Breast cancer is the most common cancer to affect women worldwide. Over the years, India also has seen an increased incidence of the deadly disease – as high as 25.8 per 1 lakh women according to one study, with a mortality rate of 12.7 per 1 lakh women.
Despite increased efforts at awareness, experts say that they still get cases of the cancer in advanced stages. This is a huge setback, because with surgical techniques and treatments becoming advanced, it is usually possible to rid someone of cancer while conserving their breast as well, if detected early.
So, what can you do to protect against breast cancer, and aid early detection? TNM spoke to two experts to find out.
Self-examination
According to Dr Mathangi J, a radiation oncologist at BGS Global Hospitals in Bengaluru, as well as Dr Rajesh Balasubramanian, an oncoplastic breast surgeon at Apollo Hospital, Chennai, the increasing incidence of breast cancer in India has to do with a shift in lifestyle – its increased sedentary nature, lack of healthy diet, increased alcohol consumption and so on.
Dr Mathangi says women should start self-examination every month, seven days after their period (because the breasts may be tender before that), from the age of 20. Post-menopausal women or those who do not have periods for any other reason, can fix a day for self-examination each month.
“It’s essential to know your breasts to understand what is normal. Some people have breasts that are different in size, some may have protruding or inverted nipples, or areolas larger on one breast than the other. All of this is normal for them. The idea is to be able to spot changes,” she says.
How to do self-examination:
1. Stand in front of a mirror which clearly shows the top of your head to the mid-section.
2. First, keep your hands by your side. Observe how your breasts normally look. Then place your hands on your hips, to see the front of the breasts; and then hands raised above to see the underside of breasts. Finally, lie down on a flat surface. In each of these positions, use slow circular motions to check for lumps in the breasts.
3. Never pinch your breast while checking for lumps; always have a flat palm and palpate it around your breasts.
Apart from the breasts themselves, self-examination should include the area from under the breast to 1-2 cm near the collarbone, and across from one armpit to another. Some bulge in the armpit area is normal, especially if it has always been there. Any changes in the skin (pulling, puckering, redness), nipple (normally protruding nipple turning inward), shape, or size of the breast, fungal infections, or discharge, should be reported to your doctor.
“Many times, the changes can be hormonal or related to age, or to other treatments or illnesses. But we need to rule those out,” Dr Mathangi says.
Screening
Ideally, Indian women above the age of 40 should go for mammograms once in two years, say Dr Mathangi and Dr Rajesh.
However, if they come from a high-risk family – where multiple first-degree relatives have reported breast cancer, then the mammograms need to start earlier. The same applies if there is a male who has had breast cancer in the family – yes, men can get breast cancer as well.
“In such cases, there is a good chance that your genetic predisposition to breast cancer is higher. The BRCA gene, one of the most common genes whose mutations determine susceptibility to breast cancer, becomes more problematic when a male family member has the disease,” explains Dr Mathangi. The BRCA gene test is given to those who come from high-risk families, to determine this.
Dr Rajesh says someone whose family member has been detected with breast cancer at an early age, that is, below 40-45 years, is also at a higher risk. “If a family member has reported breast cancer at the age of 30, then it is likely that the mutation of the BRCA gene is present. The younger members of the family should then start screening at 25 years of age, or five years before the youngest patient in the family was detected with cancer.”
Experts say that women must disclose if diagnosed with breast cancer, to close family members at least so that they can also start screenings at the right time.
Dr Rajesh also says that people not maintaining the once in two years frequency for mammograms could prove counterproductive. “Mammograms can detect cancer even before it has formed into a lump i.e. at stage zero. If you can feel the lump, and the tumour is malignant, then the cancer has crossed stage one. Maintaining a record of mammograms also allows for spotting changes more easily,” he explains.
Unless recommended, Dr Rajesh says screening should not be done more frequently than once in two years because it would unnecessarily expose one to radiation.
Breast cancer in men
Contrary to popular belief, men can also get breast cancer. Men’s breast tissue is almost identical to women’s, except that they don’t have as much mass and specialised lobules for producing milk, which means that they too can get breast cancer. However, the incidence is much, much less – about 1% of all breast cancer cases. There are no comprehensive numbers for India; although one study published in 2015 found 18 cases of male breast cancer (MBC) out of 1,752 cases of breast cancer registered during a 10-year period at a cancer research centre.
The major problem with MBC is that due to low awareness, the cancer is detected at an advanced stage, and therefore has high mortality. “If a lump of 1-2 cm is detected in women, due to the surrounding breast tissue, the tumour would not have eaten into the skin or other important parts if detected early. So, it can be removed surgically, with a margin. But in men, due to the lack of mass, the tumour may infiltrate the chest wall, and spread elsewhere much more quickly. It may soon reach beyond stage 4, or T-4, meaning it becomes inoperable or difficult to remove,” Dr Mathangi explains.
Dr Rajesh adds that MBC generally affects men who are above the age of 50, and one of the common symptoms is swelling on one side of the chest. “There is some sagging and swelling with age, which can be attributed to hormones as well that usually affects both breasts. In youngsters, such as adolescents, it could be due to fat, hormonal imbalances, or other medication as well,” he says.
He adds that for men, unfortunately, there is no screening. But like women, they should regularly check for lumps and report any abnormality to their doctor. “The treatment is the same as women – surgical removal, chemotherapy or radiation where indicated,” he says, adding that men generally develop breast cancer due to genetic predisposition, and mutation of the BRCA gene.