Last Updated on January 8, 2024 by srivastava Ankita Srivastava
Breast cancer is a prevalent and challenging health issue that affects many women. Aside from its physical impacts, breast cancer can have significant emotional and psychological effects on individuals, affecting their self-esteem, body image and relationships. Empowering women with knowledge about breast cancer can help them navigate these challenges and seek necessary support.
Dr Nikita Chauhan is a dedicated obstetrician and gynaecologist and is committed to providing dignified maternity care and aims to combat misinformation surrounding women’s health by using clear and straightforward language. Her areas of specialisation include pregnancy and childbirth, adolescent and menstrual well-being, high-risk pregnancies, and infertility concerns.
What is breast cancer and how do we differentiate its various types?
Dr Nikita Chauhan: Cancer is a condition when cells in any body tissue start growing abnormally and uncontrolled. Our breasts have various types of cells, forming glands, fatty tissues, connective tissues, and more. So, when any of these cells grow uncontrolled and invade surrounding tissues, it is referred to as breast cancer.
Are there different types of breast cancer? Yes, that’s true. Depending on the cells from which these cancers originate, the only way to differentiate between them is to take a tiny tissue sample, also known as a biopsy in clinical terms. This sample is examined under a microscope to identify the specific origin of the cancer.
There are two main types: lobular cancer and ductal cancer. This is part of the clinical and medical diagnosis. However, when it comes to treatment, there isn’t much variation between the different types.
What factors increase the risk of breast cancer in a person?
Dr Nikita Chauhan: Breast is a tissue that undergoes continuous changes throughout our life. These changes are primarily hormonal-dependent, with the major female hormones estrogen and progesterone. Even in our regular cycles, the levels of these hormones vary. Due to these hormonal changes, some women may experience breast pain or discomfort, depending on the day of the cycle.
Breast cancer mainly depends on these changes. The cancer changes primarily depend on exposure to these hormones. For instance, if someone experiences early menarche or late menopause, the duration of exposure to these hormones increases, leading to an elevated risk of breast cancer. Additionally, the risk of breast cancer rises with age, especially after a woman crosses 40. It is crucial for her to focus on regular screenings and checkups to detect cancer in its early stages.
Other factors, such as delaying the first pregnancy beyond the age of 35, can also increase the risk of breast cancer. The delayed maturation of breast tissue due to postponed pregnancy and breastfeeding contributes to this risk.
Obesity is another risk factor because high BMI, particularly with elevated visceral fat, produces estrogen hormone, predisposing women to breast cancer. Unfortunately, many of these risk factors are not modifiable.
There are studies indicating that the use of oral contraceptive pills or hormonal replacement therapy after menopause may increase the risk of breast cancer due to their hormonal nature. However, after stopping these medications, and depending on the duration of use, the risk returns to a level similar to that of someone who has not taken these medicines. Breast cancer is not entirely preventable, but early detection is crucial.
Maintaining a normal BMI is recommended, as it helps lower exposure to estrogen.
What are the common symptoms of breast cancer and how can we detect it early with recommended screenings?
Dr Nikita Chauhan: The reason detecting breast cancer in the early stages is crucial because if detected and treated earlier, the chances of survival are very high, exceeding 95%. Unfortunately, in India, there is a lack of awareness about breast cancer. Most women do not perform self-breast examinations, a practice that can be done at home. Once you are over 30, it’s advisable to perform it at least once a month.
After you have completed your menstrual cycle, doing a self-breast examination two to three days later is optimal. This is because at this time, hormone levels are relatively low, and any routine changes in tissue texture caused by hormones are not present. Thus, you can feel your breast tissue.
Self-breast examination involves being aware of how your breast normally looks and feels so that whenever you feel that something is abnormal, you can identify it early and seek a doctor’s advice. However, even with self-breast examination, cancer can be missed, especially if the growth is too small to be felt. In such cases, routine imaging, specifically mammography, becomes crucial. Mammography is essentially an X-ray of your breasts.
Once you have crossed 40, ideally, every woman should get a mammogram done once or twice a year. Many guidelines suggest avoiding mammograms in young women, especially those under 25, as it increases the risk of radiation exposure. If you have certain risks or hereditary predisposition toward these cancers, radiation can potentially precipitate breast cancer.
In young women, mammograms are not recommended. However, after 40, it is advisable not to miss them. Don’t go for a routine mammogram on your own; consult a doctor first and have them recommend it. Sometimes, your doctor might feel that an ultrasound or an MRI might be a better option, considering your risk factors.
Apart from self-breast examination and routine mammograms, clinical breast examination is essential. Seeing a doctor in person once or twice every three years allows the doctor to conduct a thorough check, leveraging their experience to identify abnormalities more effectively. If you have a family history of breast cancer and have tested positive for certain mutations responsible for breast cancer, you may need to start mammograms a little earlier.
What are the main breast cancer treatments and how do they vary based on cancer stage and type?
Dr Nikita Chauhan: Stage one is basically a tumour less than 2 cm, strictly confined to a single breast. In a young woman undergoing breast removal, there can be body image-related issues. She may experience depression and struggle to accept herself afterwards, leading to various emotional and mental challenges. If cancer is detected early and is very small in size, the surgeon or oncologist might recommend simply removing the tumour.
We can follow up for the rest of your life because, obviously, once you’ve had breast cancer, the chances of recurrence are high. Now, if the tumour has advanced and involves the lymph nodes, extensive surgery becomes crucial. It might require a mastectomy and lymph node dissection, depending on the stage.
Most doctors nowadays recommend adjuvant treatments as well. This means that after surgery, to ensure high survival rates, they might suggest radiotherapy or chemotherapy, depending on the type of breast cancer. Sometimes, it’s because, as we discussed, it’s a hormonal tissue responsive to changes in the body. Certain medicines target this aspect of breast cancer, allowing tailored treatment. A lot depends on staging, cancer type, molecular diagnostics, and other factors.
How can a person reduce the risk of breast cancer through lifestyle changes and preventive strategies?
Dr Nikita Chauhan: If you’re consuming alcohol daily, particularly exceeding one to two units daily, it has been linked to breast cancer. Especially if you are genetically predisposed to breast cancer, avoiding alcohol is essential at all costs. A recent study emphasised that no level of alcohol consumption is safe for your health.
It’s a good idea to completely avoid it. Additionally, maintaining a healthy BMI, engaging in routine exercises, practising yoga, meditation, and cardio, and keeping a healthy weight are all beneficial. They reduce your risk of breast cancer. There’s no denying that.
Can you share resources and support for those diagnosed with breast cancer and their families?
Dr Nikita Chauhan: Yes, I was genuinely pleased when I conducted some research on this topic. I also consulted my friends who treat advanced breast cancers, and they informed me that there are indeed very good, functional, and supportive groups available in India. In our country, multiple NGOs work towards spreading breast cancer awareness and providing emotional support. They offer various pieces of information. Whether you’ve been diagnosed with breast cancer or if you’re someone with a relative facing breast cancer, and you want to know how to reduce your risk, these groups can be valuable resources. So, yes, I reached out to my colleagues, and they provided me with a list of names.
As a medical professional, why do you think health literacy is important for understanding breast cancer and how can patients improve their health literacy?
Dr Nikita Chauhan: As a gynaecologist who sees female patients, women, and girls of all ages, most commonly, when these women perform self-breast examinations and notice a lump, they become very anxious, extremely tense, and understandably worried about whether it’s cancer or not. So the first thing I do is acknowledge that, yes, there is a lump, and while it could be cancer, there’s a good chance it might not be.
Most of the time, these lumps can be fibroadenomas, infectious cysts, or possibly a milk collection for a new mom feeding her baby. I don’t want anyone to be scared when they notice a lump in their breast. For me, they must know what is normal and what is abnormal, when to seek help, when to worry and when not to worry. I believe that if someone is stressed about their condition and doesn’t get the right guidance, they might be misdiagnosed, and their condition could be missed.
So, awareness regarding breast cancer is extremely important, especially since it is the most common cancer diagnosed in women in India and the leading cause of cancer-related deaths in the country. As doctors and healthcare professionals, it is undoubtedly our duty to have accurate information about this condition and inform patients.
Sometimes, young girls come to me expressing concern because someone in their family has been diagnosed with breast cancer, and they worry about their own risk. Guiding these young girls on when to start screening, whether they need testing for certain mutations that increase the risk of breast cancer — all these aspects are fundamental. I believe every woman has the right to know whether she needs to be cautious, especially cautious, or not.
How can we address the misconceptions and myths that may hinder the awareness initiatives that have been started?
Dr Nikita Chauhan: First of all, whenever you notice something abnormal, seek a doctor’s help — whether it’s a gynaecologist, a surgeon, or an oncologist, you need to see these professionals and get yourself evaluated.
There are many myths and social stigmas associated with breast cancer. Women often hear things like, “Now you’re not going to recover from this. Nobody has recovered from breast cancer. Now, this and that problem will arise. You will not be able to breastfeed or have kids, or you will lose all your hair.” I want to emphasise that these things are absolutely unnecessary.
Actually, if breast cancer is diagnosed in an early stage, the survival rate is more than 95%, which is quite good. Even if it’s diagnosed in later, advanced stages, the survival rate is still more than 70%.
It’s important to know that we have reached a point in time where breast cancer is treatable, and the survival rates are very good. There is a pretty good chance that you will have a normal life after being treated for breast cancer, and you can even conceive successfully once your follow-up with breast cancer is complete.
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