#SHEMATTERS: Breast Cancer is the most common cancer detected in Indian females, with nearly 1.5 lakh per year being diagnosed with this disease in India. The scenario in India is that nearly 70% of the patients are diagnosed in its advance stage which actually impacts upon-
1. The outcome (which directly depends on the stage)
2. The cost of the treatment which goes higher because of the late presentation and the complexity of treatment in the late stages.
There are certain myths and apprehensions discussed which we have gathered from our patients and have been the reason for their late presentation. Some of them are discussed hereby.
Myth – Breast cancer would be a painful Breast Lump.
Fact- Breast lumps are usually detected by doing a regular monthly self-breast examination which should start by 20 years of age. This is usually done by palm of the opposite hand and any swelling in the breast and armpit is checked for. Most of the lumps detected are noncancerous in nature. However, a painless lump especially after 4th decade should be reported to the family physician or Gynecologist- So most of the times early breast cancer would present as painless lump.
Myth-Breast cancer usually would happen in a lady having family history of same.
Fact – The most common cause of Breast cancer is advancing age. Most of the Breast cancers are caused after 5th decade and it is a prolonged exposure (i.e early menarche and late menopause) to the hormonal cyclical changes during the menstrual cycle which is rather responsible for it. Also attributable are certain factors as nulliparity and poor Breast feeding. Obesity is another important factor which contributes to the cancer risk. Amongst the familial cancers which account for nearly 10-15 % of breast cancers -the most common gene involved is the BRCA (breast cancer gene) mutation. This gene is responsible for both breast and ovarian cancer and also breast and prostate cancer in males, so a complete family history should be discussed with the treating physician.
Myth-Mammogram can prevent breast Cancer also Mammograms are harmful because of radiation exposure.
Fact- Mammograms have been used as a screening test and detect cancer at a very early stage and therefore, the survival and outcomes are improved. The benefit of the mammogram is enormous and far outweighs the miniscule risk of a small X -ray dose. It is indicated annually after the age of 50 years.
Myth- Biopsy is a cause of spread/spillage of cancer cells.
Fact- This particular myth is also prevalent with actually most of other cancers as well, Biopsy is of utmost importance before starting the treatment and therefore it is essential at this point of time to establish a comprehensive diagnosis that guides in appropriate treatment , as of now research done has negated this fact.
Myth – Breast cancer surgery- i.e Mastectomy is a better procedure in terms of cancer survival than preserving the Breast (Breast Conservation Surgery-which entails removal of the affected part of breast and preservation of normal tissue).
Fact- Breast Conservation surgery is the way to go if it can be done, the overall outcomes in terms of survival are quite equivalent with Mastectomy.
Myth – Surgery is the first treatment for all breast Cancers
Fact – In certain patients, the role of chemotherapy first and thereafter surgery is important in helping breast conservation, also in a subset with high risk disease it could be the first decision of choice. Make sure that the whole treatment plan is discussed in a TUMOR BOARD which comprises of various cancer specialists like medical, surgical and radiation oncologists.