Indian women are dying of a disease that’s treatable — if diagnosed in time. In 2012, 50% of all female breast cancer patients in India died. Of the women who survived, it is estimated only 60% will be alive five years later; in other countries, the five-year survival rate is closer to 90%. These are depressing numbers.

But we can change them — we can keep more women alive — if we help each other care for our pairs. Here’s how.

Reach up.

Start with a monthly self-examination, in the days right after your period ends — or, if you’re menopausal, on a fixed, monthly date. If you discover any lumps, any general changes in the feel of breast tissue, in size, or if there is discharge from nipples, see a doctor immediately to either rule out cancer or get started with treatment. Not sure where to start? It’s easy:

Reach out.

Once you’ve done that, you can remind someone you love to care for their pair. Shoot them an email or SMS to tell them you think their well-being is worth checking up on. Not sure whom to remind? Check it:

Review.

Make sure you know the facts about your body with our handy (and handsy) FAQ. To help you brush up on your knowledge, we’ve broken it into sections:

• All about breasts
• All about lumps
• All about risk factors
• All about prevention and screening
• All about diagnosis and treatment

All about breasts

What is the best way to look after my breasts?

Educate yourself by consulting your doctor and learn to a do a regular breast self-exam (BSE). If you’re over 40, be sure to get a mammogram every 1 year. If you notice any abnormal changes in your breasts or armpits, consult a doctor immediately.

How often should I do a breast self-exam?

A BSE should be done once a month, 7 to 10 days after menstruation begins. (So, generally just after your period ends.) Menopausal women should also do a monthly BSE, on a fixed date. Remember, please read about the symptoms and signs of breast cancer (below), before you proceed to examine yourself. You should know what to watch for.

If you discover any changes in the feel of breast tissue, in size, discharge from nipples, or if you feel any lumps, you should see a doctor immediately to rule out cancer.

My breasts often hurt – do I have cancer?

Breast pain without a lump could be related to a number of things, most commonly a the hormonal changes around the menstrual cycle, but also stress, excessive caffeine, inadequate sleep, or thyroid problems. If you experience breast pain without a lump, it is usually nothing to worry about. However, if the pain persists over a long period of time, consult a doctor.

My breasts are often painful during menstruation. Is this normal?

Breast pain is a very common symptom of menses, and most women will experience it at some point in their lives. If no lump accompanies it, it is not cause for concern.

All about lumps

I think I have a lump. What should I do?

First, don’t Google your symptoms and attempt to self-diagnose. It is best to seek a medical opinion immediately from your family physician or gynecologist, who will advise you how to proceed.

I think I have a lump. Could it be anything other than cancer? 

Yes, it could. Most lumps in women under 30 tend to be fibroids, which are ‘firm-feeling, rounded’ lumps. These are very common in the general population and are not cancerous, nor do they become cancer. From 30 to 50 years of age, the probability of a breast lump being cancerous increases. Beyond 50, most newly detected breast lumps are cancerous.

Regardless of age, however, if you feel a lump in your breast, it is best to consult your doctor or a health care professional trained in breast diseases. If you don’t know who to approach, you can reach out to the medical team at thepinkinitiative@gmail.com for help.

All about risk factors

What are the risk factors for breast cancer?

While exact risk factors continue to be studied, the following have been linked to an increased risk for breast cancer:

• Getting your first period at an early age (typically before age 12)
• Entering menopause at a late age (typically after age 55)
• Giving birth for the first time after age 30
• Never breastfeeding
• A family history of breast and ovarian cancers
• Exposure to radiation during childhood
• Unhealthy lifestyle factors like chronic stress, an unbalanced diet, irregular sleeping habits, stress, alcohol abuse, lack of exercise, a sedentary lifestyle, and obesity

Who has a predisposition?

Women who fall into any of the following categories are at an increased risk:

• Family History: One or more family members with a history of breast or ovarian cancer
• Genetic Predisposition: One or more family members is known to harbour a ‘genetic’ abnormality causing breast cancer, such as BRCA I and BRCA II passed from parent (father or mother) to child.
• Previous Radiation Therapy to chest wall: If a woman has received radiation therapy to the chest wall for any cause, she is at an increases risk
• Apart from these, there are more factors, based on density of breast tissue and other variables, which are better assessed by a doctor

Is there any specific risk to Indian women?

While the number of breast cancer cases diagnosed in India across all ages has increased significantly in recent years; most experts attribute this rise to improved access to health care and diagnosis. There is no conclusive evidence that Indian women are more at-risk than women elsewhere — but neither are they less at-risk.

What Indian women are more at-risk of — due to lack of awareness and screening — is dying if they do have breast cancer. The death rate of breast cancer patients is the highest in the world due. Therefore, it is essential for Indian women to be vigilant about their breast health.

If someone in my family has had cancer, do I need to take extra precautions?

Not necessarily. Only 6 to 8% of breast cancer cases are hereditary, and it’s possible to discover if you have inherited the genetic markers (BRCA 1 & BRCA 2) that increase your risk of falling within those stats through a genetic test. The blood test is simple, but the process is complex, and women should only go through it with the help of a genetic counsellor. (An oncologist should be able to help you get in touch with a genetic counsellor, or you can reach out to thepinkinitiative@gmail.com for help.)

If you haven’t inherited the genetic marker, there’s no need to take any extraordinary measures beyond regular self-exams. If you have, an oncologist can guide you about your preventative options.

Is there any known cause? How can breast cancer be prevented?

There is no known method to prevent breast cancer.

All about prevention and screening

What steps should women take to monitor their breast health?

The most important weapon in the war against breast cancer is ‘breast awareness’ – educating oneself on the symptoms of breast cancer and actively looking out for them. The NCCN Guidelines are widely accepted across the world and lay down the standard methods and tests across age groups

Guidelines for women of all ages with an increased risk of breast cancer (as defined above):

• Monthly self-exam
• Annual clinical breast examination
• Annual mammogram: For women who have received radiation therapy to the chest, a mammogram should be done annually after 25 years of age. For those with a family history of breast or ovarian cancer, annual mammogram should start by 35 years of age. For women with a genetic risk or family history of breast or ovarian cancers, annual mammograms must begin at age 25.
• Annual MRI of the breast

Guidelines for normal-risk women between 20 to 40:

• Monthly self-exam
• Clinical Breast Examination every 1 to 3 years, or at the very least, a visit to clinician

Guidelines for normal-risk women above 40:

• Monthly self-exam
• Annual Clinical Breast Examination by a qualified medical professional
• Annual mammography (after age 50, a mammography may be done every 2 years)

When should I do a mammography?

Before age 40, there is no need to have a mammogram unless your doctor recommends one. At this age, women’s breasts are denser, which makes mammograms more difficult to analyse and allows for false identification of cancer. After age 40, as mentioned above, it’s best to visit your doctor once a year and let him or her recommend a mammography schedule and guide you about the results.

I have heard mammography emits radiation – is it safe?

Yes, radiation is emitted during mammography. But the amount is within safe limits and the benefits of a mammogram far outweigh any risk.

Will the mammography detect all cancerous lumps?

No; mammography, at best, has a sensitivity rate of 60 to 70%. Which means, for every 100 ‘small’ (lumps smaller than 2 cm) cancers, it may miss out 30 or so.

However – lumps this small cannot typically be felt by hand. So the benefit of mammography is that, for 60 to 70 women out of 100, the cancer is detected at the earliest stage, offering the highest chances of a cure.

At what age should I start screening, and what does that entail?

 See the first question in this section.

What are the different methods of screening?

Screening includes a variety of imaging technologies such as mammography, advanced techniques including 3 D Tomography, MRI and many others. The decision of which screening technique is best for an individual should be taken by a surgical oncologist in collaboration with his radiologist.

There are certain blood tests advertised for early detection of breast cancer. Please note that none of these are validated and one should not rely on them at all. None of them are endorsed by any international agencies, including the USFDA.

When should I seek medical attention?

Cancer does not believe in mathematics. Even a few months’ delay can allow the cancer to grow and make it harder to fight. The earlier cancer is detected, the greater the chance of a cure. If you feel a lump no matter how small or at what age, consult your consult your doctor (preferably a surgical oncologist or any health care professional trained in breast diseases). If you don’t know whom to approach, you can reach out to the medical team at thepinkinitiative@gmail.com for help.

All about diagnosis and treatment

What are some common symptoms of breast cancer?

Common symptoms of breast cancer are as follows:

• A hard lump or a knot in the breast which was not observed earlier. While most cancerous lumps are painless, it’s possible to feel pain or irritation when applying pressure on the spot.
• A ‘lumpy’ feel in the breast. Sometimes, breast cancer isn’t a defined lump. Breast tissue in a particular area that feels harder than the rest of the breast and does not soften within a week could be cancer.
• Recent retraction of the nipple, that is, the nipple is pulled inwards, as if something below it is pulling it inside the breast tissue.
• Bloody or blood-stained nipple discharge. Nipple discharge is common, and a watery, yellowish or greenish fluid is usually harmless. But blood in the discharge or a watery discharge with blood stains, calls for further attention.
• Changes in the skin over the breast, as the skin becomes hard and leathery, like an orange peel.
• Knots or lumps in the armpits. Breast tissue often extends all the way up the side of the torso and into the armpit region.

I have done a mammography. How do I evaluate my results?

The correct way to interpret your mammography result is, of course, to ask the radiologist performing it and then getting it reviewed by your doctor.

To decide, whether you need a further opinion or not, whether you need any intervention or not, we go by the ‘BIRADS’ criteria. BIRADS is an internationally accepted interpretation of mammography findings. There are 6 BIRADS categories, labelled from 1 to 6. Your radiologist, after doing your mammography (which may include x-ray mammography and sono mammography), will categorize the findings into one category and write it in the results. The following is the interpretation:

• BIRADS 1 and 2: 1 is a normal finding; in 2, some cysts (fluid filled) or small benign fibroids (and other similar findings) are seen. These are clearly non-cancerous. If your report mentions as BIRADS 1 or 2, you may do your follow up mammography after a year. If there is some large cyst or fibroid, you may get it evaluated by your doctor.
• BIRADS 3: In this category, the radiologist cannot clearly make out the character of the finding in the breast. It looks non-cancerous, but doesn’t look normal as well. If your report mentions as BIRADS 3 category, it is advisable to visit a surgeon or a surgical oncologist (preferably) to see if anything needs to be done.
• BIRADS 4 or 5: In 4, there is definitely some suspicion on the lump being a cancer. Depending on the level of suspicion, it is graded as BIRADS 4 a, b or c. In BIRADS 5, the features definitely look like a cancer. If your report mentions as BIRADS 4 or 5, it is advisable to see a surgical oncologist at the earliest and in most probability, a core biopsy will be advised.

There are times when the radiologist has not mentioned the BIRADS category in your report. In that case, you can request the radiologist to write the category. The interpretation of a mammography report is a delicate affair and it is strongly advised to take the opinion of a surgical oncologist.

Is genetic testing effective in early detection?

Genetic testing does not detect breast cancer; it identifies families who are at-risk and allow doctors to monitor women’s breast (and ovarian and uterine) health more attentively. It’s this heightened monitoring that allows for early detection, if cancer ever develops (it may not).

If someone is diagnosed with breast cancer is chemotherapy necessary?

Every breast cancer case is different, and it is up to the oncologist to recommend treatment based on the specifics of each patient and clear medical guidelines. In some cases, if the cancer is in a very early stage, chemotherapy may not be needed.

What is the treatment for breast cancer and how long does it take?

Treatment varies by type of breast cancer, stage, and many other factors, so it is impossible to outline an ‘average’ treatment plan. It could involve only one or a combination of the following: surgery, chemotherapy, radiation therapy, targeted therapy, and hormonal therapy. Breast cancer research is a highly funded, rapidly evolving field; the treatments available now are more effective and different from treatments available only a few years ago.

What are the survival rates?

While statistics for survival by stage aren’t available in India, data from the US disease that the earlier it is detected, the higher the survival rate.

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If you have any other questions about breast cancer, or need a medical opinion but don’t know where to go, you can reach out to thepinkinitiative@gmail.com for help.