Do You Know These Basic Facts About Breast Cancer?

Ria: Breast cancer is a large umbrella term. Can you tell us a little bit about all the conditions that fall under it?

Dr. Upasna Saxena: There are a lot of breast diseases, and they are largely divided into two types - benign and malignant. The cancerous lesions are ductal or lobular carcinoma in situ, invasive ductal or lobular carcinoma, inflammatory carcinoma of breast, and Paget's disease of the breast.

There are a lot of other diseases of the breast but they are benign, like fibroadenoma or fibroadenocyst or cystic disease of the breast. That means they are not cancerous.

Ria: What are the most common symptoms of breast cancer?

Dr. Upasna Saxena: The most symptom is a [breast] lump that people observe in the routine course of events.

Other than that, you can have associated symptoms like a lump in the underarm, which is a lymph node. In fact, sometimes people do not see the lump in the breast, but they see the lump in the underarm.

Also, there can be changes on the skin, like redness or ulceration, discharge from the nipple (blood or fluid), a dent on the surface of the breast (which is known as dimpling), an inward turning of the nipple, or a change in the size of the breasts. That is, on comparing, one breast may appear larger than the other.

There can also be a heaviness in the breast. Or simply prominent veins on the surface.

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Ria: Who are at a high risk of developing breast cancer?

Dr. Upasna Saxena: There are a lot of risk factors. Some are not-modifiable. That is you can't do anything about them. And others are modifiable. But the most important risk factor is gender. Men also get breast cancer but it is very rare. So women are more predisposed than men.

The second is age. As age advances the risk of breast cancer becomes higher.

Then there are other risk factors that you can modify, like cigarette smoking, alcohol consumption, urbanization, late age of pregnancy, lesser number of children, lack of exercise, and increased body weight. Now, increased body weight is associated with a lot of other diseases, but it also increases the risk of breast cancer.

So these are the factors associated with lifestyle. That's why we are seeing a rise in the number of cases.

Then, there are children who are exposed to radiation during treatment for some other cancer in the chest region. They are also at a higher risk.

Ria: What about oral contraceptive pills? Since increased exposure to estrogen is a risk factor for breast cancer, what should women who take these pills do about it?

Dr. Upasna Saxena: See, there are many different kinds of oral contraceptive pills with different compositions of estrogen and progesterone. So it depends on which one you are taking.

So if you are taking a pill that has estrogen, it increases the risk for individual cancer.

[Please note: Self-medication can be dangerous. So please consult a gynecologist before you take any oral contraceptive pills.]

Basically, these cancers have receptors for the hormone estrogen. So when you take these pills, you feed those receptors and give them a positive stimulus for the development of cancer.

Even people who have an early start to their menstrual cycle [a.k.a menarche] or in whom it stops very late [a.k.a late menopause] are exposed to estrogen for long periods of time.

And someone who does not have children will be continuously exposed to estrogen because during pregnancy estrogen is very reduced in the body and it is mainly progesterone which is elevated. So pregnancy is a kind of break. And even breastfeeding prevents cancer.

Plus, estrogen is produced in the body's fat cells. So if someone is overweight, they have a higher level of it.

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Ria: Can you tell us a little bit about benign breast conditions and the ones which predispose to breast cancer?

Dr. Upasna Saxena: There are two kinds of benign breast conditions - ones which predispose and ones which don't. Usually, ductal hyperplasia predisposes to breast cancer. And it has two types - typical and atypical.

Atypical ductal hyperplasia has a greater predisposition to breast cancer.

Other than that there are other benign conditions that do not predispose to breast cancer, like fibroadenoma. If you remove a fibroadenoma, it will recur, but it will not cause breast cancer.

Then there could be cysts - fibroadenocysts - which are painful breast conditions. They do not convert.

Ria: What about LCIS? Why does it have the highest risk of turning malignant?

Dr. Upasna Saxena: There are two types [of pre-malignant conditions that have a high risk of turning malignant] -ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS).

If it's DCIS, it usually stays confined. But if it is LCIS, then both breasts have a higher risk of developing breast cancer. It is the nature of the disease to convert into cancer.

Basically, the difference between in situ and invasive carcinoma is that in situ remains superficial. In the epithelium. And when it starts invading into the deeper tissues, then it becomes invasive.

So the nature of LCIS is such that it has a higher risk of becoming invasive cancer.

Ria: Moving on, what is the deal with the BRCA1 and BRCA2 gene mutation? Why do these cause breast cancer?

Dr. Upasna Saxena: There is a certain gene that repairs the damage done to the body. It is called PTEN and it is a tumor-suppressor gene. That is it prevents the development of cancer.

And BRCA1 and BRCA2 block its action so as a result there is a higher incidence of breast cancer.

These genes [BRCA1 and 2] are associated with multiple cancers, like ovarian and pancreatic cancer. And if you are a male, then it is also associated with prostate cancer. Plus, it is associated with a certain skin cancer called melanoma and some leukemias.

It's a complex.

Secondly, it runs in families. That means if someone has BRCA1 mutation, the risk is significantly increased for that person, although it is not necessary that they will get any of these cancers.

Plus, if one person is affected by BRCA, then others in the family are also at a higher risk of this cancer.

Ria: Do you mean the immediate family members?

Dr. Upasna Saxena: Immediate and even those related by blood, like aunts, uncles, second cousins, and third cousins. But I won't do a full BRCA evaluation for every patient who comes to me.

When they fall in a certain category, that's when BRCA evaluation and genetic counseling for the entire family is done.

Plus, BRCA associated cancers occur at a younger age. They are more aggressive and not responsive to some of the medications we give. So the prognosis becomes worse.

Ria: And how do you decide who is screened and who is excluded?

Dr. Upasna Saxena: There are certain guidelines. Like if a family member was diagnosed with breast cancer below 30 years of age, if someone had both ovarian and breast cancer, or if someone is affected by triple negative breast cancer under the age of 50.

There are many more guidelines apart from these.