Breast Cancer FAQs
Question. Doctor, I am afraid of breast cancer, can you give me some overview.
Answer. Breast cancer is the most common type of cancer among women in India at present. Though it can be detected early by Mammogram, only minority of Indian women undergo this screening test. Once breast cancer develops it can be treated with a combination of surgery, radiation and chemotherapy depending on the stage of the tumour. The good thing about breast cancer is that if it is hormone positive then a long-term survival can be expected even in advanced stage for disease.
Question. How I can know if I am at increased risk of breast cancer.
Answer. There are few clues in history which are suggestive of an increased risk, for example older age, personal history of breast cancer in the past, family history of breast cancer, exposure of breast tissue to oestrogen, taking hormonal therapy for symptoms of menopause, grade 2 obesity for hormone positive breast cancer and alcohol. There are few mathematical tools to find out the risk of breast cancer in individuals. click here for link to external site for one such mathematical tool.
Increased exposure to oestrogen happens if you start menstruating at an early age of 11 and/or late menopause and also in case of late pregnancies or in a woman who has never been pregnant.
Question. Are there any protective factors of breast cancer also?
Answer. Yes, few factors reduce the chance of developing breast cancer. For example, reducing exposure to oestrogen, undergoing regular screening, undergoing mastectomy for breast removal surgery, and adequate exercise to keep weight in healthy zone and breastfeeding as it reduces oestrogen level in the body
Question. I have been taking hormonal contraceptives for last couple of months, am I at increased risk of breast cancer?
Answer. Relationship between oestrogen containing hormonal contraceptives and breast cancer is not very strong. Some studies show a slight increase in the risk, while others do not. Hence at present hormonal contraceptives are not considered to be an additive risk factor
Question. I heard that smoking is one of the most common causes of lung cancer, does it also increase chances of breast cancer?
Answer. Smoking does increase risk for multiple cancers but its relationship with breast cancer is not strong, hence it is not considered to be a risk factor for breast cancer. Similarly there are other misquoted risk factors for breast cancer, like a versions, diet, multivitamins, cholesterol lowering drugs and working late shifts. These are not found to be associated with breast cancer.
Question. I found a lump in my breast since last two weeks, can it be cancer, I am worried?
Answer. Physical examination is very important in breast lump evaluation but majority of breast lumps are not cancerous and can be kept under observation or treated with surgery or medications. However it is best if you consult a doctor for this. Based on physical examination if a cancer is suspected then further tests will be ordered.
Question. I underwent physical examination and the doctor said that it could be a breast cancer, what will be my next step of action.
Answer. After suspicion of breast cancer the next most important step is to confirm the diagnosis by a biopsy. Biopsy is a small interventional procedure, done by either a surgeon or a radiologist with ultrasonic guided biopsy needle. In most cases it is uncomplicated and is not painful or associated with significant bleeding. Some patients fear that a biopsy may spread the cancer in the body, however this is a misconception and nothing of that sort actually happens.
Question . Ok, my biopsy is also done which confirms it to be breast cancer but I could not make head and tail of the biopsy report, can you explain it to me?
Answer. Sure. The most important part of the biopsy is the type of breast cancer. Intraductal cancer is the most common type of breast cancer. The next most important thing to be seen is the hormone status which is known as ER, PR viz oestrogen receptor, progesterone receptor. Result of these ER, PR tells us if we can use oral hormonal agent in metastatic cases or whether we need to offer tablets after surgery. The third most important thing is HER-2 status. If HER-2 status is positive then one must receive anti HER-2 therapy in the form of trastuzumab along with chemotherapy.
Question. My PET CT scan suggests that there is a focal area in my bones along with my breast lump, what does it imply?
Answer. The purpose of PET CT Scan is to find out if there are any distant metastasis. Usually based on the PET CT scan we are able to tell whether it is metastatic site or not. If a metastatic site is confirmed that makes it is stage 4 disease.
Question. What does stage 4 mean and what is the implication of stage 4?
Answer. When a cancer originates at one organ, say in breast and spreads to other organs for example the liver, bone, brain then it is known as stage 4 disease. In most cases for a stage 4 disease our intention changes, it means that uptill stage 3 we expect cure. However in stage 4 our primary intention of treatment is to control the disease. Based on the biology of the disease we can expect good control for months to years.
Question. I read a lot about breast cancer on internet and found that there is something known as triple negative breast cancer. what does it mean and how to know if I have triple negative breast cancer
Answer. In biopsy report you can find out ER, PR and HER-2 status. If all three of them are negative then it is known as triple negative breast cancer. It is usually more aggressive type and chances of relapse after treatment is higher. If it is metastatic stage 4 triple negative breast cancer it means that we cannot offer you oral tablets of hormonal agents, but there are multiple treatment options even for triple negative metastatic disease.
Question. I don't want to take chemotherapy, I heard about immunotherapy can I take that?
Answer. In stage 2 cancer if hormone status is positive we can send operative tissue for certain tests known as oncotype DX or mama print. Based on this we might be able to avoid chemotherapy if the risk comes to be lower.
If the hormone status is negative then chemotherapy is highly recommended in any stage.
At present only in stage four metastatic disease, with Limited benefit of progression free survival control.
Question. So am destined to receive chemotherapy what are the usual side effects I can expect.
Answer. Chemotherapy for breast cancer is usually well tolerated with only a minority of patients developing side effect which require hospitalization. Specific Side Effects are protocol dependent and is available on my website under the section “for current patients”.
Question. I am found to have breast cancer while I am pregnant, how will the treatment plan differ from non pregnant women?
Answer. Depending on the stage you are diagnosed with radiation maybe an important part of your treatment plan. Since radiation cannot be given if the baby is still in the womb so a breast conservation surgery is usually avoided. Chemotherapy options are usually the same because they do not cross the placenta. Lactation has to be avoided if chemotherapy is being given. Trustuzumab may cause oligohydramnios.
Question. Can breast cancer happen in males?
Answer. It is rare to find breast cancer in males but 1% of breast cancers do happen in them. Usually male breast cancers are found at an early stage because lumps are palpable early. Evaluation and management is more or less similar. A family history of breast cancer and genetic mutation like BRCA2 can predispose a male to breast cancer.
Questions. What can I tell my friends and family members, when to seek medical help regarding breast cancer?
Answer. Following points are Red flag signs for breast cancer:
A lump or thickening in or near the breast or in the underarm area.
A change in the size or shape of the breast.
A dimple or puckering in the skin of the breast.
A nipple turned inward into the breast.
Fluid from the nipple, especially if it's bloody.
Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple).
Dimples in the breast that look like the skin of an orange, called peau d’orange.
Question. I heard about Angelina Jolie removing her breast by operation for prevention of cancer. Is this surgery the only way to prevent breast cancer?
Answer. Angelina Jolie’s case is different. She was found positive for a family genetic mutation known as BRCA 1 in the blood sample. These tests are also available to Indian population. If this test is positive then breast cancer and ovarian cancer risks are higher. Breast removal definitely reduces the chance of breast cancer but does not prevent against ovarian cancer or peritoneal malignancies associated with this change.