The not so silent killer

Dr Chinnababu Sunkavalli

Precancerous stage of breast cancer, where the cancer has not spread outside the ducts or lobules into the surrounding breast tissue, is the earliest stage which can be treated easily. Ayushmann Khurrana’s wife, Tahira Kashyap, was recently diagnosed with stage 0 breast cancer and she underwent mastectomy. The chances of recovery after stage 0 are 95 per cent and there are remote chances of the disease recurring, explained Dr. Chinnababu Sunkavalli, Consultant Surgical Oncologist at Apollo Cancer Hospitals.

Q1. Is the stage 0 breast cancer detected accidently in women who undergo routine mammogram?
Yes it is being detected accidentally. Some women decide that they must opt for a mammogram test and that is where these are picked up. DCIS is picked up mostly in mammograms. Women must opt for mammograms after they are 40 years of age. This is a preventive method to detect the cancer early and treat it for better survival.  

Q2. It is often said that self-examination of breast is also important to detect any change in the breast. What is the scientific and approved method of self-examination?
Self-examination allows a woman to examine her breast tissue for any physical or visual changes. It is often used as an early detection method for breast cancer. Women should perform a basic self-examination, at least once each month, beginning at age 18 years. The steps are — start by standing topless in front of a mirror with your hands by your sides. Visually inspect your breasts for the following: changes in size, shape, or symmetry, dimpling, inverted nipples, puckering, asymmetrical ridges at the bottom. Check for these signs with your hands by your sides. Then, with your arms over your head, and again when lifting one breast at a time.

1. Using the pads of your fingers, not the tips, inspect your breasts while lying down and again in the shower. The water and soap in the shower will allow your fingers to glide easily over your skin.

2. Using varying pressure and taking your time, massage your fingers over your breasts in a spiral pattern starting at the nipple. Make your way up to the top of your breast near the collarbone, to the center by your breastbone, and to the sides near your armpits. Do this by putting one arm over your head, while massaging your breast with the other hand.

3. Lastly, gently squeeze your nipples to check for discharge.

Q3. What is the treatment required for stage 0?
Surgical Excision is the treatment for both DCIS and LCIS. Sometimes watchful waiting with medication for risk reduction is the best option for LCIS.

Q4.Does it require mastectomy?
Mastectomy is based on the spread of the cancer cells. If it is very extensive then it is suggested, depending from patient to patient. Wide surgical excision is found to help in DCIS.

Q5. After treatment what is the survival rate of stage 0 breast cancer patients? How long must they follow up?
Survival rates after treatment of stage 0 breast cancer is more than 95 per cent. The survival rate is taken as 5 years of survival. Follow up is usually for 5 years. For the first 2 years, once in every three months. Later once every 6 months for a year and then yearly once. The chance of the disease recurring is remote. Stage 0 breast cancer does not occur in other parts of the body. But it can reoccur locally if it has to.

Q6. What must be the lifestyle modifications that the people with cancer must opt for, so that the chances of relapse are reduced?
1. Be as lean as possible without becoming underweight. Avoid obesity.

2. Be physically active for at least 30 minutes every day. Walk,  run and be fit.

3. Avoid sugary drinks and limit consumption of energy dense foods.

4. Eat more of a variety of vegetables, fruits, whole grains, and legumes such as beans.

5. Limit consumption of red meat and avoid processed meat.

6. If consumed at all, limit alcohol consumption to one drink per day.

7. Limit consumption of salty foods and avoid food processed with salt.

8. Stop smoking.

9. Reduce stress.

Stage 0 breast cancer are of two types

1 Ductal carcinoma in situ (DCIS) is a non-invasive cancer. The abnormal cells are in the lining of the breast milk duct. The cells have not spread to the breast tissue. Stage 0 DCIS is being diagnosed as women are coming for routine mammogram and screenings. DCIS being invasive hence treatment is important.

2 Lobular carcinoma in situ occurs in abnormal cells develop in the breast lobules. These cells are not cancerous. They rarely become invasive. LICS increases the risk of developing breast cancer and is found to become invasive in 20 to 25 per cent of the patients over 15 years after initial diagnosis.

3 LCIS is diagnosed mostly when a biopsy is done for some other indications.