Breast cancer is the malignant tumor that starts in the cells of the breast. It occurs both in men and women. It is the most common cancer in Indian women. However male breast cancer is rare.In 2018, 1.6lakh new cases and 0.8lakh deaths were reported for breast cancer in India
The earliest form of breast cancer is called non-invasive or pre-invasie breast cancer. Non-invasive breast cancer is when the abnormal cells haven’t spread from their original location. Some of these start in cells in the ducts (the milk ducts) or the lobules (milk-producing glands).
Invasive breast cancer spreads beyond the ducts into other nearby tissues in the breast. Invasive ductal carcinoma accounts for over 80% of all cases. Early breast cancers are often small and frequently do not spread to the lymph nodes. There are different types of invasive breast cancer. The two most common are invasive ductal carcinoma and invasive lobular carcinoma.
Triple-negative breast cancer (TNBC) accounts for about 10-15% of all breast cancers. The term triple-negative breast cancer refers to the fact that the cancer cells don’t have estrogen or progesterone receptors and also don’t make too much of the protein called HER2. (The cells test "negative" on all 3 tests.) These cancers tend to be more common in women younger than age 40, who have a BRCA1 mutation.
Triple-negative breast cancer differs from other types of invasive breast cancer in that they grow and spread faster, have limited treatment options, and a worse prognosis (outcome).
Breast Self Examination (BSE): It can be done at the comfort of your own home.Women who are menstruating – Every month BSE should be done 7 days/ 1 week after the menses have stopped.Post menopausal – On a fine day every month.
Clinical Breast Examination: A doctor examines your breasts and under arm area for any lumps by palpation. Nipples are examined for any suspected discharge, skin changes and retraction.
Biopsy: Fine needle aspiration biopsy/cytology (FNAB/FNAC): After a positive physical examination/ ultrasound or mammogram, a small piece of tissue/fluid is taken from an abnormal finding area of the breast and examined for cancer cells using a thin needle and a syringe without using anesthesia.
Core needle breast biopsy: A larger, hollow needle is inserted into the breast lump and cylindrical piece of breast tissue (core) is taken out for histopathological examination to confirm cancer. A core biopsy provides more breast tissue for examination than FNA.
Surgical (open) biopsy: Occasionally, surgery may be recommended to remove a part or whole breast lump to check for cancer. This is performed under anesthesia.Nipple discharge cytology (nipple discharge exam): A sample of fluid or discharge from the nipple is examined under the microscope to look for cancer cells. Even if the nipple discharge cytology result is negative, the surgeon may go in for other tests if there is a clinical suspicion.
Mammogram: A mammography machine uses low-dose x-rays to take images of your breast. First the machine compresses each breast and takes x-ray images on film. This is commonly used for early detection of breast cancer.
Breast Ultrasound: In this procedure, a device sends high frequency sound waves through your breast. The sound signals received from tissues are converted into pictures on computer screen. These images allow the doctor to look for any abnormality.
MRI Scan: In this procedure, a high-powered magnet and a computer is used to scan and to create detailed images of the breast and surrounding organs. Breast MRIs are recommended only in specific cases where mammogram information is insufficient.
Immunohistochemistry (IHC) for HER2 testing:Immunohistochemistry (IHC) Testing: Tissue sample is taken from the cancer site and sent to pathology lab to see if a tumor has too much of the HER2 receptor protein on the surface of the cancer cells. With too many HER2 receptors, the cells receive too many signals telling it to grow and divide.
Immunohistochemistry (IHC) for hormone receptor testing: Tissue sample is taken from the cancer site and sent to pathology lab to see if there are hormone receptors on breast cancer cells. If hormone receptors are present, this means that the cancer cells’ growth is fueled by the hormones estrogen and/or progesterone.
Immunohistochemistry (IHC) for PDL1 Testing: Tissue sample from Triple Negative Breast cancer patients is taken and sent to pathology lab to see if the programmed cell death ligand (PD-L1) is expressed in their cancer. Your doctor will recommend to test the biopsy sample to know if your cancer will respond to Immunotherapy.
Genomics & Transcriptomics: Tests that can identify DNA-& RNA based changes (point mutations, gene amplification, fusion, deletion, insertion, or nucleotide polymorphisms) leading to abnormality at the gene level and requires personalised medicine approach. Tests can range from single gene test, panel of genes, whole exome sequencing, RNA sequencing etc
The new guidelines recommend that gene testing to include BRCA 1/2 and PALB2 mutations (and other genes as appropriate based on clinical scenario and family history) be made available to all newly diagnosed breast cancer patients.
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