Detecting breast cancer: What are signs and risk factors you shouldn’t ignore

Each woman’s risk factor varies, so screening must be individualised.

Women at high risk include those with a family history of the disease among blood relatives. (Photo: Pexels)

The incidence of breast cancer is increasing in India, accounting for nearly 15 per cent of all cancer cases, going by 2020 estimates. Indian women are also developing breast cancer at a younger age compared to their Western counterparts.

Considering that we already carry a burden of lifestyle diseases given our largely sedentary lifestyles — obesity, diabetes, cholesterol, high blood pressure — all of which are risk factors, awareness and screening become important, according to Dr Anita Mamtani, breast surgeon, Memorial Sloan Kettering Cancer Center, New York, US.

Which Indian women are at high risk of breast cancer?

Women at high risk include those with a family history of the disease among blood relatives. Then there are several external factors. For example, women who received radiation in the chest before the age of 32 or have a history of significant hormonal exposure are at a higher risk. Additionally, those with a strong family history or mutations in genes such as BRCA1 or BRCA2, among others, are also at increased risk.

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The majority of breast cancers are of a hormone receptor-positive subtype (Cancer cells have receptors for estrogen or progesterone that use these hormones to grow). More aggressive and invasive breast cancer subtypes, including the triple-negative (cancer cells don’t have hormone receptors and don’t have much of the protein HER2) are being diagnosed in younger women.

Young women are also more likely to have dense breast tissue, which appears white on mammograms, can obscure tumours — also white — making detection challenging and potentially delaying diagnosis. Given these trends among young Indian women, breast awareness, early and individualized screening and genetic testing for patients meeting eligibility criteria are crucial.

Are all lumps dangerous?

While not all lumps in the breast or underarm are cancerous, any new or unusual mass should be evaluated immediately. Watch out for significant changes in breast size or shape, such as swelling, or noticeable asymmetry, which can signal the presence of early-stage breast cancer. Alterations in the texture of the breast skin — such as dimpling or a puckered appearance reminiscent of an “orange peel” — should not be overlooked. Unusual nipple discharge, particularly if it is bloody or occurs spontaneously without pressure, is a critical warning sign, along with changes like nipple inversion or scaling around the nipple area.

Persistent pain in the breast or nipple that is not linked to the menstrual cycle may indicate a potential issue. Redness, irritation, or rash-like conditions on the breast or nipple can suggest an underlying problem; if these symptoms persist or worsen, seek medical consultation.

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Swollen lymph nodes in the underarm or near the collar bone can indicate that breast cancer has spread beyond the breast tissue. Watch out for changes in one breast or unusual warmth of the affected breast.

Why do treatment paths need to be personalised?

In many cases, surgery is the first step. A lumpectomy removes the tumour while preserving the remainder of the breast; a mastectomy removes the entire breast. Radiation therapy is needed in certain cases to eliminate microscopic cells missed during surgery. This reduces chances of recurrence.

Chemotherapy may be administered in some cases, sometimes before surgery, at other times, after it. Hormone therapy is prescribed for hormone receptor-positive cancers, blocking the hormones that fuel tumour growth. Targeted therapies and immunotherapy, on the other hand, focus on specific proteins like HER2 and may enhance the immune system’s ability to identify and eradicate cancer cells.