Breast cancer is now the most common form of cancer and has surpassed cervical cancer. Breast cancer is also now more common in the younger age group with more women in their thirties and forties being now diagnosed with breast cancer. This can also be attributed to increasing awareness on the disease but genetic, lifestyle and environmental factors are also at play. We often hear that early diagnosis is important. So how can we maximize the chance of catching breast cancer early? Here are some points to note.
Signs and symptoms of breast cancer-
- A lump or swelling in the breast, armpit or upper chest resulting in change in size of the breast (an increase in the size may be noted)
- Any changes in the nipple (rash or being inverted or any inflammation) or discharge from the nipple
- Pain in the breast itself may not be a sign of cancer but unusual pain could be a sign of cancer
Risk of family history:
Risk for breast cancer for women is high if there is family history. If a woman has a mother or a sister who has had breast cancer or family members on either her maternal or paternal side who have had breast or ovarian cancer, her risk for developing cancer is higher and therefore it is important for her to screen more often. Inherited gene mutations, such as BRCA1 and BRCA2 increase risk of breast cancer. Women who have inherited these genetic changes are a greater risk. The BRCA gene test is a blood test that helps determine if you have mutations in your DNA that increase the risk of breast cancer.
A self - breast examination along with other diagnostic tools can be powerful in detecting breast cancer early. Breast self-exam is no cost and convenient and helps understand your body better and most importantly if there are any changes, you may catch it early. A breast self-exam is recommended for all women above 20 years of age. There are many guides that help in a detailed self-breast examination and this usually does not take more than 15 minutes. A week after the menstrual cycle is the best time to do a self - breast exam.
Clinical breast examination
A clinical breast exam is recommended annually for those between 20 and 30 years, half yearly for those between 30 and 60 years and annually for those above 60 years. A clinical breast exam happens at the doctor's office.
Mammograms are nothing but low dose x-rays of breast. A mammogram can detect breast changes so early that it may be years before physical symptoms develop and therefore for a women who is at average risk, a mammogram is a good diagnostic tool, especially when ordered after a clinical breast examination when any changes are noted.
Mammograms are not perfect and therefore may miss some cancers and may also lead to over-diagnosis. It is possible that someone is diagnosed with cancer which is caught during screening which may not have caused any problems at all. There is also 3D Mammogram that is available now that is especially found to be useful in women with dense breasts. Your doctor will help you understand the risk and limitations of a mammogram and accordingly provide medical guidance.
The Mammogram Guidance for a women with average risk as per the American Cancer Society is as below. Average risk is defined if a woman she doesn't either have a personal history of breast cancer of a family history or a genetic mutation like the BRCA gene or has not undergone chest radiation therapy before the age of 30.
- Women between 40 and 44 have the option to start screening with a mammogram every year.
- Women 45 to 54 should get mammograms every year.
- Women 55 and older can switch either to an annual mammogram or undergoing mammogram every two years. Screening should continue in a similar pattern as age progresses as long as woman is in good health.
- Ultrasound is also used as an additional diagnostic tool to diagnose breast cancer.
To improve survival rates and treatment outcomes, it is important for women and men to be fully aware of breast cancer, understand one's own risk and take steps to increase the chances of diagnosing breast cancer early.
(Dr Simi Bhatia from SRL Diagnostics, Mumbai has almost 30 years of experience in laboratory medicine)
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