Expert Care for Breast Cancer

Breast cancer develops when abnormal cells in breast tissue grow uncontrollably. It usually begins in the milk ducts or lobules and may spread to nearby lymph nodes or other parts of the body if not detected and treated.

Although breast cancer mainly affects women, men can also develop it. Not every breast lump is cancerous, but any new or unusual breast change should be evaluated by a qualified doctor.

At AIROC Hospitals, Kondapur, Hyderabad, patients with suspected or confirmed breast cancer receive coordinated evaluation, personalised treatment planning and supportive care from a multidisciplinary cancer-care team.

Overview and Types

Ductal Carcinoma in Situ

Ductal carcinoma in situ, or DCIS, is an early condition in which abnormal cells are found inside a milk duct but have not spread into surrounding breast tissue. It is sometimes referred to as stage 0 breast cancer.

Invasive Ductal Carcinoma

Invasive ductal carcinoma begins in the milk ducts and spreads into nearby breast tissue. It is the most common type of invasive breast cancer.

Invasive Lobular Carcinoma

Invasive lobular carcinoma begins in the milk-producing lobules and spreads into surrounding breast tissue. It may sometimes affect more than one area of the breast or both breasts.

Inflammatory Breast Cancer

Inflammatory breast cancer is a rare and aggressive form in which cancer cells block lymph vessels in the breast skin. The breast may appear red, swollen, warm or thickened, sometimes without a noticeable lump.

Triple-Negative Breast Cancer

Triple-negative breast cancer does not have oestrogen receptors, progesterone receptors or excess HER2 protein. Treatment may involve chemotherapy, immunotherapy and other approaches depending on the cancer stage and individual findings.

HER2-Positive Breast Cancer

HER2-positive breast cancer contains higher-than-normal levels of the HER2 protein, which can encourage cancer-cell growth. HER2-targeted medicines may be included in treatment.

Hormone-Receptor-Positive Breast Cancer

These cancers contain oestrogen or progesterone receptors. Hormone therapy may help block the hormones that support cancer growth.

Paget Disease of the Breast

Paget disease is a rare breast cancer involving the nipple and surrounding areola. It may cause persistent redness, scaling, itching, discharge or nipple changes.

Breast cancer is classified by where it begins, whether it has invaded surrounding tissue and its biomarker characteristics.

Symptoms and Causes

Breast cancer may not cause noticeable symptoms during its early stages. Possible warning signs include:

• A new lump or thickening in the breast or underarm
• A change in breast size, shape or appearance
• Swelling affecting part or all of the breast
• Skin dimpling or an orange-peel appearance
• Persistent redness, warmth or thickening
• Nipple inversion or a change in nipple direction
• Unusual nipple discharge, particularly blood-stained discharge
• Scaling, crusting or irritation around the nipple
• Persistent breast or nipple pain
• Swollen lymph nodes under the arm or near the collarbone

Most breast lumps are not cancerous. However, a new lump or persistent breast change should be assessed promptly. Breast cancer is generally more treatable when identified before it has spread.

What Causes Breast Cancer?

Breast cancer develops when genetic changes cause breast cells to grow and divide abnormally. The exact cause is often unknown.

Breast cancer:

• Is not contagious
• Is not always inherited
• Can occur without a family history
• Is not caused by touching, pressing or injuring the breast
• Cannot be diagnosed from symptoms alone

Only a proportion of breast cancers are associated with inherited gene changes, such as alterations in BRCA1, BRCA2, PALB2 or other cancer-related genes.

Diagnosis and Treatment

Diagnostic Evaluation

Breast-cancer evaluation may include:

• Medical and family-history assessment
• Clinical breast examination
• Diagnostic mammography
• Breast ultrasound
• Breast MRI in selected patients
• Core-needle or image-guided biopsy
• Histopathology examination
• Oestrogen-receptor and progesterone-receptor testing
• HER2 testing
• Additional molecular or genomic testing when appropriate
• CT, PET-CT, bone scan or other imaging for selected patients

A biopsy is required to confirm breast cancer. Tissue testing helps identify the cancer type, grade and biomarkers that influence treatment.

Breast Cancer Staging

The cancer stage is based on factors including:

• Tumour size
• Involvement of nearby lymph nodes
• Spread to distant organs
• Tumour grade
• Hormone-receptor status
• HER2 status
• Other relevant biological findings

Breast cancer may be classified from stage 0 to stage IV. Stage IV, or metastatic breast cancer, means the disease has spread beyond the breast and nearby lymph nodes.

Treatment Options

Treatment depends on the cancer type, stage, grade, biomarker results, menopausal status, overall health and patient preferences. Many patients receive more than one form of treatment.

Breast Surgery

Surgical options may include:

• Lumpectomy: Removal of the cancer with a margin of surrounding tissue while preserving most of the breast.
• Mastectomy: Removal of the entire breast.
• Sentinel lymph-node biopsy: Removal of the first lymph nodes to which cancer is most likely to spread.
• Axillary lymph-node surgery: Removal of additional underarm lymph nodes when clinically required.
• Breast reconstruction: Reconstruction performed during or after cancer surgery in eligible patients.

Radiation Therapy

Radiation therapy may be recommended after breast-conserving surgery and in selected patients after mastectomy. It may also be used to control locally advanced, recurrent or metastatic disease.

Chemotherapy

Chemotherapy may be administered before surgery to reduce tumour size or after surgery to lower the risk of recurrence. It may also be used to manage advanced breast cancer.

Hormone Therapy

Hormone therapy may be recommended for hormone-receptor-positive breast cancer. It works by reducing hormone production or blocking hormones from stimulating cancer cells.

Targeted Therapy

Targeted treatment may be used when tumour testing identifies HER2 or other actionable biological characteristics.

Immunotherapy

Immunotherapy may be considered for selected patients, particularly certain triple-negative breast cancers, based on the cancer stage and biomarker findings.

Supportive and Rehabilitative Care

Supportive care may include:

• Pain and symptom management
• Nutritional counselling
• Psychological and emotional support
• Physiotherapy after breast surgery
• Lymphoedema prevention and management
• Fertility counselling
• Menopause and bone-health support
• Palliative care

Treatment commonly involves an individualised combination of surgery, radiation, chemotherapy, hormone therapy, targeted therapy or immunotherapy.

Prevention and Risk Factors

Breast cancer cannot always be prevented. Some risk factors can be modified, while others cannot be changed.

Possible Risk Factors

• Increasing age
• Female sex
• Personal history of breast cancer
• Family history of breast or ovarian cancer
• Inherited genetic changes, including BRCA1 and BRCA2
• Dense breast tissue
• Early onset of menstruation
• Later menopause
• Never having had a full-term pregnancy
• Older age at first full-term pregnancy
• Previous radiation treatment involving the chest
• Certain non-cancerous breast conditions
• Postmenopausal overweight or obesity
• Physical inactivity
• Alcohol consumption
• Long-term exposure to certain hormone treatments

Having one or more risk factors does not mean that a person will develop breast cancer. Many patients have no strong family history or identifiable high-risk gene alteration. 

Risk-Reduction Measures

The following measures may help reduce risk:

• Maintain a healthy body weight
• Exercise regularly
• Limit or avoid alcohol
• Avoid smoking and tobacco
• Breastfeed when possible
• Discuss the benefits and risks of menopausal hormone therapy
• Attend age- and risk-appropriate breast screening
• Seek genetic counselling when there is a strong family history
• Discuss preventive medicines or surgery if identified as having a very high inherited risk

Breast Cancer Screening

Screening can help detect breast cancer before symptoms develop. Depending on age and personal risk, screening may involve:

• Mammography
• Clinical breast examination
• Breast MRI for selected high-risk individuals
• Personalised surveillance for people with inherited cancer risk

The appropriate starting age and screening frequency should be discussed with a doctor because recommendations vary according to age, family history, breast density and individual risk.