Mammography Tips

Breast cancer(स्तन कैंसर) is on the rise in india. Surveys show that every 4 out of 5 Indian women who have breast cancer, suffer from an advanced stage of the disease by the time they reach the doctor. Urban women are at two times more risk of being diagnosed with breast cancer than rural women. Being overweight, eating unhealthy food, and consuming excessive alcohol or tobacco are some of causes that can make you susceptible to this disease.

How you can avoid breast cancer?

1. Every woman should do a self-breast examination every month after the periods. You should check for any abnormal lump, change in skin texture or any abnormal discharge from the nipples. Any abnormality above aspects should be promptly investigated by a doctor's appointment, and an ultrasound or Mammography, as required.
2. Apart from self-examining your breasts every month for a lump, going for a mammography (an X-Ray of the breast) is vital for early detection of the problem.
3. Consult a gynaecologist before going for the test as its frequency depends on your age and risk factor. About 80-90% of tumours can be traced through this screening.

Breast cancer may run in family. If there is no family history of breast cancer, you start doing mammogram at 40 yrs of age but if there is a family history you start even earlier as advised by your gynaecologist.

With the modernization of all economies around the world, one health hazard that has become one of the largest perils within both developed and developing nations is the incidence of cancers of the female reproductive system, especially cervical and breast cancer.

Breast cancer

Breast cancer is the formation of malignant tumors within the breast tissues of a woman. Usually, breast cancer affects women in the age range of 40 to 50, but there have been many reports of it occurring earlier. About 48 % percent of the Indian women having breast cancer have been reported to be under 50. This is an almost 17 percent jump compared to figures 25 years earlier.

Alarming Signs of Breast Cancer:

• The most common symptom of breast cancer is a new lump or mass. A painless, hard mass that has irregular edges is more likely to be cancerous, but breast cancers can be tender, soft, or rounded.
• Swelling of all or part of a breast (even if no distinct lump is felt)
• Skin irritation or dimpling
• Breast or nipple pain
• Nipple retraction (turning inward)
• Redness, scaliness, or thickening of the nipple or breast skin
• Nipple discharge (other than breast milk)

Screening Guidelines for Breast cancer:

• Mammography: US Preventive Services Task Force (USPSTF) recommends mammography once in every 2 year for females between age group 50-75 years. Women with a family history has a benefit of starting at age 40 years. After 75 years there are insufficient evidence of benefit of screening mammography.
• Breast Self Examination and annual Clinical examination: breast self examination is easy to learn and and any abnormality should be reported to the oncologist.
• For High Risk/ Genetic risk factors: screening should start by age 25 or 10 years earlier of youngest relative affected. Annual mammogram and MRI or Doppler ultrasound alternating at 6 month interval can be considered.

Treatment Options:

Some of the common treatment options for breast cancers are:

• Breast conservation surgery - This is where the tumors are removed without cutting out too much of the surrounding breast tissue.
• Mastectomy - If the cancer has spread too far then large amounts of breast tissue has to be removed along with the tumor to stop its spread any further.
• Sentinel lymph node Biopsy - it's part of both surgical procedures, it decreases morbidities of lymph node dissection first draining lymph nodes only are removed in patients with clinically negative axilla. If negative on frozen section further axillary dissection is avoided. It avoids the morbidity of complete axillary clearance.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Breast pain, lumps in the breast or discharge from the nipples are some of the more common complaints seen in women. Also, it is generally observed that such women are between the ages of 40-69. While most of these cases are benign, the diagnosis or the problem should be deciphered only after a detailed analysis of the case, symptoms, and history of breast cancer if any.

1. Breast Pain: Breast pain can arise from a condition called mastitis. It is generally seen in new mothers where the bacteria can enter the milk ducts through the cracks in the nipple causing an infection in the tissue. These infections can also be caused in menopausal women as well, it is more commonly seen in young mothers.
2. Lumps in Breast: Breast tissue changes constantly during a woman’s lifetime and the changing hormone levels during a menstrual cycle can also cause such benign lumps. Benign lumps move as you press against them and can usually be seen in both breasts.
3. Nipple Discharge: While most nipple discharges arise as a result of a benign condition, it will need to be investigated further to understand whether it due to an abscess, an injury, birth-control pills, pregnancy/childbirth or hormonal changes.

Screening:

1. Breast Exams: The doctor will typically examine the patient’s armpits and breast in various angles for irregularities in shape, inward-turned nipples or lumps. The armpits are checked for enlarged lymph nodes as well.
2. Mammography: This form of testing which involves x-rays of both the breasts is more effective in older women when the fat tissue is generally a lot more. In such cases, it is easier to identify other tissues from the fat tissue.
3. Sonography: Where an abnormality is discovered in a mammography, the sonography helps to clarify things further. A lump which is filled with liquid are rarely cancerous and this can be done through a sonography.

Risk Factors:

Most women are still not aware about the factors that can put you at risk when it comes to breast cancer. Compiled below are some points that can help understand the same and what can be done to lower the risk:

1. Age: While it is possible for any woman to get fibrocystic breast disease, women between 30 and 50 are more susceptible to such conditions thanks to the hormonal changes during this time.
2. Family history: If anyone in your family has been diagnosed with breast cancer then automatically your risk increases. Also, if the person diagnosed is in first relation then the risk factor doubles and in case there are two people in first relation who have been diagnosed then the risk factor increases by 5 times. It is also sometimes linked to faulty gene such as BRCA1 and BRCA2. 
3. Exposure to radiation: In case you have undergone a treatment and were exposed to the any type of radiation near the chest area for any type of medical treatment then your risk of acquiring breast cancer increases. The younger you were at the time of radiation exposure higher is the risk. 
4. Obesity: Women who have a BMI over 25 are more at risk of developing breast cancer than others. Further, obesity also increases the risk of recurrent breast cancer. 
5. Pregnancy & breastfeeding:  Women who conceive after 30 years of age are more at risk of acquiring breast cancer, as breast growth cells are immature and active before a full term pregnancy and mature only after it and regulates them. Further, not breastfeeding your baby for 1 complete year can increase your risk of cancer. 
6. Alcohol: Alcohol has the tendency to damage the DNA in cells and  increase levels of estrogen and other hormones associated with hormone-receptor-positive breast cancer. Women who drink alcohol 3 drinks a week have 15% more risk of developing breast cancer, which further increases by 10% if you consume it regularly.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Fibroadenoma
Fibroadenoma or a benign breast lump is the state of occurrence of a tumour or lump in the breast of women. Although, many of its patients suffer from a fear before its diagnosis by assuming it as a symptom of breast cancer. But take a note that it is different from a breast cancer.

In the Inflammatory Breast Cancer (IBC), the breast skin over the lumps turns red and inflamed. But a fibroadenoma usually does not cause any such kind of inflammation over the skin, unless rubbed or pressed hard multiple times while checking it. It is also painless in most of the cases.

In summary, those are harmless to the human body. However, it is recommended to get those diagnosed and treated by the doctor as and when those are observed. It is noted that around four of every five cases of a tumour in the breast is diagnosed as fibroadenoma and are non-cancerous. A fibroadenoma is a soft to hard tissue developed by the fibrocystic or other hormonal changes in the women body.

The normal size of observable lumps caused by fibroadenoma could be of 2 to 5 cm. They are shaped like a marble and are movable within the skin. Note that these tissues tend to shrink or even disappear during the menopause since the hormone levels are lowest in the female body during that phase. When trying to hold it with fingers, you would be able to feel it rubbery.

The lumps developed by fibroadenoma may grow during the days of pregnancy due to many hormonal changes. A fibroadenoma is normally developed in females of age between 15 to 30 years. However, women of any age may observe it developed in their breast.

The occurrence of fibroadenoma is not rare. Fibroadenoma could be of the following types:
- Simple Fibroadenoma: It refers to the development of tissues in the breast that have very slow or at times no growth, once developed. Such kind of fibroadenoma has no risk of developing breast cancer in the future.

- Complex Fibroadenoma: The lumps developed in this type of fibroadenoma are filled with some fluid along with deposition of calcium within its lumps. Once reported, those require monitoring on a regular basis for any behavioural changes. Those may have the risk of developing breast cancer at a later stage. If the growth is rapid, the doctor may recommend getting the biopsy test done with a part extracted from the tissue, for confirmation of cancer.

- Juvenile Fibroadenoma: In this type of fibroadenoma, the lumps are developed in the breast of girls aged between 10 to 18 years of age. The lumps developed by juvenile fibroadenoma may grow large. However, most of those shrink or disappear over the time, as and when the associated hormones are completely developed.

- Giant Fibroadenomas: The normal size of the lumps caused by fibroadenoma is up to 5 cm. Those developed due to giant fibroadenoma may grow even more than 5 cm. Although, they do not cause any harm to the body. But at times, those may suppress the breast tissues. Also, their existence due to a larger size may make the sufferer feel a bit uncomfortable psychologically. In such cases, the patient may get those removed from their breasts.

Symptoms of Fibroadenoma:
Following are the symptoms of fibroadenoma:

- One or more solid lumps in the breast

- The lumps could be of round shape and smooth border

- Those are moved easily when pressing softly with a finger

- These lumps are of rubbery nature

- Those do not cause any pain in the breasts or any other part of the body

- The lumps caused by fibroadenomas may be either in any one or both of the breasts

- There is no irritation or itching on the skin over the lumps unless you rub those

- Unlike IBC, the skin over the fibroadenomas lumps does not get red

Causes of Fibroadenoma:
The actual cause of fibroadenoma is not known yet. However, it is assumed that those can occur due to the development of the reproductive hormones. Fibroadenoma may also be developed due to any changes in such hormones. This is the reason why the lumps caused by this disease grow in size in the pregnancy period or may shrink after menopause in females.

It is assumed that if the diet taken during the development of hormones does not contain essential nutrients, it may cause abnormality in the hormones being developed, which could be a cause of fibroadenoma.

Prevention of Fibroadenoma:
Since fibroadenoma lumps are developed due to the hormonal changes, your body must get sufficient diet during the phases of major hormone development. The various precautionary measures that you may take to avoid fibroadenoma are discussed below:

- Try to reduce or eliminate meat from your diet. It is best to switch to a vegetarian diet. A plant-based diet is considered as best during the period of major hormonal changes in the females. If elimination of meat from the diet is not possible, switch to the organic meat, which is free from chemicals and external hormones.

- Avoid the intake of refined sugars.

-  Avoid food items rich in estrogen. Some of those include sesame seeds, flax seeds, soy-based products, peaches, strawberries, green beans, white beans, black beans, and more.

- Include lots of vegetables in your diet. Drink juices or smoothies of organic vegetables on a daily basis.

- Include wheatgrass in your diet, as it tends to not only prevent fibroadenomas but also reduces those post their development. Eat the vegetables more, which are significant in the well-functioning of the breast tissues such as spinach, kale, dandelion leaves, parsley, celery, cucumber, and more.

- Try to keep your body alkalized by consuming fresh and organic food items.

- Adopt some detox program on often basis for the elimination of toxins and chemicals from your body.

- Avoid stress and have sufficient sleep to avoid fibroadenoma. Try meditation and breathing exercises to keep your stress level in control.

- Avoid junk or deep-fried foods. Also avoid processed food items, as those may contain tumour-promoting carcinogens.

- Avoid taking birth control pills, as those are highly associated with the risk of developing fibroadenomas.

- Try to reduce caffeine from your daily diet.

How is it diagnosed?
In case you observe one or more lumps in your breasts, you must visit the doctor and explain your medical history and symptoms. The doctor may recommend the mammogram test, in which the impacted breast is placed stationary and an X-ray capturing is done.

The X-ray report of a mammogram would confirm the presence of some lump along with its shape and size. If the age of the patient is below 40 years, the doctor may also recommend an ultrasound test of the breast rather than or along with mammography to know about the lump’s consistency.

Actually, the breast of women with age below 40 years has harder tissues. The X-ray done in mammography may not capture clear pictures of the fibroadenoma lumps because of their interference with harder breast cells in the image.

The doctor may also recommend a cytology test to confirm if the lump is a cyst. In this test, a needle is inserted into the lump and a little part of it is extracted out with the help of vacuum. In case the extracted material is just fluid, it confirms that the lump is a cyst.

In case the physician suspects that the lump is caused by cancer, a core needle biopsy is recommended. In this test, a bit thicker needle is inserted in the lump and some part of the tissue is extracted and sent to the laboratory for biopsy. The report of biopsy confirms if the lump has cancerous cells.

Treatment of Fibroadenoma:
When the doctor confirms by analysing the diagnostic reports that the reported lumps are due to fibroadenoma, the patient is generally not recommended any treatment. In normal cases, it is avoided to extract the lump by surgery, as it may distort the shape of the breast.

Additionally, it may result in the reformation of the lump at a later stage. But, if it is a giant fibroadenoma with multiple lumps, those could be removed from the patient’s breast. There is one more way called as cryo-ablation to destroy the lumps. In this method, a thin tube is inserted into the lump, and some gas is passed from the tube to the tissue.

The gas freezes the tissue and makes it inactive for a long time or even for the lifetime. However, this methodology may be used for treating lumps of smaller size. The best way to minimize the size of the lumps or to make them disappear is to adopt a healthy diet and lifestyle. It is also recommended to keep noticing the size of lumps and visit the doctor on a timely basis. The complex fibroadenoma may have the risk of developing breast cancer at a later stage.

Complications of Fibroadenoma:
Usually, fibroadenomas do not cause any problem in the human body. However, their existence may cause psychological stress in the mind of its patient. In any case, it is must for you to visit a doctor and get all the medical investigations done to know about the nature of fibroadenoma. You must be very cautious in case the lumps are because of complex fibroadenoma, as those may cause cancer, if not taken care on time.

Myths of Fibroadenoma:
Myth #1: Fibroadenoma may only occur in the breast of females

Fibroadenoma is mainly associated with the fibro-glandular tissue, which is found in the breasts of females and is not available in the normal male individuals. In some extremely rare cases, fibroadenoma is also reported in males. Those cases involve male-to-female transsexuals and the cases where estrogen therapy is provided in aged individuals suffering from prostate carcinoma.

Myth #2: A lump in the breast is always the breast cancer

Fibroadenoma causes the development of lumps in the breast that are harmless. The lumps related to cancer may be painful and may show the signs of rashes or bruises on the skin surface of the lump.

Myth #3: When the result of the mammography test is clear, when you have a breast lump, you need not even visit the doctor again.

At times it happens then the mammography test does not confirm the occurrence of fibroadenoma. This is because the X-ray performed in mammography, at times in case of some young women, may not detect the existence of the fibroadenoma lumps. In that case, you will need to revisit your doctor, who may further recommend you several tests in order to understand the exact nature of the lumps and avoid any probable complications in future.

Myth #4: The lumps caused by the breast cancer are always painful and any painless lump would be a harmless fibroadenoma.

This is not necessary. The lumps developed by breast cancer are not always painful. At times, the patient could not distinguish between fibroadenoma and breast cancer just by visibly observing the symptoms.

Myth #5: Fibroadenoma may only be developed in the females of younger age.

Fibroadenoma may cause lumps in the breasts of the females of any age group.

Myth #6: Smaller lumps in the breast are caused by breast cancer, whereas bigger lumps are developed because of fibroadenoma.

A lump caused by fibroadenoma will also be developed initially with a smaller size and may grow up to a larger size.

Myth #7: A painless lump in your breast could only be because of fibroadenoma if you have no history of breast cancer in your family.

Note that a breast cancer is not a hereditary problem and could occur to any female. You must be very cautious with the sign of any lump in your breast.

Conclusion
Fibroadenoma is a mild condition in which you may observe single to multiple lumps in one or both of your breasts. It may be primarily caused by hormonal changes in the female. In any of its symptoms, you must visit a physician and get all the prescribed investigations done. If confirmed, you may not be prescribed any medication course to get it treated. In some extreme cases, you may consult with your doctor and get it extracted from your breasts.

Test to screen for breast cancer:

Mammogram:

1. Mammography is the most common screening test for breast cancer. A mammogram is an x-ray of the breast. This test may find tumors that are too small to feel. A mammogram may also find ductal carcinoma in situ (dcis). In dcis, there are abnormal cells in the lining of a breast duct, which may become invasive cancer in some women.

2. Mammograms are less likely to find breast tumors in women younger than 50 years than in older women. This may be because younger women have denser breast tissue that appears white on a mammogram. Because tumors also appear white on a mammogram, they can be harder to find when there is dense breast tissue.

Enlarge Mammography:

1. The left breast is pressed between two plates. An x-ray machine is used to take pictures of the breast. An inset shows the x-ray film image with an arrow pointed at abnormal tissue.

2. The breast is pressed between two plates. X-rays are used to take pictures of breast tissue.

The following may affect whether a mammogram is able to detect (find) breast cancer:

1. The size of the tumor. How dense the breast tissue is. The skill of the radiologist.

2. Women aged 40 to 74 years who have screening mammograms have a lower chance of dying from breast cancer than women who do not have screening mammograms.

Clinical Breast Exam (CBE):

1. A clinical breast exam is an exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual. It is not known if having clinical breast exams decreases the chance of dying from breast cancer.

2. Breast self-exams may be done by women or men to check their breasts for lumps or other changes. It is important to know how your breasts usually look and feel. If you feel any lumps or notice any other changes, talk to your doctor. Doing breast self-exams has not been shown to decrease the chance of dying from breast cancer.

3. Mri (magnetic resonance imaging) in women with a high risk of breast cancer

4. Mri is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (nmri). Mri does not use any x-rays.

MRI is used as a screening test for women who have one or more of the following:

1. Certain gene changes, such as in the brca1 or brca2 genes. A family history (first degree relative, such as a mother, daughter or sister) with breast cancer. Certain genetic syndromes, such as li-fraumeni or cowden syndrome.

2. Mris find breast cancer more often than mammograms do, but it is common for mri results to appear abnormal even when there isn't any cancer.

3. Other screening tests are being studied in clinical trials.

Thermography:

1. Thermography is a procedure in which a special camera that senses heat is used to record the temperature of the skin that covers the breasts. A computer makes a map of the breast showing the changes in temperature. Tumors can cause temperature changes that may show up on the thermogram.

2. There have been no clinical trials of thermography to find out how well it detects breast cancer or if having the procedure decreases the risk of dying from breast cancer.

Tissue sampling:

Breast tissue sampling is taking cells from breast tissue to check under a microscope. Abnormal cells in breast fluid have been linked to an increased risk of breast cancer in some studies. Scientists are studying whether breast tissue sampling can be used to find breast cancer at an early stage or predict the risk of developing breast cancer. Three ways of taking tissue samples are being studied:

Fine-needle aspiration: a thin needle is inserted into the breast tissue around the areola (darkened area around the nipple) to take out a sample of cells and fluid.

Nipple aspiration: the use of gentle suction to collect fluid through the nipple. This is done with a device similar to the breast pumps used by women who are breast-feeding.

Ductal lavage: a hair-size catheter (tube) is inserted into the nipple and a small amount of salt water is released into the duct. The water picks up breast cells and is removed.

When the skin of a breast looks uneven, it is known as a dimpled skin. Sometimes the skin might appear to be red or inflamed. In this condition, the breast tissue gets affected and this can be a serious sign of concern for cancer. Moreover, this sign is hard to detect on your own. Usually when the sign occurs, it only occurs in one of the breasts. If a woman has it in both the breasts, then likely that it has not been caused by cancer.

Causes of breast cancer dimpling are as follows
1. Advanced breast cancer
2. Breast abscess: A hollow space in the breast that is filled with pus and is at times surrounded by an inflamed tissue.
3. Duct obstruction: The ducts that carry the milk from the nipple are obstructed causing rapid abnormal growth and functioning of the cells present in the breasts causing cancer.
4. Fat necrosis: In this condition, the neutral fats are split into glycerol and fatty acids because the adipose tissue tends to degenerate.
5. Inflammation: Inflammation in the fatty tissue of the breast
6. Mastitis: The breast tissue tends to swell up and get infected. This happens because of the bacteria that enter the breasts through the nipple and this may cause infection in the milk glands.
7. Genetic: Carrying the faulty gene is one of the main reasons why many women end up literally inheriting breast cancer. This can usually be tested with a mammography, especially if one has a history of breast cancer in the family. Yet, one must remember that it is not advisable to take this test too many times as it puts you at risk of contracting breast cancer even if you do not have it, when there is repeated exposure.

1. Surgery: The cancerous tissue is removed from the breast or at times when the tissue is too big, the entire breast might have to be removed.
2. Chemotherapy: Chemotherapy is a medication that uses a method to send fluids that tend to kill the cancerous cells or prevent them from growing. It is a three to four hour long session at times.
3. Radiation: High beam x-rays are used in order to target and destroy the cancer cells present in the breasts.
4. Hormonal therapy: In this treatment, the hormones that fuel the growth of cancerous cells are blocked either through medications or surgically. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

While some women feel their breasts are too small, others have heavy breasts that they feel are too large for their frame. Large breasts not only affect the silhouette of a woman but can also lead to health problems such as backaches, posture problems and can restrict a woman’s participation in sporting events. Thankfully, with cosmetic breast surgery, a woman can choose to reduce the size of her breasts if need be

Breast reduction surgery involves the removal of skin and tissue from the breasts to resize and reshape the breasts. The darkened area around the areola may also be made smaller. This surgery is usually performed as an inpatient procedure and the person is put under general anesthesia for the duration of the surgery.

Once the patient is under anesthesia, the surgeon will make one or more incisions in the breast. Skin and tissue will then be removed and mobilised from these incisions before stitching the incision cut mainly in a keyhole manner. The nipples and areola may also be cut and repositioned to suit the new contours of the breast. In some cases, liposuction may also be performed. In cases where there is no excess skin and most of the breast comprises of fatty tissue, liposuction alone may be able to reduce the size of the breasts. 

The first step to undergoing breast reduction surgery is to find a cosmetic breast surgeon who agrees with your sense of aesthetics and whose work you have confidence in. Ask to see before and after photographs of your doctor’s earlier patients and be open and honest with him or her about how you would like your breasts to look. Discuss any emotional and physical conditions you may have felt as a result of your breast size as well as your medical history and surgical history if any. 

Steps taken during the procedure of breast reduction

• During your consultation, your doctor may photograph and measure your breasts.
• A mammography and breast exam may also be conducted.
• Once you and your doctor have decided how much tissue needs to be removed and a surgery date is set, it is important for you to start preparing your body for the surgery.
• Have nutritious, well-balanced meals and quit smoking and alcohol for some time.
• If you take any blood-thinning medicines such as aspirin, you will also need to stop taking these for some time.
• In case you are overweight, you may be asked to reduce weight before the surgery so as to reduce chances of complications. It would also be a good idea to take a week or two off work while you recover. 

The surgery itself should not take more than 3-5 hours for one breast and you should be able to notice the results of the surgery quite soon. In case you have a concern or query you can always consult an expert & get answers to your questions!