Do not ignore early signs of breast cancer amidst the COVID-19 crisis

As COVID-19 continues to burden healthcare systems around the globe, we cannot ignore its impact on non-COVID patients. The treatment of diseases like breast cancer that largely depends on early diagnosis of its symptoms have clearly taken a backseat. Why? Simply because the patients are wary of visiting a medical facility for the fear of catching the infection. That said, these facts are particularly alarming in case of breast cancer as it is the most common type of cancer, accounting for 14% of cancers in women.

Today, for diagnosis and management of breast cancer, doctors face unequaled challenges as hospital resources and staff become less available. Therefore, in a country where for every 2 women newly diagnosed with breast cancer, one woman dies of it in India; early diagnosis is the only way to change the grim story of the suffering and mortality due to the deadly disease. Dr Sajeeda K, Consultant Radiologist at Vijaya Medical Centre, Vizag shares everything you need to know about breast cancer.

Breast cancer and the role of early detection

When breast cells grow uncontrollably, it can lead to breast cancer. They are of various types, depending on the cells that turn into cancer. Breast cancer can develop in any of the three parts of the breast— ducts (responsible for carrying milk to nipples), lobules (milk-producing glands) and connective tissue (which is the intervening matrix). Most cancers of the breast start in the lobules. The cells from the breast can spread to the lymph nodes and other parts of the body.

Unfortunately, a major problem with the disease is that the symptoms are silent. For a lot of people, there are no warning signs at all. Hence, early diagnosis and screening are critical in improving breast cancer outcomes and survival rates.In 2018, an estimated 60,000 women died of breast cancer in India. Additionally, the country has far lower survival rates of 66 percent for breast cancer when compared to 90 percent in USA.

The next important question is, how does one get screening done when there are no symptoms?

According to research reports, 90 percent of breast cancer cases are the ones detected by women themselves. 85-90 percent of breast cancers are sporadic, developed due to acquired gene damage and 10 to fifteen percent are due to an abnormality inherited from parents. The factors associated with the sporadic development of the cancer are increasing age, beginning menstrual cycle at a younger age, starting menopause at an older age, having your first child at an older age, and drinking alcohol.

As we maintain a social distance and restrict hospital visits one should be extra cautious and vigilant about any symptoms noticed in the body, and self-awareness is key. Every month women should self-examine themselves to look for unfamiliar signs like nipple pain or retraction, a lump in the breast or your armpits, changes in the shape or size of the breast, dimpling of the skin and a rash or discharge from the nipple. The five-year survival rate for women with early breast cancer is close to 100 percent. Hence, to successfully treat breast cancer, early detection is the key.

Managing breast cancer with minimally invasive procedures

Conventionally, methods such as clinical examination, mammography, imaging tests, image guided core needle biopsy, surgical biopsy are used for detection and diagnosis of breast cancer. Today, technological breakthroughs with state of art equipment have made accurate and precise diagnosis possible through minimally invasive procedures.

VABB or Vacuum-Assisted Breast Biopsy is one such equipment which aids to diagnose microscopic malignancies. VABB not only aids in a detailed histopathological analysis of the breast lesion but also helps to initiate appropriate treatment. The technique is quick, does not require hospital admission and is performed under local anesthesia, with a single small incision which does not require stitches for closure.With a single insertion of the needle, larger amounts of specimen are retrieved during the procedure eliminating the necessity for re-biopsy. The patient can leave the hospital and resume normal activities soon after the procedure.

VABB is also used to remove benign lesions up to three cm. VABB is carried out under sonographic, mammographic, and magnetic resonance imaging guidance. VABB is a risk free, highly accurate and safe procedure to diagnose the presence of breast tumor in a less invasive way.

The larger specimen obtained with VABB minimizes discordant biopsies and allows for detailed immunohistochemistry studies and hormonal receptor status. As neoadjuvant treatment is well established for all breast cancer subtypes, the additional information obtained from the immunohistochemical studies aid in setting the chemotherapy, radiotherapy or endocrine therapy protocols. Therefore, surgery may be deferred when appropriate without affecting long term outcomes in the patients. However, these protocols may carry the risk of disease progression and compromised breast cancer specific outcomes. The benefits need to be weighed against viral exposure to patients and staff, each individual’s comorbidities and age to predict risk of mortality from COVID-19.  

The Way Forward

Even as the breast cancer burden continues to pose a threat to women’s health, thesolution here is to create awareness and conduct screening programs to fight this burden to expand breast cancer care for women in India. Lack of awareness, asymptomatic nature of the disease in the earlier stage, minimal access to diagnostic facilities and social cultural attitudes are the reasons why implementation of screening programs for breast cancer in India have not been very successful.

These measures become even more imperative in the times we live in as we battle the pandemic which has restricted the patient access to non-Covid treatments. As we already know, prevention is always better than cure.