Think Pink October
Every October is National Breast Cancer Awareness Month and we wouldn't let the month get over without our two words on the subject matter. Breast Cancer is perhaps the most dreaded two words in a woman's life, and even though it's frighteningly common words in today's times, proper awareness of the subject is a must. Anyone who has come into contact with breast cancer will know that certain risk factors - such as increasing age, early onset of womanhood, late onset of menopause and a family history of breast cancer - are completely out of our control. But there are many risk factors, which we can control easily.
While many perceive that breast cancer can only occur to elderly women, the importance of awareness amongst the young is higher than ever. Studies prove that the average age of diagnosis has moved from a late fifty to an early thirty. These "controllable" risk factors readily translate into simple changes that we can all make in our day-to-day lives to help prevent or treat breast cancer.
In a recent chat with Dr. Nevitha Athikari (MD Path), Histopathologist and Cytologist at Kokilaben Dhirubhai Ambani Hospital and Research Centre in Mumbai, she stressed, "Nowadays we see younger women aged between 18-24 have recorded detection, and bilateral breast cancer incidents are on rise. To add on, simultaneously having two different cancers in the same person (ovary, thyroid or endometrium) is also common, which is evaluated while undergoing treatment."
Now we've all perhaps heard that incorporating a five-minute monthly ritual in our lifestyles - a breast self-examination is a must after the age of 25, but one needn't be afraid of every small lump. Not every lump is cancerous. There are cyclical changes in the body with menstruation which may cause heaviness. Other causes include stagnation of lactation milk, skin pustules, abscesses, benign (not malignant) lumps which are also very common in young females, called fibroadenoma.
A regular visit to the gynaecologist is a healthy habit. To answer whether a physical examination is likely to hurt, Dr. Nevitha Athikari answers, "I can answer this in two parts - self examination with a flat palm (another joke in clinical practice is ,most of the time it's the spouse who detects the lump earlier than the person herself - a healthy justification of happy relationships), doctors (gynaecologist, general surgeon, oncosurgeon) screen with hands, and it doesn't hurt because only bearable pressure is applied by the professionals. Some basic investigations are asked for depending on his findings - lump size, additional findings, lymph nodes, tests like USG, USG-MRI, mammogram for screening, and so on. A USG-guided biopsy is advised then, in which a thin core of tissue is removed with a small needle prick, outpatient based procedure. At max it is a 10-minute outpatient procedure. If nipple discharge is seen, it's sent for Cytology, if the lump is big, it's been sent without USG guidance for FNA cytology. All these samples come to the lab to a Histopath like myself, where we examine the sample with a microscope and give an appropriate diagnosis.
Gone are the days when detection meant the end of the world. Not only detection, ever surgery isn't what used to be. Surgical skills are so polished nowadays that patients are left with no scars, under the right hands. No more is the whole breast and entire axilla fat with nodes are removed, which used to be a debilitating process and involved a lot of swelling and pain. According to Dr. Nevitha, "Each case is treated tailored-based, depending on the findings of the Histopathology biopsy and clinical findings of nodes, metastasis, and so on.
Most of the cases in our centre are treated with only lumpectomy (i.e., only tumour with 1 /2 cm fat around it), added with axillary sentinel node (first drainage node) removal and surgery is not complete without prompt support from Histopath with frozen diagnosis, where on table we update the surgeon about margin, tumour grade and nodal metastatic status. While the patient waits for the initial surgical scar to heal for a month, we study the tumour in detail and submit a report which is seen by a medical oncologist and radiation therapist. The experts further treat chemotherapy or radiotherapy, depending on IHC and molecular markers in individual cases. In essence, it's teamwork. Expert plastic surgeons even offer complete scar removal, surgical augmentation as a part of the surgery. Patients feel comfortable in their body and in some cases, no stigma of cancer is left and it's all over for good."