Breast Cancer

EPIDEMIOLOGY
Based on National Cancer Registry Programme (ICMR), report of (2001-03), about 25% of the total cancer cases among Indian women constitutes of Breast cancer. The crude incidence rate of Breast cancer at India level is about 85 per 100,000 women per year. It is estimated that about 85000 new cases of Breast cancer are occurring in India, every year. The mortality rate is around 7 per 100,000 cases per year.
Cancer of cervix followed by breast cancer are the commonest cancers among women in Barshi, Bangalore, Bhopal & Chennai. Breast cancer is the commonest in Delhi & Mumbai followed by cancer cervix. The rise in incidence is being documented mainly in the metros, it is reported that one in 22 women in India is likely to suffer from breast cancer during her lifetime, while in America one in eight women is a victim of this deadly cancer.

Common Cancers in among Women in India
Rank	Bangalore	Bhopal	Chennai	Delhi	Mumbai	Barshi
1	Cervix	Cervix	Cervix	Breast	Breast	Cervix
	30.8	24.9	41.9	29.0	27.1	27.7
2	Breast	Breast	Breast	Cervix	Cervix	Breast
	21.4	22.2	22.4	29.0	19.5	8.0

Figures are age-standardized rates for the specific cancer sites. Figures for Bangalore, Chennai & Mumbai are for the years 1982-94. For other registries the figures are for the years 1988-94.

What is a breast cancer?
Breast cancer is a malignant tumor that develops from ductal and lobular cells of the breast. A malignant tumor is a group of cancer cells that have a tendency to  invade surrounding tissues or spread (metastasize) to distant areas of the body.

Types of breast cancers
There are several types of breast cancer, although some of them are quite rare. In some cases a single breast tumor can have a combination of these types or have a mixture of invasive and in situ cancer.
Carcinoma in situ
This term is used for the early stage of cancer, cells remain confined to ducts (ductal carcinoma in situ) or lobules (lobular carcinoma in situ). They have not invaded into deeper tissues in the breast or spread to other organs in the body, and are sometimes referred to as non-invasive breast cancers.
Ductal carcinoma in situ
Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is the most common type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts but have not spread through the walls of the ducts into the surrounding breast tissue.
About 1 in 5 new breast cancer cases will be DCIS.
Invasive (or infiltrating) ductal carcinoma (IDC)
This is the most common type of breast cancer. Invasive (or infiltrating) ductal carcinoma (IDC) starts in a milk passage (duct) of the breast, breaks through the wall of the duct, and grows into the surrounding tissue of the breast. Though at this point, it may be able to spread (metastasize) to other parts of the body through the lymphatic system and bloodstream. There are further many types of breast cancer based on the histopathology report.

RISK FACTORS:Many factors may influence the development of breast cancer:

1. Age-It is less common in women 35 or younger, most cases occur in women 50 or older.
2. Family history-Risk is higher with a family history (especially mother, sister, daughter) of breast and/or ovarian cancer.
3. Hormones / childbirth-Occurrence of first menstrual period before age 12, menopause after age 55. No children or first child after age 30 or postmenopausal use of hormonal therapy(HRT). This is because of the increased duration of estrogen exposure.
4. Previous biopsy-If one had an abnormal breast biopsy(15-25% increased risk), benign breast diseases requiring biopsies.
5. Genetic alterations-Inherited susceptibility genes BRCA1 and BRCA2 account for about five to 10% of all breast cancer cases.
6. Oral contraceptive use, diet high in saturated fats, physical inactivity, alcohol (more than one alcoholic drink a day) also are under evaluation.

Symptoms of Breast Cancer:

1. Lump or mass in breast is the most common presentation and is a vague swelling usually in the upper outer quadrant of the breast. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, irregular shaped lump that feels firmly attached within the breast is more likely to be cancer.
2. Sudden increase in the size of lump present for long time usually a fibroadenoma.
3. Enlarged lymph nodes in the armpit associated with swelling over arm or pain in axilla.
4. Changes in breast size, shape, skin texture or color.
5. Nipple retraction or discharge.
6. Usually early breast cancer does not cause pain.
7. Bony pains, significant weight loss and anorexia.