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Breast cancer as common as the disease in India?

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Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an X-ray or felt as a lump: Aparna Dhar, Medical Geneticist, CORE Diagnostics

Every October, we observe Breast Cancer Awareness Month. The aim of this awareness campaign is to help create awareness about Breast Cancer, through early detection, education and support services. It is essential to understand the nuances of Breast Cancer to help reduce your risk of developing the disease.
Every year 1.5 lakh new cases of breast cancer are diagnosed in India, thus making it the leading type of cancer among women. It has replaced Cervical Cancer. 60 per cent of the patients are below the age of 60. These figures show the severity of the disease. Doctors say a lack of awareness about self-examination means that early detection and treatment are rare and that’s contributing to a higher death toll.
Cancer registries are showing that the incidence rate of Breast cancer is definitely higher in the metropolitan cities. Doctors are attributing it to the lifestyle – obesity, alcohol consumption, increasing pollutants – both in the environment and the food we eat. All these factors contribute in increasing ones cancer risk.

What is Cancer?
Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump. The tumor is malignant (cancer) if the cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Breast cancer occurs almost entirely in women, contrary to popular belief men can get breast cancer too.
Where does Breast Cancer start from?
Breast cancers can start from different parts of the breast. Most breast cancers begin in the ducts that carry milk to the nipple (ductal cancers). Some start in the glands that make breast milk (lobular cancers). There are also other types of breast cancer that are less common.
How do you categorize Breast Cancer?
Breast Cancers may be categorized by their primary site of origin or by their histological or tissue type. There are different types of breast cancers i.e. ductal carcinoma in situ (DCIS), Invasive ductal carcinoma, lobular carcinoma in situ (LCIC), Invasive lobular carcinoma, Inflammatory breast disease, etc.

How do you diagnose Breast cancer?
Clinicians use various diagnostic tools to characterize the type of disease. Various methods to detect the stages of cancer advanced imaging techniques and other biopsy tests are required to assess the stage of breast cancer followed by better treatment to improve illness.
Although many types of breast cancer can cause a lump in the breast, not all do.  Many breast cancers are found on screening mammograms which can detect cancers at an earlier stage, often before they can be felt, and before symptoms develop. There are other symptoms of breast cancer you should watch for and report to a health care provider.
It’s also important to understand that most breast lumps are benign and not cancer (malignant). Non-cancerous breast tumors are abnormal growths, but they do not spread outside of the breast and they are not life threatening. But some benign breast lumps can increase a woman’s risk of getting breast cancer. Any breast lump or change needs to be checked by a health care professional to determine if it is benign or malignant (cancer) and if it might affect your future cancer risk.

What are the early signs and symptoms of Breast Cancer?
Knowing how your breasts normally look and feel is an important part of breast health. Finding breast cancer as early as possible gives you a better chance of successful treatment. Screening tests (e.g. mammograms) can help find breast cancer in its early stages, before any symptoms appear.
Symptoms one should look out for:Swelling of all or part of a breast (even if no distinct lump is felt)
Skin irritation or dimpling: Skin of the breast, aureola, or nipple that becomes scaly, red, or swollen or may have ridges or pitting resembling the skin of an orange
Breast or nipple pain: Nipple tenderness or a lump or thickening in or near the breast or underarm area
Nipple retraction : Nipple that is turned slightly inward or inverted
Nipple discharge (other than breast milk)

How do you check for Breast Cancer?
Doctors suggest all women above the age of 20, especially ones with a family history of breast cancer, should self-breast test regularly, seven days before or after menstruation.
With your arms relaxed look for any changes in size, shape, or position, or any skin changes. Look for sores, or skin discoloration. Check your nipples for peeling, or change in their direction.
Place your thumb and forefinger on the tissue surrounding the nipple and with firm pressure, look for lumps.
Check if the nipples are retracted or whether there is any discharge.
After the age of 30, a clinical breast exam is a must, and after 40, an ultrasound or an MRI helps detection too.
It is only after the age of 45 that the doctors suggest that a woman undergo a mammogram. Sometimes the breast is dense and the mammogram is not able to pick up anything.
Are there healthy habits one could adapt to help reduce the chance of being affected by this disease?
There is no sure shot guide that will ensure one does not diagnosed with Breast Cancer. However the following could help in reducing ones chances:
Maintain a healthy weight
Stay physically active
Eat fresh fruit and vegetables
Cut down on saturated fat
Consume more fiber in your diet
Do not smoke

Can genetic testing help me understand my risk of Breast Cancer?
Women newly diagnosed with breast cancer face so many unknowns: What does the diagnosis mean for my future? What kind of treatment is best? Did I inherit a high-risk gene? What effect will my cancer, if it is genetic, have on my children or grandchildren?
Genetic testing can answer some of those questions. But what precedes and follows that test is vital. Many women have been helped by genetic counseling, a detailed discussion by a trained professional of a woman’s specific circumstances. Genetic testing is very complicated, it’s not just a simple blood test, the interpretation hinges not only on the test results, but also on the personal and family history. Genetic tests are far different now than they used to be. Whereas previous tests looked for mutations on only the BRCA genes, today’s genetic tests can identify variations associated with breast cancer on 20 or more genes.
Some of the salient features to consider before opting for genetic testing are:
The chances of breast cancer are high in women with a family history. However, only in 5 to 10 per cent of the breast cancer cases, the gene is thought to be inherited.

Men make up only 1 per cent of all cases of breast cancer. Inheriting the gene can cause breast or prostrate in them.
If you have a family history of breast and ovarian cancer, it is a good idea to get tested for at least the BRCA 1 and BRCA 2 gene mutation.
A genetic test involves giving a blood or saliva sample that can be analyzed to pick up any abnormalities in these genes.
You can consider gene testing if you have a history of breast or ovarian cancer at a young age in two or more close relatives, such as your parents, siblings and children.
Most importantly visit a Genetic Counselor or Medical Geneticist to check if you qualify for genetic testing and knowing the pros and cons of the test.
When it comes to breast and other cancer, the most important weapon that any individual can have is knowledge. Informing yourself about various prevention, screening, and treatment options will allow you to choose what you feel is healthiest for you.

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