Let's know some important facts on Breast cancer

By: Reshma Jain

Due to the “taboo” associated with the disease, lack of awareness and absence of an organised nationwide population-based breast cancer screening programme, more than 70 per cent of breast cancers in India are present in advanced stages, and as a consequence, the majority succumb to the disease within a year of being diagnosed. With 87,000 deaths per annum, tragically, a woman loses her life to breast cancer every 10 minutes in India.

This having stated, benign non-cancer breast health issues are far more common than breast cancer. In a conversation with Socio Story, Dr. Raghu Ram Pillarisetti OBE, Founding Director & Consultant Surgeon, KIMS-USHALAKSHMI Centre for Breast Diseases, KIMS Hospitals, Hyderabad, busts a few myths and throws light on the facts.

MYTH

Most breast lumps are cancers

FACT

9 out of 10 breast lumps are not cancers. However, it is vitally important to investigate the breast lump by way of Triple assessment (Clinical Breast Examination by a Specialist, Bilateral Mammogram and Ultrasound guided core needle biopsy) in order to obtain a definitive diagnosis.

MYTH

Breast cancer affects only older women

FACT

Although the majority of breast cancers occur in women over the age of 50 in the western world, it can in fact occur at any age. It is alarming to note that the majority of breast cancers in India are diagnosed at a much earlier age in India (< 50 years).

MYTH

Breast cancer does not occur in men

FACT

Many people are unaware that men can develop breast cancer because they do not think men have breasts. In fact, both men and women have breast tissue. It is important to be aware that a small proportion of men do get breast cancer each year. Although precise statistics in India are unknown, approximately 350 new cases of breast cancer are diagnosed in men each year in the United Kingdom (approximately 1% of breast cancers)

MYTH

We know what causes breast cancer

FACT

We do not know what causes breast cancer. There are however well recognized risk factors. Being a woman and increasing age are the two most important factors.

Other known risk factors are:

· Previously diagnosed breast cancer in the same or other breast

· Strong Family history of breast cancer (close relatives with breast cancer)

· Early onset of menstrual period (before age 12)

· Late menopause (after age 55)

· Not having children and having first child after age 30

· Long term use of Hormone replacement therapy

· Obesity (overweight particularly after menopause)

MYTH

If you have a risk factor for getting breast cancer, you are likely to get the disease

FACT

The risk of getting breast cancer is not a certainty, even if you have one of the strongest risk factors

MYTH

Family history of breast cancer is the most important risk factor for getting breast cancer

FACT

The vast majority of women with breast cancer do not have a family history of breast cancer. Strong family history (genetic predisposition) accounts for only 5-10% of breast cancers. Those found to be positive for faulty genes (BRCA1 & BRCA2) have significant lifetime risk of getting breast cancer. Not everyone who has BRCA positivity gets breast cancer. The test should ONLY BE CONSIDERED when there is a significant family history of breast cancer (HIGH RISK GROUP) and that too only after adequate genetic counselling. 

MYTH

Breast cancer screening is effective in all age groups

FACT

Whilst it is important for women of all ages to be 'Breast Aware', Breast screening is effective only in women over the age of 40 years. Routine breast screening for women under 40 and without symptoms is not effective.

MYTH

Mammography is painful

FACT

Whilst Mammography may cause momentary discomfort, it is not painful.

MYTH

Mammography is not safe. It causes radiation hazards.

FACT

Mammography involves a tiny dose of radiation – the risk to health from this is insignificant. The radiation dose delivered during Mammography is the same as receiving a dental X ray.

MYTH

Breast screening prevents breast cancer

FACT

No, breast screening only helps find breast cancer if it is already there.

MYTH

Breastfeeding prevents breast cancer

FACT

Breast feeding does not prevent breast cancer, but reduces the risk.

MYTH

Birth control pills causes Breast cancer

FACT

Modern day birth control pills contain a low dose of oestrogen and progesterone & hence are not associated with an increased risk of getting breast cancer

MYTH

Injury to the breast can cause breast cancer

FACT

Injury to the breast does not cause breast cancer

MYTH

Breast self-examination is no different from breast awareness 

FACT

Breast self-examination (BSE) is a regular & repetitive monthly self-examination of the breast performed by a woman at the same time each month to a set method. The concept of BSE has not proven to be beneficial.

Breast Awareness is about becoming familiar with the breasts and the way they change throughout a woman's life. It is a concept that encourages women to know how their breasts look and feel normally so that they gain confidence about noticing any change which might help detect breast cancer early.

BREAST AWARENESS, as a concept, is gaining increasing acceptance world over.

Changes that one should be aware of:

-A change in size - it may be that one breast has become noticeably larger or noticeably lower
-A  nipple has become inverted (pulled in) or changed its position or shape
-A rash on or around the nipple
-Blood stained discharge from one or both nipples
-Puckering or dimpling of the skin
-A swelling under the armpit or around the collarbone (where the lymph nodes are)
-A lump or thickening in the breast that feels different from the rest of the breast tissue
-Constant pain in one part of the breast or in the armpit.

Breast Awareness 5 - Point Code

1.   Know what is normal for you

2.   Know what changes to look & feel for

3.   Look and feel

4.   Report any changes to your Doctor without delay

5.   Have a screening Mammogram (X- ray of the breast) every year if you are aged 40 and over

A brief on Dr Raghu Ram's journey:

In 2002, came a defining moment: Dr. Raghu Ram Pillarisetti's mother Dr Ushalakshmi, a renowned Gynaecologist was diagnosed with breast cancer. The unexpected diagnosis in someone close to him, coupled with huge disparity in breast cancer care across India, became the turning point in his life. Despite rewarding career opportunities in the United Kingdom, he relocated to India in 2007.

With a vision to make breast cancer an openly discussed one and empower women about the importance of early detection in addition to spreading the message of Hope, Survival and Courage, he founded Ushalakshmi Breast Cancer Foundation - a ‘not for profit’ Breast Cancer Charity (2007).

In 2017, he developed the World’s First breast health mobile phone app (‘ABCs of Breast Health’) in English & 11 commonly spoken Indian languages (2017), making women across India aware about every conceivable aspect of breast disease (both benign & malignant) explained in simple easy to understand format.

Between 2012 – 2016, he has overseen the implementation of South Asia’s largest Clinical Breast Examination (CBE) based Breast Cancer Screening Programme in rural regions of Telangana and Andhra Pradesh that has reached out to over 200, 000 underprivileged women spread across 4000 villages. This milestone population based Screening Programme made national impact in 2016 and is currently being rolled out all over the country as part of the Government of India’s National Health Mission (NHM).