treatment blocks hormones or prevents their production. It is often a long-term treatment (five to ten years) after initial therapy to prevent recurrence.
Patients with HER2-positive breast cancer receive specific targeted drugs before and after surgery.
These drugs disrupt the process of new blood vessel creation (angiogenesis) that some tumours use to grow rapidly.
Targeted Therapy Side Effects may include: Fever or chills, heart problems (especially with certain HER2 drugs), diarrhoea, and skin rashes.
Immunotherapy aims to boost the immune system's ability to detect and destroy cancer cells. This treatment may be used for patients diagnosed with triple-negative breast cancer and is often combined with chemotherapy for more effective results.
Immunotherapy Side Effects may include: Fatigue, skin problems (rashes, itching), fever and chills, nausea, and diarrhoea.
After completing treatment, consistent follow-up care is essential to maintain health and monitor for any signs of recurrence. Male breast cancer survivors are advised to: