Breast Cancer

Breast cancer occurs when cells in the breast grow abnormally and form a tumour. It is the most common cancer in women worldwide and early detection significantly improves treatment success.

• Age: Risk increases with age (most common after 50).
• Genetics: ~5-10% link to inherited mutations (e.g., BRCA1, BRCA2).
• Hormones: Early menstruation, late menopause, prolonged hormone replacement therapy (HRT).
• Reproductive History: No children, first pregnancy after 30.
• Lifestyle Factors: Obesity (post-menopause), alcohol consumption, physical inactivity.
• Other: Dense breast tissue, previous chest radiation, personal/family history of breast/ovarian cancer.

Symptoms

• A new lump or thickening in the breast or armpit.
• Changes in breast size, shape, or appearance.
• Skin changes: Dimpling, puckering, redness, scaling (like an orange peel).
• Nipple changes: Inversion, discharge (especially bloody), rash.
• Persistent breast or nipple pain (less common).

Prevention & Risk Reduction

• Maintain a Healthy Weight: Especially post-menopause.
• Limit Alcohol: Avoid or restrict intake.
• Stay Active: Aim for ≥150 minutes moderate exercise weekly.
• Breastfeed: If possible, for several months.
• Limit Hormone Therapy: Discuss risks/benefits and type of HRT with your doctor.
• Know Your Risk: Discuss family history/genetic testing if high-risk.
• Prophylactic Options: High-risk women may consider medications (e.g., tamoxifen) or surgery.

Screening

• Self-Exams: Know your breasts; report changes immediately.
• Clinical Breast Exams: Performed by a healthcare provider.
• Mammograms:
  • Average Risk: Typically start at age 40-50years, however, discuss timing with your doctor.
  • High Risk: May start earlier and include additional tests (MRI).
• Screening Frequency: Usually every 1-2 years for average-risk women.

Diagnosis

• Imaging: Diagnostic mammogram, ultrasound, MRI.
• Biopsy: Essential for diagnosis (e.g., needle core biopsy, surgical biopsy).
• Pathology: Determines cancer type (e.g., ductal, lobular), grade, and receptor status (ER, PR, HER2).

• Surgery:
  • Lumpectomy: Removal of tumour + surrounding tissue (often + radiation).
  • Mastectomy: Removal of entire breast (simple, modified radical).
  • Sentinel Lymph Node Biopsy / Axillary Dissection: Checks lymph node spread.
• Radiation Therapy: Targets remaining cancer cells post-lumpectomy or high-risk mastectomy.
• Systemic Therapies:
  • Chemotherapy: Kills rapidly growing cells (given before/after surgery).
  • Hormone Therapy: Blocks hormones (e.g., Tamoxifen, Aromatase Inhibitors) for ER/PR+ cancers.
  • Targeted Therapy: Attacks specific cancer markers (e.g., Trastuzumab for HER2+ cancers).
  • Immunotherapy: Boosts immune system against cancer (for some types).

Frequently Asked Questions (FAQs)

• Q: Is breast cancer hereditary? 
  A:Most cases are not, but family history increases risk. Genetic testing is advised for high-risk families.
  
  
• Q: Do antiperspirants or underwire bras cause breast cancer? 
  A:No, scientific evidence does not support this.
  
  
• Q: Does a breast injury cause cancer? 
  A:No, but trauma may draw attention to an existing lump.
  
  
• Q: What’s the survival rate? 
  A:Varies greatly by stage. Localized (Stage I) has >99% 5-year survival; advanced stages are lower. Early detection saves lives.
  
  
• Q: Can it come back? 
  A:Yes, recurrence is possible. Lifelong follow-up is important.
  

eGynaecologist Advice

• You should promptly report any changes in breast including new lump, skin change, or nipple discharge which will require immediate evaluation.
• Many early breast cancers cause NO symptoms, and you must, therefore, adhere to breast screening and follow recommended mammogram schedule based on your risk.
• You should seek opinion from you gynaecologist to discuss family history and opt for genetic testing to know your risk profile