BREAST CANCER

History

Breast cancer is known to humans for a long time. Dating back to 3,000 – 2,500 BC, the medical text—Edwin Smith Surgical Papyrus—describes cases of breast cancer. However, the modern approach to the treatment and research of breast cancer started taking shape in the 19th century. William Halsted performed the first radical mastectomy in 1882. In 1895, George Beatson, a Scottish surgeon, found that removing the ovaries led to shrinking of breast tumor in one of his patients. Many surgeons, thereafter, began removing both ovaries and performing a radical mastectomy for breast cancers. This surgery remained the standard procedure to treat breast cancer until 1932, when a new approach to mastectomy was developed involving a surgical procedure that was not as disfiguring and which became the new standard afterwards. In addition to surgery, radiation therapy began to be used in 1937, to spare the breast. During late 1970s, the use of anti-estrogen drug tamoxifen was started in the treatment. With the arrival of modern medicine, by 1995, less than 10 percent of women suffering from breast cancer had to undergo mastectomy. Many novel therapies such as hormone treatments, surgeries and biological therapies for breast cancer also developed during this time.




Statistics

Breast cancer is the most common cancer in women and also the second most common cancer in overall population, worldwide. There were over 2 million new cases in 2018. According to the World Cancer Research Fund International, breast cancer now represents one in four of all cancers among women, across the world. Since 2008, breast cancer incidence has increased by more than 20 percent, globally; and mortality has increased by 14 percent. India too is now witnessing more and more cases of breast cancer. It ranks as the number one cancer among Indian women with age adjusted rate as high as 25.8 per 100,000 women and mortality 12.7 per 100,000 women. According to Lancet study, India’s breast cancer survival rate continues to be low with only 66.1% women diagnosed with the disease between 2010 and 2014 surviving.

Causes, Symptoms, and Treatment

Breast cancer is caused when breast cells begin to multiply abnormally. These cells divide at a more rapid pace than that of healthy cells and keep accumulating to form a lump or mass. The cells may metastasize too and spread to other parts of the body. Breast cancer can be classified as ductal carcinoma, which begins in the milk duct and is the most common type, and lobular carcinoma which starts in the lobules.

Although the exact causes of breast cancer are not clear, certain risk factors—hormonal, environmental, lifestyle, and genetic—have been identified that increase its likelihood. Increasing age in women, hormone replacement therapy to treat symptoms of menopause, radiation exposure, obesity, alcohol intake, family history, and inheriting BRCA1 and BRCA2 gene mutations are some of the factors that increase the risk of breast cancer. However, the presence of risk factors does not indicate the inevitability of its occurrence.

At an early stage, there are hardly any symptoms and therefore, a regular breast examination is recommended. However, at a later stage, some of the symptoms that might be noticeable include lump in breast, change in the size and shape of the breast or nipple, dimpling of the breast tissue, discharge from nipple, breast pain etc.

Treatment of breast cancer varies with the type and stage of the cancer and patient’s age, sensitivity to hormones, and overall health. The main treatment modalities for breast cancer include surgery such as lumpectomy, mastectomy, and breast reconstruction; radiation therapy; chemotherapy; biological therapy or targeted drug therapy; and hormone therapy.

Even after the breast cancer treatment is complete, it is imperative to go to all of the follow-up appointments so that the doctor can assess the patient’s condition closely. During these visits, the healthcare team may conduct lab tests or imaging tests to monitor signs of cancer or the side effects of the treatment.

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