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Queries of Breast Cancer
Q. What symptoms should women watch out for to detect breast cancer early?
Any lump in the breast, particularly after the age of 40 or 45, should be treated with suspicion. Most breast lumps aren’t cancerous but the possibility needs to be ruled out. Very often the lump is painless, making detection difficult. Apart from lumps, look out for dimpling, puckering or bulging of the breast, inverted nipples, discharge from the nipples, redness, soreness, rashes or swellings. These could indicate the presence of cancerous cells. Seek an appointment with a doctor if you have any of these symptoms.
Q. What are the tests for detecting breast cancer?
There are several tests. Screening tests are given regularly to apparently healthy individuals to rule out or detect the disease. Diagnostic tests are given to those with signs or symptoms to establish the presence and severity of the disease. Genetic testing can help determine whether you are genetically pre-disposed to the disease.
Q. What tests would you recommend for women in their 30s?
I would not recommend any test before one is 40, unless there is a lump. But a monthly self-examination is a must for women of all ages.
Q. What is the best time of the menstrual cycle to go in for a mammogram?
The best time for mammography is just after your period. During periods the hormones are active making the breasts dense and sensitive. So a mammogram in which the breasts are pressed hard against the machine could be painful.
Q. How accurate are mammograms?
Quite accurate. A mammogram can detect a lump in 95% of cases. Mammography has proved to be the most effective in detecting cancers early. It is credited with a 20 to 30% reduction in the death rate from breast cancer. The special X-ray machines are equipped with transparent plates to hold and flatten the breasts at the correct angles for getting images. When interpreted by a radiologist, mammograms can reveal suspicious masses plus other changes that cannot be felt or palpated. But if the breast is small and the lump is at the periphery, it can be missed making a physical breast examination necessary along with screening mammography. Ultrasound may be used as a complementary study.
Q. I’ve heard about MRIs. What is their role and how safe are they?
It is recommended only when there is suspicion of a lump which is not located by a sono-mammogram. It is a safe procedure without side effects.
Q. When does one need a biopsy? What exactly is it?
If mammography or other screening methods
reveal a mass or lesion that may be cancerous, a biopsy is performed to remove a sample of the suspicious tissue. It is then sent for pathological examination to determine whether it is benign or cancerous.Q. Are there special tests for high risk groups? Who would you say fall under this category?
We do a gene test—BRCA1 and BRCA2 for patients who have a family history of cancer. If these genes are present, one is considered a hereditary breast cancer case. Such people and their children need to be kept under observation. They may have to undergo an MRI even at 30 because a mammogram may not be able to detect cancer.
Q. What is the latest diagnostic procedure?
The emphasis now is on gene mapping where the defective gene is identified and isolated from the tumor tissue and subjected to customized treatment. There is tremendous gene variation and genetic polymorph. Put simply, it means that there are different types of defective breast cancer genes. Not all respond to the same treatment. Specific defects need specific/customized treatment available in very few centers in the world.