With a family history of breast cancer, Priya Rao, 42, a theatre practitioner from Bengaluru underwent breast cancer screening in early 2021. As her mother and grandmother had suffered from the same, Priya was well aware of her risk factor. The radiological findings incidentally showed a lump in her breast which was malignant, despite having no obvious breast cancer symptoms. “The precautionary early screening was crucial for early detection and significantly less complicated treatment,” says Priya. When those who have battled breast cancer share their diagnosis, it adds to awareness, Priya adds.
Benefits of early screening for breast cancer
Recently, the US preventive task force issued a new guideline stating that mammograms should start a decade early at 40 years, instead of 50 years to initiate early screening of breast cancer. This could result in 19% more lives being saved.
Indian doctors welcome the move, stressing that earlier detection can be life saver. Dr Sriprada Vinekar, obstetrician and gynecologist, Cloud nine hospitals, Bengaluru points out that she came across three women in their late 30s who had breast cancer in the last three months. “This is alarming. None of them had a family history of breast cancer. They were aware and hence concerned about the lumps. They underwent mammography, followed by a biopsy and were detected with breast cancer,” said Dr Vinekar. Those with a family history of breast cancer must be more vigilant, she added.
Priya underwent a lump removal surgery (lumpectomy) followed by radiation and chemotherapy in 2022. Priya stresses the need for support groups that help in creating awareness on early screening and managing breast cancer.
“We are seeing younger women with breast cancer, even without family history. There has been a higher incidence and we don’t know why. This needs to be studied further,” said Dr Vinekar.
What is a mammogram?
“A mammogram is a specialised X-ray machine which takes a relatively magnified radiological image of the breast in multiple positions by compressing the breast tissue to get a clear view of it,” says Dr Ayan Basu, HOD, Radiation oncology, HCG EKO Cancer centre, Kolkata. He explains that the mammography machine has compression plates and a person undergoing the screening stands and keeps the breast between plates. “That’s how it is different from routine X-ray. There is an objective scoring system for interpreting the mammograms called Breast Imaging-Reporting And Data System or BIRADS scoring system. Based on the BIRADS score assigned to a person’s mammogram, the oncologists take a decision regarding whether any visible breast cancer liaison needs to be further investigated with biopsy or not,” said Dr Basu.
Symptoms of breast cancer
Dr Basu points out that the mammography is a screening investigation which helps in detecting cancer before the obvious symptoms of breast cancer.
Typical symptoms of the breast cancer according to Centre for Disease Control, US are:
- New lump in the breast or underarm (armpit).
- Thickening or swelling of part of the breast.
- Irritation or dimpling of breast skin.
- Redness or flaky skin in the nipple area or the breast.
- Pulling in of the nipple or pain in the nipple area.
- Nipple discharge other than breast milk, including blood.
- Any change in the size or the shape of the breast.
- Pain in any area of the breast.
“Most breast cancer lumps are painless but one must not ignore any changes seen in breast self examination,” says Dr Basu.
“Breast cancer occurs a decade early in India”
Dr Niti Raizada, the Director of Medical Oncology and Hemato Oncology, and Transplant Physician at Fortis Hospital, Bengaluru says that the move is useful in Indian context. “In India breast cancer happens a decade early. We often see women in their 40s having cancer. Undergoing mammography from the 40s makes a lot of sense,” said Dr Raizada.
Dr Anadi Pachaury, consultant, surgical oncology, HCMCT Manipal Hospital, Delhi says that screening at an earlier stage is advantageous. “But if we consider screening through mammography only, then it’s not a good tool (for all). Because in youngsters, the breast is denser under the influence of hormones and stromal tissues (a type of connective tissue) in the breast. In mammography we can’t easily visualise the stromal tissues. It’s relatively tougher to conclude the presence of a lump in a younger breast only through mammography and therefore, not fruitful.”
He adds that in many hospitals in India, another imaging method, sonography is also used. It is especially done for those with dense breasts. The combined diagnosis is called sonomammography. “We have to do combined investigations complementing each other,” said Dr Pachaury.
Agreeing with Dr Pachuary, Dr Das adds that the texture of the breast keeps changing. “The mammogram must be performed in the second week after a woman’s period. That’s when the breast is least dense,” Dr Das said.
The youngest person with breast cancer that Dr Pachaury’s team treated was a 25-year-old woman from Delhi, who had a lump in the breast in 2019. According to Dr Pachaury breast-self-examination is another effective screening method that women must practise.
Takeaways
The US preventive task force issued a new guideline stating that the mammograms should start at 40 years, instead of 50 years. Indian doctors agree with the move. There is a need to build awareness on early screening, doctors say.
