Q1) I HAVE A LUMP IN MY BREAST AND I AM AFRAID IT IS CANCER. SHOULD I BE WORRIED?
A) 80% of the women who feel lumps in their breast have benign lumps (not cancerous). 20% of the women could have malignant lumps (cancerous in their breast). A benign lump can be a collection of normal or hyperactive breast gland cells, or maybe a water filled sac (cyst) and it does not have cancer
If you feel a lump and you are worried, DO NOT HESITATE TO SEE A DOCTOR. It will ease your fears and if it is something serious you can start the treatment immediately.
Q2) WHAT IS BREAST CANCER?
A) Breast cancer is the collective term for all the cancers that originate in breast tissue. Breast cancer is a disease in which malignant (cancer) cells form in the tissue of the breast.
Q3) WHAT ARE THE WARNING SIGNS?
The commonest signs of breast cancer are
a) Lump or thickening in the breast
b) Change in the size or shape of the breast
c) Discharge from the nipple
d) Change in the colour or feel of the skin of the breast or nipple (dimpled, puckered, scaly, warm, red or swollen)
e) Nipple turning inwards
f) Lump in the under arm area
There may be no warning signs or symptoms. Breast self examination, clinically breast examination, regular mammogram are essential for early detection of breast cancer.
Q4) WHAT ARE MY RISKS FOR GETTING BREAST CANCER?
Being a woman and getting older are biggest risk factors.
a) Onset of menstruation before 12 years of age
b) Onset of menopause after 50 years of age
c) Not having children or having a first child after age 30
d) Family history of breast cancer
f) Alcohol consumption
g) Using hormone replacement therapy or birth control pills.
Q5) HOW DOES WEIGHT INFLUENCE BREAST CANCER AND CAN EXERCISE REALLY HELP TO CUT DOWN THE RISK OF BREAST CANCER?
Maintaining a healthy weight is one thing that can be done to lower the life time risk of breast cancer. Higher BMI (body mass index) can increase the risk of breast by 30 to 60 % (particularly worrisome is often hidden abdominal fat).
Physical activity reduces breast cancer risk. Exercising three or more hours per week could reduce the risk by 20 to 30%.
Q6) IF NO ONE IN MY FAMILY HAS BREAST CANCER, CAN I STILL GET IT?
Yes you still can. Only about 30% of women who develop breast cancer have a family history of the disease. The other 70% have what is called a ‘sporadic occurrence’ (without a known family history of the disease)
Q7) WHEN SHOULD I START HAVING MAMMOGRAMS AND HOW OFTEN SHOULD I HAVE THEM?
Women from the age of 40 years should have a mammogram done yearly. The younger women typically have dense breasts and on a mammogram this dense breast shows up as white-which is the same colour that cancer appears as on mammogram. As the woman ages the dense tissue in the woman’s breast is replaced with fatty tissue which looks grey on a mammogram. It is much easier to see the white cancer against this grey background. Mammogram can help you find your cancer early.
Q8) IS A MAMMOGRAM PAINFUL?
The pressure caused by spreading the breast tissue maybe uncomfortable, but not painful.
Q9) IS THE RADIATION EXPOSURE FROM GETTING A MAMMOGRAM HARMFUL?
The radiation exposure from low dose, modern mammography machines is minimal. Radiation doses usually are so low that they are negligible. The medical benefits of early detection outweigh any potential risk.
Q10) HOW IS BREAST CANCER DIAGNOSED?
When you are referred to a specialised breast centre, physical examination and some few tests will be organised to determine if you have breast cancer.
b) Ultrasound/ MRI breast
c) Biopsy- a small sample of breast tissue is removed using a needle on an outpatient basis. The result of biopsy is available within 3 or 4 days.
Q11) HOW DOES BREAST CANCER SPREAD?
Breast cancer cells can break away from the original site and move around the body to form secondary breast cancer. This spread usually occurs via blood and lymphatics. Lymph nodes in the arm pit are a common place for breast cancer to spread. Such spread can happen to some of the distant organs like liver, lungs, bones, brain, etc.
Q12) HOW DO I DECIDE WHICH TREATMENT OPTION IS BEST FOR ME?
Your physician will discuss about the treatment options. Although there are four standard ways to treat breast cancer, surgery, chemotherapy, radiation therapy, hormonal therapy, several treatments may be combined. Your doctor will recommend treatment depending on the type and location of cancer, the stage at which it is detected, your age, and general health condition.
Q13) HOW DO I DECIDE WHICH SURGERY IS RIGHT FOR ME?
Two main types of surgery are used in treatment of breast cancer.
First is the breast conservation surgery- Only the cancerous lump in the breast and a small amount of surrounding normal tissue is removed. Rest of the breast tissue is left intact.
The second is the mastectomy- Whole of the affected breast is operated and removed.
Your surgeon will decide the type of surgery most suitable for you, considering number of factors like the size and the location of the tumour within the breast.
Women who undergo breast conservation surgery will require radiation therapy after surgery. Radiation therapy reduces the chances of tumour recurring in the breast.
Q14) IS IT NECESSARY TO UNDERGO AN OPERATION TO REMOVE THE GLANDS FROM THE ARM PIT?
The most common site for breast cancer cells to spread is to the small glands called lymph nodes in the arm pit. This is done through a procedure known as sentinel lymph node biopsy or axiliary lymph node dissection. This is normally performed at the same time as removal of the breast tumour or complete breast. This procedure helps us in planning the further treatment like chemotherapy and radiation therapy.
Q15) IF I HAVE A MASTECTOMY, DOES THAT MEAN I WONT NEED ANY OTHER TREATMENT AFTER SURGERY?
NO. In some cases after mastectomy it may still be necessary to undergo radiotherapy, chemotherapy and hormonal therapy depending on the type of the tumour and the stage of the disease.
Q16) WHAT ARE THE SIDE EFFECTS OF THE TREATMENT?
The side effects of chemotherapy are different for different people. This also depends on the different kinds of drugs and drug doses which are used. The side effects of chemotherapy are
a) Nausea and vomiting
b) Hair loss
e) Mouth sores
Not everyone will experience all the side effects.
Fibrosis or scarring of the remaining breast tissue may occur following radiotherapy. In some cases breast can become noticeably smaller and harder. Fibrosis can also block lymph drainage of the arm and cause lymphoedema.
The side effects are similar to symptoms experienced by women who are going through the menopause such as hot flushes, night sweats, vaginal dryness, irregular periods and in some cases joint pain.
Q17) SHOULD MY FAMILY MEMBERS BE TESTED FOR CANCER?
Some cancers like breast, prostate, pancreatic and colon can have a hereditary component. If someone in the family has one of the these cancers, it may be advisable for other family members to undergo genetic testing.
Q18) WILL MY CANCER COME BACK?
This is one of the most common questions asked by cancer survivors. In some cases cancer can recur or a new cancer can form years or even decades after treatment. One of the goals of breast cancer support group is to help patients come to terms with their fears about cancer recurrence so that they can lead a productive and fulfilling life. Another goal is to ensure that the survivors realize the importance of periodic checkups after their last treatment for cancer.