Breast Cancer


There is a major fear about family history and hereditary breast cancer. While breast cancer is known to be hereditary, it is important to get this risk into perspective. First of all, the majority of breast cancers are NOT FAMILIAL. Only7-10 % of all diagnosed breast cancers are familial, hence the majority of breast cancers are "sporadic" ie that they occur in a normal population with no obvious familial factor. It is important to realise that our knowledge regarding hereditary breast cancer is slowly growing and it will still be some time before we are able to quantify the risk of this type of breast cancer accurately and translate this information into prevention/ management of breast cancer.

What is "family history?"
It is important to understand what is "family history of breast cancer". Any affected relative, at any level of relation, does not constitute a risk of hereditary breast cancer.

What is "significant family history?"
  • Multiple family members being affected by breast / ovarian cancer.
  • First degree family member (ie mother/sister) affected.
  • Early age at diagnosis (< 50 years)

It is important to realise that if a mother or sister is diagnosed to have breast cancer at the age of 70 years, then this history is unlikely to signify an increased risk of breast cancer for the daughters or the sisters of the affected individual. Such type of disease is more likely to constitute "sporadic" breast cancer.

Is it possible for me to get genetically tested for the risk of developing breast cancer?
There are some ways of testing for the presence of cancer-determining-genes. However such testing should be undertaken after adequate counselling with a consultant in genetics. These tests are still in their infancy and their interpretation should also be undertaken with caution.

How will I know that I have breast cancer?

The commonest sign of a problem in the breast is the development of a lump. Other signs which require evaluation are:

  • fluid discharge from the nipple
  • retraction of the nipple
  • skin changes over the breast/ nipple and areola and
  • breast pain.

It is possible for breast cancer to mimic any change in the breast and it is important to be aware, that if there is any change in the appearance of the breasts, or any new symptom in relation to the breasts then you should visit your family physician for advice.

Is there anything I can do to minimise the chance of developing breast cancer?
While there is nothing one can do to prevent the development of cancer, being aware of the signs and symptoms and by examining ones breasts regularly, it is possible to detect the possibility of a potential problem at a early stage.

What should I do if I feel a lump in the breast?
The most appropriate action would be to seek proper medical advice from your family physician.

How is breast cancer detected?
Cancer affecting the breast is detected by appropriate investigations some of which are listed below:

Breast Imaging
  1. Mammogram

  2. This is an x-ray of the breast. It is able to detect masses, changes in breast density and depositions of calcium within the ducts of the breast. It is more effective in the elderly and of limited use in younger ladies as their breasts are more dense.

    Deposition of calcium in the breast tissue is often the earliest indication of an abnormality in the breast.

    More about Mammography

    Example of Mammographic Abnormalities
    Example of Cancer

  3. Ultrasound of the breast

  4. This examination is useful in younger women, where the mammograms are of limited use. It is able to differentiate between a solid and a cystic structure. Moreover it can often detail the outline of the breast lump and provide important information.

    Pictures of Ultrasound of the breast

  5. MRI of the breast.

    MRI is being used for the diagnosis of breast conditions, however its overall significance in the management of breast diseases is still under evaluation.

Pathological assessment of breast tissue.

The only definite way of diagnosing cancer is by obtaining proof of its existence in the tissues of the breast. This can be achieved by the following ways.

  1. Fine Needle Aspiration Cytology (FNAC).

  2. In this method a small needle is inserted in to the mass felt in the breast and a few cells are aspirated and then spread out on a glass slide. The pathologist looks at these cells and gives a diagnosis.

    Pictures of FNAC being done and Cancer Cells

    More about FNAC

  3. Core needle biopsy.

  4. The principle is the same as the FNAC. However, instead of a few cells a core of tissue is extracted from the breast. A larger bore needle is used for in this technique and hence a local aneasthetic agent is used to numb the area prior to inserting the needle.

    A core needle biopsy allows more tissue to be removed from the breast. This allows the pathologist to give a histological diagnosis as against a cytological diagnosis obtained by FNAC

    Both the above tests can be easily performed in the consulting room.

  5. Open biopsy

  6. In this technique, the mass or abnormal area in the breast is removed and sent to the pathologist for examination. This requires a cut to be made on the breast and is done under local or general anaesthesia. More about open biopsy

  7. Needle-localisation excision biopsy

This method is used for diagnosing tumours which are too small to be felt by the doctor but are seen on mammogram. It involves the placement of a fine needle in the breast guided by mammograms. The surgeon then removes the necessary area around the needle (guided by it) and submits it for examination.

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