Breast cancer is one of the leading causes of sickness and death among women which can be prevented. About 416,000 women are diagnosed to be suffering from breast cancer in the U.S.A. and 20,000 die due to it. In developing nations, diagnosis of breast cancer is often delayed or missed because infectious diseases take up much attention of both the family and concerned personnel. There is also poor awareness about the disease due to which women may report late in the disease or not report at all and die. Breast cancer can occur both in men and women but prevalence is much higher in women, therefore it is discussed mainly in the context of women. It is a hormone dependant tumor. Women having early menarche, few or no pregnancy, first pregnancy at a later age, late menopause are at higher risk of developing breast cancer. With more and more women working at par with men in different fields, they have less time for womanly activities like raising a family, especially in developed western world. Thus they are exposed to a higher risk of breast cancer. Oral contraceptives increase risk of breast cancer when taken for a long time. Similarly estrogen replacement therapy in women after menopause places them at a higher peril of breast cancer. Some researchers put abortion also as a risk factor for breast cancer. Exposure to radiation therapy at a younger age can lead to the development of breast cancer at a later date. Use of very tight brassieres is also said to increase chances of developing breast cancer because of the chronic irritation caused. There is a strong genetic component which determines the development of breast cancer. If there is a mother or sister or some female relative suffering from breast cancer, there are greater chances of a woman to have breast cancer when exposed to the above risk factors. Breast cancer may be silent in early stages and detected when it is fairly spread to other parts of the body. There may be affection of the breast tissue or milk ducts. It may manifest as a painless lump in affected part of breast. A lump, howsoever small, should alert one to the possibility of breast cancer. Bloody discharge from a nipple, persistent eczema, painless lump in the axilla, all these features indicate the possibility of a breast cancer. In some cases the overlying skin of the breast may be red and inflamed, something called “ peau de orange”. Untreated, the cancer may spread to other breast, bones, lungs, stomach, thyroid and even brain directly or through lymphatics or blood. Diagnosis is established by physical examination, mammography and confirmed by biopsy of the lump. But once diagnosed there is no treatment left except for removing affected breast and adjoining tissues. In earliest stages, this is life saving and ensures long and good life. But in later stages, surgery is followed by chemotherapy and or radiation therapy depending on the extent of spread of the tumor. Mastectomy (removal of the breast) is mentally disturbing for the affected lady. Chemotherapy causes depression in bone marrow function, reduced immunity and also loss of hair adding to the cosmetic disability induced by surgery. Radiation therapy has hazards of its own, like fibrosis of the lungs or stricture of food pipe causing further disability.Net result of all these types of treatment is only prolonging the life but without quality. Considering these hazards and benefits of very early treatment it is imperative that women should be educated about breast cancer. They need to be taught self examination of breasts. Middle aged women need to examine there breasts everyday. Any lump or nodule howsoever small should be reported immediately. This will help in the breast cancer being detected in the early treatable stage and prevent it from spreading to other parts of the body. More so in resource poor settings, where facilities for diagnosis and treatment are limited, it can prevent sickness and death from breast cancer in women. The author is a specialist in Internal Medicine. E-mail – rachna212002@yahoo.co.uk
