Breast cancer – it’s not just you, it’s also about where you live

The breast is a modified skin appendage which is functional in females during lactation but is rudimentary in males.
Cancer of breast is among the commonest human cancer throughout the world. Its incidence varies in different countries but is particularly high in developed countries.
The incidence of breast cancer is highest in premenopausal age group and is uncommon before the age of 25 years.
Clinically, the breast cancer usually presents as a solitary, painless, palpable lump which is detected quite often by self examination.

Higher the age, more are the chances of breast lump turning out to be malignant. Thus, all the breast lumps, irrespective of age of the patient are removed surgically.
Its diagnosis can be made by techniques like :
1. Mammography
2. Xero – radiography
3. Thermography
4. Fine needle aspiration cytology
5. Stereotactic biopsy

Risk factors
1.Geography : The incidence of breast cancer is about 6times higher in developed countries than the developing countries.
2.Genetic factors : First degree relatives (mother, sister, daughter) of women with breast cancer have 2 to 6 higher risk of development of breast cancer.
3.Oestrogen excess : Excess endogenous oestrogen or exogenously administered oestrogen for prolonged duration is an important factor in the development of breast cancer.
4.Miscellaneous factors : These include a host of following environmental influences and dietary factors associated with increased risk of breast cancer :

1. Consumption of large amounts of animal fats, high calorie foods.
2. Cigarette smoking.
3. Alcohol consumption.
4. Breast augmentation surgery
5. Exposure to ionising radiation during breast development.

5.Fibro cystic changes : Fibrocystic change, particularly when associated with atypical hyperplasia, has about 5 fold higher risk of developing breast cancer subsequently.
Cancer of the breast occurs more often in left breast that the right and is bilateral in about 4% cases.

Histologic grading and clinical staging of breast cancer determines the management of clinical course in these patients.

The breast cancer is divided into various histologic of grades depending upon the following parameters :

1. Histologic type of tumor
2. Microscopic grade
3. Tumor size
4. Axillary lymph node metastasis
5. Oestrogen and progesterone receptors
6. HER2/neu overexpression
7. DNA content

Spread of breast cancer to axillary lymph nodes occurs early. Later, however distant spread by lymphatic route to internal mammary lymphatics, mediastinal lymph nodes and pleural lymphatics my occur.

Prognostic factors in breast cancer

1. Potentially pre malignant lesions
These conditions are as under :
2. A typical ductal hyperplasia is associated with 4 to 5 times increased risk than women of the same age. Such lesions are commonest in the age group of 45 to 55 years.
3. Clinging carcinoma is a related lesion in the duct but different from carcinoma in situ and has lower risk of progression to invasive cancer than in situ carcinoma.
4. Fibro adenoma is a long – term risk factor for invasive breast cancer, the risks being about twice compared to controls.
5. Invasive breast cancer : prognostic are predictive factors for invasive breast cancers are:

1.Routine histopathology criteria
2.Hormone receptor status
3.Biological indicators

Overall, taking the most important parameter of breast cancer, the prognosis varies – localised form of breast cancer without axillary lymph node involvement has a survival rate of 84% while survival rate falls to 56% with nodal metastasis.
To know more about your specific condition, please visit an Medical Oncologist in a a trusted hospital close to you.