The multidisciplinary approach to breast cancer patients: Breast cancer patients are discussed in detail in a multidisciplinary tumor board consisting of medical oncologist, radiation oncologist, surgeon, pathologist, radiologist, nuclear physician and palliative team. Every patient’s treatment is individualized following the international and national protocols of breast cancer management.
Specialists related to breast oncology: All specialists required to treat breast cancer are available under a single roof. Our breast surgeon, medical oncologist, radiation oncologist, pathologist, breast radiologist, nuclear physicians, breast care nurse, palliative team, physiotherapist work together for the best possible outcomes.
Breast cancer statistics – the extent of the problem: Breast cancer is the most common cancer among urban women in India, and the incidence is set to increase steadily with increasing urbanization. As per the published data from the Indian Council for Medical Research, there were 14.5 lakh new cases in 2016. This number is projected to increase to 17.3lakhs in 2020.
Breast cancer is the most common cancer among urban women in India, and the incidence is set to increase steadily with increasing urbanization. When found and treated early, breast cancer is most often curable. October has been internationally designated as the breast cancer awareness month, in recognition of the magnitude of the problem.
There are different types of Breast Cancer. The most common is the invasive ductal cell carcinoma
- Invasive ductal carcinoma: It is the most common type and constitutes 70 to 80% of all breast cancers. It arises from the milk ducts and spreads to the surrounding breast tissue.
- Invasive lobular carcinomas: It constitutes 10-15% of breast cancer and arises from the milk-producing lobules of the breast. These tumours are multiple and sometimes patients can have simultaneous lesions in the opposite breasts.
Other Rare Types
- Tubular carcinomas: It constitutes 1to 5 % of breast cancer
- Mucinous carcinomas: It comprises 1-2 % of breast cancers and has a good prognosis
- Medullary (seen in BRCA1 mutation)
- Invasive papillary carcinomas
- Inflammatory breast cancer: It is an aggressive variant with poor prognosis in which the entire breast is swollen and red because of the blockage of the lymphatics
- Metaplastic carcinoma
Classification of Breast Cancer: Molecular Subtypes
Determining the molecular subtype of the cancer is essential for formulating the treatment plan. After confirming the diagnosis of breast cancer by doing a biopsy, further analysis has to be done on the biopsy sample to check for the following receptors.
- Estrogen receptors (ER)
- Progesterone receptors (PR)
- HER2/neu receptors
- Ki-67: Proteins to assess how fast the tumour is growing
These molecular details are essential to understand biology, to plan treatment and to assess the overall prognosis of breast cancer. Based on these molecular details the breast cancer is subdivided into luminal types.
Luminal A: These breast cancers are estrogen receptor and progesterone receptor-positive (ER/PR positive) with low Ki-67 (slow-growing) and are HER 2neu negative. These tumours constitute the majority (50%), are slow-growing and have a good prognosis.
Luminal B: These breast cancers are ER/PR positive with high Ki-67 (rapid-growing) and are either HER 2 positive or negative. These tumours grow slightly faster and are slightly aggressive.
Triple-negative or basal-like: These tumours are negative for ER/PR/ HER 2 receptors. These tumours are aggressive and have a poorer prognosis.
HER 2 enriched: These breast cancers are positive for HER 2 and negative for ER/PR receptors. These tumours are aggressive but respond to drugs like trastuzumab/pertuzumab.
Being breast aware and performing a breast self-examination at least once a month (preferably done 5 to 10 days after periods) will help in early detection. Any new onset lumps (typically painless) in the breast or armpits, thickening of the skin, recent deviation or pulling in of the nipple, bloody nipple discharge, nipple excoriation etc has to be brought to the notice of your doctor.
How Does a Doctor Diagnose Breast Cancer?
Breast cancer is usually suspected when a lump or other change in the breast or armpit is found by a woman herself or by her doctor. If a breast lump is found, a mammogram and a breast ultrasound are usually performed. A biopsy is performed in case the mammogram or ultrasound hints at cancer. A biopsy is a procedure wherein your surgeon gives a local anaesthetic and inserts a small needle to take a few cells to be examined in detail, under a microscope by the pathologist.
Mammography: It is a soft tissue X-ray of the breast, and helps in identifying the suspicious lumps in the breasts. These lumps are characterized using breast imaging reporting and data system classification (BIRADS). Lumps labelled as BIRADS 4a and above need needle biopsy and have a progressive risk of cancer.
Staging of Breast Cancer
Once a diagnosis of cancer is confirmed by biopsy, the next step is to assess the extent of the spread of cancer. The following tests are usually done to look for the spread of breast cancer, depending on the stage of breast cancer.
- PET-Scan (positron emission tomography) of the whole body
- Bone scan
- Ultrasound abdomen
Most people with breast cancer will require one or more of the following forms of treatment depending on the stage of breast cancer
- Mastectomy involves removing the entire breast along with an assessment of the armpit lymph nodes. This is indicated when the lumps are multiple or large.
- Breast-conserving surgery removes just the cancerous area and a small amount of surrounding normal tissue, along with the armpit lymph nodes for assessment. The remaining breast has to be radiated to prevent the local recurrence. This procedure is suitable for small single lumps in the breast.
- Radiation therapy – Radiation is given in locally advanced cancers, in patients with lymph nodal involvement and in patients undergoing breast-conserving surgery.
- Chemotherapy: Some women require medicines before surgery to shrink cancer and make it easier to remove while others require it after surgery to prevent the spread or recurrence of cancer.
- Hormone therapy: Some form of cancers grows in response to estrogen and progesterone, and medications are given to block the action of these hormones
- Monoclonal antibody: Some forms of breast cancer which are HER 2 enriched respond to drugs like trastuzumab/ pertuzumab.
It is best to consult your doctor if you find a lump or any other change in your breast, as early detection is the key to successful management. Fortunately, treatment outcomes for patients with breast cancer are improving with good survival rates, largely due to advances in treatment modalities and a better understanding of the disease.
- Examine your breasts once a month (best done 5-10 days from the first day of your period)
- If you no longer have periods, choose one fixed day each month.
- Visit a doctor if there are any changes
- Remember, most breast changes are NOT cancer, but DO checkup to be sure!
Breast Cancer Specialist in Hyderabad
Our team of Oncologists are amongst the finest in the world, be it in academic qualifications, clinical expertise, hands-on experience or in research publications. Committed to patient-centric care, they contribute to our record of unmatched clinical outcomes.