Welcome to Beat Breast Cancer online----------

A joint effort of AIRTEL and Swaasthya Sanchar

Press 1 What is Breast Cancer?

Press 2 for high risk factors and signs and symptoms of breast
cancer
Press 3 for questions related to breast Breast Self Examination
ination
Press 4 for diagnosis and treatment
Press 5 for general questions on breast and cosmetic issues.
Press 6 for details of service providers

1. What is Breast Cancer

Q1-What is Breast Cancer?
A-Cancer is any abnormal growth of cells. The cells which make the breast,
multiply at a faster rate than usual. These fast multiplying abnormal cells can
even go out of the breast into the nearby areas and also to distant organs
like liver, bones, brain etc. This can affect the normal functions of various
organs of the body. So Breast Cancer, if not treated in time, can make
someone die. Breast cancer usually arises in the milk glands and the milk
ducts.

2. High risk factors and signs and

symptoms of breast cancer

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Q1. What is the cause of breast cancer?
A1. The exact cause of breast cancer is unknown. Although there are
many theories available which tell about probable causes of breast cancer.

Q2. How do I know if I have breast cancer?

A2. A person cannot know for sure if he or she has breast cancer.
Please remember to go to a doctor if you notice
a. A new lump in your breast, which may or may not be painful
b. Discharge from a nipple, particularly if blood stained
c. Change in shape and size of the breast
d. Change in appearance of skin on the breast
e. Rash on the nipples or surrounding areas
f. Inversion or turning in of the nipple
g. Swelling on the upper arm
h. Swelling in the armpit

Q3. Am I at risk of breast cancer?

A3. Exact cause of breast cancer is unknown. Almost 3/4ths of women
who develop breast cancer have no identifiable risk factors. However, the
following factors may increase your risk:
a) Increasing age
b) Family History
c) Genetics
d) First period before 12 years of age
e) Late menopause (after 55 years of age)
f) Not having borne children
g) Not having breastfed

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 h) First childbirth after the age of 30 years
i) High fat diet
j) Hormone replacement therapy
k) Radiation therapy

Q4. What is the difference between a non cancerous or benign breast

problem and breast cancer?
A4. A benign breast problem is any non-cancerous breast problem.
The most common benign breast conditions include fibrocystic change,
benign breast tumors, inflammation etc. Most benign conditions (such as
fibrocystic change or fibroadenomas) do not increase a woman’s risk of
breast cancer during her life.

Q5. I had a fibroadenoma/fibrocystic change in my breast earlier. Does

it increase my risk of developing breast cancer?
A5. Relax! Most benign conditions like fibrocystic changes or
fibroadenomas of the breast do not increase your risk for breast cancer.

Q6. Can I suffer from breast cancer if my family members or relatives

had breast cancer or in other words Is breast cancer a genetic disease?
A6. If you have breast cancer in your family or u have genes of breast
cancer then you should be extra careful and more knowledgeable of breast
cancer. Genes get passed on from parents to kids. BRCA1, BRCA2 are
genes which protect against breast cancer. In certain women these genes
become defective. These women with defective genes are at a higher risk of
developing breast cancer. But remember Breast cancer develops for many

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reasons, many of which are not yet understood. Family history is one of
them and is, in fact, a relatively minor factor, being significant in only 5-10%
of cases.

Q7. What is BRCA1 and BRCA2?

A7. BRCA1 and BRCA2 are two genes thought to be responsible for
breast cancer. They have a protective role in cancer of the breast as they do
not allow the cells to divide without any control. If there is a defect in these
genes, it may lead to uncontrolled division of the cells, which is the
underlying cause of a cancer.

Q8. Everyday we use various pesticides, detergents and plastics. Are

they harmful? Could they be potential risk factors for Breast Cancer?

A8. Everyday products like pesticides, detergents, and plastics may

contain chemicals having very unfamiliar names for common people. These
chemicals are of alkyl phenol and phthalate variety. These chemicals are
also called Endocrine Distruptors or EDCs. They mimic the hormone
estrogen and are of particular concern to women's health.

Q9. Am I at increased risk even if my father’s family had history of

breast cancer?

A9. Since breast cancer can be transmitted through genes, history of

breast cancer in your father’s family is also important. You can inherit the
risk from your father’s side of the family.

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Q10. Can men get breast cancer?
A10. Men can also get breast cancer, although it is rare. For every 100
cases of breast cancer in females, 1 occurs in males. Although the size of
the breasts in men is very small, if breast cancer occurs in them it is much
more dangerous as compared to breast cancer in women.

Q11. Does breast size affect breast cancer?

A11. There is no conclusive evidence that breast size is related to
breast cancer.

Q12. I feel a pain in my breast. Could it be cancer?

A12. If you have an unusual sensation in your breasts, do see a
doctor. Usually, pain is not a sign of breast cancer. Pain in the breast is more
often associated with benign conditions.

Q13. I feel a painful lump in my breast. Could it be cancer?

A13. Do not worry! 90% of the breast cancers are not painful. It is far
more likely to be an abscess, which is always painful. But definitely consult a
doctor.

Q14. I have a discharge from my nipple. Does it indicate breast cancer?

A14. Any discharge from nipple is a warning sign! The discharge may
be milky, yellow, green, bloody or watery fluid. Spontaneous bloody
discharge or watery discharge from one of the nipples is usually associated
with a tumor which may even be cancer. Consult a doctor.

Q15. My nipples are pulled in. Is it a cause of concern?

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 A15. If the condition is old (chronic) and unchanged, there is nothing to
worry about. This may be normal. However, if you have noticed this change
only recently, do consult your doctor.

Q.16. I had an injury to my breast some time back. Does it increase my

chances of developing breast cancer?
A16. No connection has been found between breast cancer and breast
injury. In some cases, an injury to the breast may make an existing tumor
more apparent.

Q17. No one in my family has been diagnosed with breast cancer. Am I

safe?
A17. Unfortunately, no woman is completely safe from breast cancer.
More than half of breast cancer cases remain unexplained. However, an
early detection increases your chance of survival dramatically.

Q.18. Can a stressful life increase my chance of developing breast

cancer?
A18. There is no concrete proof that only stress can cause breast
cancer. But stress is bad for health anyway.

Q19. I have heard bras can cause cancer. Is that true?

A19. There in no conclusive evidence, which supports that, bras cause
cancer.

Q20. If I exercise regularly can I cut down the chances of having breast
cancer?

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 A20. Yes, half an hour of aerobic exercise five times a week can
reduce your chances of breast cancer. Exercise reduces the level of female
hormones that stimulate breast cells.

Q21. Does breast-feeding offer protection against breast cancer?

A21. Yes, breast-feeding offers protection against breast cancer.

Q22. How can I prevent breast cancer?

A22. As with other cancers, it is not possible to truly prevent breast
cancer. You can however, reduce your risks by cutting down on some of the
modifiable factors.
a. Maintain an ideal weight
b. Increase physical activity
c. Avoid fatty foods, especially those containing animal fat
d. Avoid alcohol and smoking (even passive smoking)
e. Avoid unnecessary exposure to X-rays
The best way to fight breast cancer is to detect it early. If detected in
the earliest stage, the chances of surviving in a healthy condition is
extremely high.

Q.23. How can I change my diet to reduce the risk of breast cancer?
A23. It might help if you try these:
a. Avoid fatty foods, especially those containing animal fat
b. Avoid animal fats such as butter and ghee
c. Consume olive, canola, or other oils rich in monounsaturated fats

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 d. Add cruciferous vegetables such as cauliflower, broccoli, and
cabbage
e. Grill or stew meat rather than fry
f. Eat more chicken, fish, and vegetable proteins instead of red meat
g. Eat soy rich products such as tofu

3. Breast Self Examination

Q1. What is Breast Self Examination (BSE)?
A1. It is a method in which you use a mirror and then your fingers to
examine your own breasts. It helps you to detect early changes in your
breasts.

Q2. Who needs to do a Breast Self Examination (BSE)?

A2. All women over the age of 20 years need to do a monthly Breast
Self Examination (BSE). Do it even if you have reached menopause. You
can safely do a BSE even if you are pregnant or breastfeeding. Even if you
had a breast surgery or an artificial implant placed in your breast, do a
regular BSE.

Q3. What is the appropriate time of doing a BSE?

A3. Do a BSE just as your period ends. If you do not menstruate, do it
on any fixed date each month.

Q4. When I do a Breast Breast Self Examination, I feel lumps

everywhere in my breasts. Is it normal?

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 A4. This is normal. The breasts are composed of firm glandular tissue
and soft fatty tissue that may make the breast tissue feel lumpy. This is
normal. If you feel a lump, check the other breast and see if it also has a
similar lump at a similar place. A lesion which has a mirror image in the other
breast is likely to be normal. A lump in the upper-outer quadrant of the breast
is more likely to be cancerous.

Q5. When I do my Breast Self Examination, how do I know if there has

been a change?
A5. Do your examination just after your menstrual flow stops. That is
when the breasts are least likely to feel lumpy. Draw a sketch of your entire
chest and armpit on a piece of paper. Mark on this sketch, location of all the
finding, which you think are significant and keep it at a safe place. The next
month, again repeat the whole process of doing the Breast Self Examination,
drawing the sketch and marking the findings. Compare the sketches. Usually
after 3-4 repetitions, you will start feeling comfortable in recognizing what is
normal for you. Avoid examining your breasts when they are most tender
and lumpy i.e. a week or two before the periods.

Q6. Both my breasts are of different sizes. Is it something to worry

about?
A6. Do not worry! In most women, one breast may be larger than the
other. This is normal. However, if you notice a recent change in the size of
one of the breasts, consult a doctor.

Q7. Can I do Breast Self Examination in standing position in the

shower?

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 A7. You can do it in the shower but remember to follow it up by doing
the examination in lying down position as well. Doing Breast Self
Examination in lying down position is the best way to catch any abnormality
in the earliest stage.

Q8. Why do I need to lie down to examine the breasts?

A8. When you lie down and put a pillow or a folded towel under the
shoulder of the side to be examined and extend the arm at 90 degrees, the
breast tissue spreads very well on your chest and you will be able to pick up
any abnormality along the whole thickness of the breast.

Q9. I want to learn Breast Self Examination. What should I do?

A9. Your doctor, especially a surgeon, can teach you the technique.
You can also log on to www.youtube.com and search for “Indian Breast Self
Examination” in youtube’s search field . Swaasthya Sanchar also conducts
training programs for women to teach them the technique of doing a Breast
Self Examination.

Q10. If I perform Breast Self Examination regularly, why do I need a

mammogram?
A10. Mammograms can help discover abnormalities as small as the
head of a pin. Changes of this tiny size cannot be felt during a Breast Self
Examination. The sooner breast abnormalities are detected, the easier and
more successful is the treatment. So if you are above 40 years of age, get
an annual mammogram even if you do a monthly BSE.

Q11. What is a cyst?

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 A11. Cysts are harmless accumulations of fluid in the breast. They are
common to change with hormonal variations, either during normal menstrual
cycles or post- menopausal hormone replacement therapy. Cysts do not
become cancer or increase the risk of cancer.

Q12.What is Paget’s disease?

A12. It is a condition of the nipple that may resemble eczema i.e.
inflammatory condition of the breast characterized by itching, redness and
small blisters. Paget’s disease can in fact be pre-invasive or invasive breast
cancer. If you notice redness or blisters on your breasts, do not ignore it.
Consult a doctor.

Q13. What are fibrocystic changes?

A13. Some women develop pockets of fluid in the breast tissue. These
are called cysts. These feel like lumpy water balloons under the skin. These
cysts run in families, but it does not cause you cancer. However, it is very
important to do a Breast Self Examination and find these lumps so they can
be investigated to make exact diagnosis.

Q14. Should I perform BSE even if I have fibrocystic changes in my

breasts?
A14. Yes, do a regular BSE irrespective of such changes. If you find
any lump, get them investigated properly. Cystic breasts are often very
difficult to evaluate on Breast Self Examination and mammography, as they
are very ‘lumpy’. Therefore it is essential to have a good baseline
mammogram and know what is normal for you.

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Q15. What is a fibroadenoma? What does it feel like on Breast Self
Examination?
A15. Fibroadenoma is the most common benign, solid growth in the
breasts. It is round, movable and firm. Please remember, It does not put you
at increased risk of breast cancer. Practice BSE and get your regular check
up done by a doctor.

Q16. Why do I feel more lumps in my breast around the time of my

menstrual flow?
A16. Relax! This is normal. If you are a menstruating woman, your
breasts may increase slightly in size or swell and become tender or sensitive
just before your menstrual period due to certain hormonal changes in the
body. These symptoms typically disappear as menstrual bleeding begins. If
you are using hormones for birth control, the symptoms may vary on a
monthly basis or persist in your breast for sometime, until your body adjusts
to the type of hormones you're using. Symptoms of tenderness or pain
occasionally persist or become bothersome enough to warrant changing the
amount or type of hormonal contraceptive you use, or you may opt for a non-
hormonal method of birth control.

Q17. I have small breasts but large nipples. Is this normal?

A17. Yes, this is normal. The two are not related to cancers.

4. Diagnosis and Treatment

Press 1 for diagnosis

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 Press 2 for treatment

4(a). Diagnosis
Press 1 for early detection of breast cancer

Press 2 for screening for breast cancer

Press 3 for mammogram

Press 4 for other methods or investigations used for making the

diagnosis

Press 5 for other terminologies related to breast cancer (this could not
get hyperlinked)

4(a1) Early detection of breast cancer

Q1. Why is early detection of breast cancer so important?
A1. If breast cancer is found early i.e., before it has spread outside the
breast tissue, there may be more treatment choices available. For example,
women with small tumors may have the option of breast-conserving
treatment where the entire breast need not be removed. Side effects of
chemotherapy and radiation therapy becomes less as the duration and
extent of treatment becomes less.

Q2. What does “in situ’’ mean?

A2. The term “in situ” is used to indicate an early stage of cancer in
which a tumor is confined to the area where it began. It means that the
cancer remains confined to ducts or lobules of breasts and it has neither
spread to the surrounding tissue in the breast nor spread to other organs in
the body.

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4(a2) Screening for breast cancer

Q1. How should I get myself screened for an early detection of breast
cancer?

A1. If you are 20-39 yr old, do a Breast Self Examination (BSE) once every
month and get a Clinical Breast Examination (CBE) by a doctor every 3 yrs.
If you are 40yr or older, do a BSE once every month and get a CBE and a
mammogram (breast X-ray) every year. If you are at a higher risk, the doctor
may advise a mammogram earlier.

Q2. What is Clinical Breast Examination (CBE)?

A2. It is the examination of your breasts by a doctor. Remember to get it
done by a doctor who has good experience in examining breast related
diseases.

Q3. What are the different types of screening available for breast
cancer?

A3. There are a number of methods, varying in complexity that are used
to detect and help confirm a breast cancer diagnosis:
1. Breast Self-Examination (BSE): Regular examination of breasts by
a woman to detect any lumps.
2. Clinical Breast Examination (CBE): Recommended annual
examination by a doctor.
3. Mammogram: Special X-ray of the breast that can often find tumors
that are too small to feel.

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 4. Ultrasonography: Ultrasound is used to evaluate lumps that have
been identified by BSE, CBE, or mammography.
5. Magnetic Resonance Imaging (MRI): MRIs are used to evaluate
breast masses that have been found by BSE or CBE and to
recognize the difference between cancer and scar tissue.

4(a3) Mammogram

Q1. What is mammogram?

A1. Mammogram is an X-ray of the breasts. It usually involves two x-
rays of each breast. Mammograms make it possible to detect tumors that
cannot be felt. Mammograms can also find micro calcifications (tiny deposits
of calcium in the breast) that sometimes indicate the presence of breast
cancer.

Q2. What is screening mammogram?

A 2. A screening mammogram is an x-ray of the breast used to detect
breast changes in women who have no signs or symptoms of breast cancer.

Q3 What is diagnostic mammogram?

A3. A diagnostic mammogram is an x-ray of the breast that is used to
check for breast cancer after a lump or other sign or symptom of breast
cancer has been found. It may also be used to evaluate changes found
during a screening mammogram, or to view breast tissue when it is difficult
to obtain a screening mammogram because of special circumstances, such
as the presence of breast implants. It takes longer than a screening
mammogram because it requires more views of the breast from several

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angles. The technician may magnify a suspicious area to produce a detailed
picture that can help the doctor make an accurate diagnosis.

Q4. Why aren’t mammograms recommended for women under age of

40 years?
A4. Physicians do not generally recommend that women under age of
40 years receive a screening mammogram. It is because younger women
tend to have more dense tissue in their breasts and it shows up on
mammogram films as white areas, just as breast cancer does. Therefore, it
is difficult for the physician to detect breast cancer in women with dense
breasts. As women reach menopause, their breasts become less dense,
making it easier to interpret mammograms.

Q5. What precautions should I take before going for a mammogram?

A5. Go for mammogram at the end of your menstrual period. On the
day of the examination, do not use talcum powder or cream around the area
of the breast or armpit.

Q6. What should I expect during the mammogram?

A6. You will be asked to undress to the waist and stand in front of the
X-ray machine. The radiographer will then position one of your breasts
between two plates so that it is compressed and flattened. He/she will then
take X-ray images of your breast. Normally two images per breast are taken
on the first visit and one or two on every subsequent visit. You may
experience only a slight discomfort. Only a few women say it is painful.

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Q7. What happens after a mammogram is done?
A7. The X-ray film will be examined and you will be told about the
results. A minority of women will be asked to return for a second
mammogram either because something has shown up that requires further
investigation, or because there is a technical problem with the first X-ray.

Q8. Can mammogram detect all the breast cancers?

A8. Mammogram is very good in most cases for diagnosing breast
cancer. But remember mammogram can also fail in certain cases.
Remember this tip here; get your mammogram done from a renowned
center. If someone is above 50 years, it is very unlikely that breast cancer
would be missed by mammogram.

Q9. Is it safe for a woman to get exposed to radiations during a

mammogram?

A9. Modern screening equipment emits an extremely low dose of radiation

and the chances that a mammogram will cause a cancer to develop is
therefore extremely small. The benefits in terms of the number of cancers
detected far outweigh the small risks of mammography.

Q10. Can mammography show whether a tumor is benign or

malignant?
A10. Mammograms are good for identifying abnormalities in the breast
but they don't always show whether those abnormalities are benign (non-

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cancerous) or malignant (cancerous). Further tests are sometimes
necessary.

Q11. What do the ‘calcifications’ on my mammogram mean?

A11. Calcifications are tiny mineral deposits within the breast tissue,
which look like small white spots on the films. They may or may not be
caused by cancer. The shape and layout of the calcifications help the
radiologist judge whether it suggests cancer.

Q12. Does every woman need a mammogram?

A12. Yes. Although we are aware of risk factors related to breast
cancer, we do not know the cause. Approximately 75 percent of women who
develop breast cancer have no significant risk factors. Therefore, every
woman should undergo screening for breast cancer.

Q13. Is mammogram a painful procedure?

A13. Compression of the breasts is necessary for a good
mammogram. It allows the radiologist, the doctor who reads the
mammogram, to see the normal breast tissue better and to detect an
abnormality. Compression also lowers the radiation dose to the breasts.
Women who have very tender breasts may experience discomfort. To
reduce this discomfort, schedule your mammogram one week after your
period when the breasts are typically not as tender.

Q14. Why shouldn't I wear any deodorant?

A14. Some ingredients in deodorant can simulate calcifications in the
breasts. When calcifications are seen on a mammogram, additional

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mammogram pictures are required to better visualize them. Thus, deodorant
may cause you to have additional unnecessary pictures.

Q15. Why do I need additional views?

A15. Usually two views for each breast is adequate. However, it is
common for the technologist to perform additional views if an area of tissue
is not well seen on the standard views. In addition, the radiologist may
request extra views to clarify to a dense area or calcification seen on the
standard views.

Q16. What exactly does it mean when a mammogram report states that
there is increased density in the breasts?
A16. Increased density usually points to the presence of more
glandular tissue than fat. Often it indicates a degree of fibrocystic change. It
is not associated with malignancy but the "denseness" makes it more difficult
to read the mammogram.

Q17. Can I have an ultrasound instead of a mammogram?

A17 Mammography is the best test to evaluate the entire breast.
Ultrasound is used as a "problem solver" to further evaluate an abnormality
seen on a mammogram or a lump felt by the patient or physician.

Q18. I have had many negative mammograms in the past. Is it

necessary to keep having them?
A18. Since the risk of breast cancer increases with age, it is important
to keep having mammograms. If a cancer is found, it is best to find it early
when the chance for a cure is highest. Studies have shown that a

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mammogram every year is the best test we have to catch breast cancer
early.

Q19. What happens if the doctor feels a lump, but the mammogram
doesn’t show anything?
A19. Whenever a doctor or nurse finds a suspicious lump during a
clinical breast exam, extra tests should be done, even if the mammogram
results are normal. Most often the woman will get an ultrasound, which is a
painless breast exam that uses sound waves. Another option is to see a
breast specialist, such as a breast surgeon, who will repeat the clinical
breast exam.

Q20. After a mammogram, what further investigation may be

necessary?
A20. Further mammograms, an ultrasound scan , a fine needle
aspiration cytology may be required (FNAC), MRI or a breast biopsy may be
required.

Q21. Do I need to have a doctor refer me to a mammography facility?

A21. No. You can have a mammography exam and receive the follow-
up report without a doctor's referral. (This is known as "self referral.") Before
your exam, do verify that the facility accepts self-referred patients. Some
facilities do not.

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4(a4) other methods or investigations used for
making the diagnosis
Q1. What is FNAC?
A1. Fine needle aspiration cytology is a technique by which a
pathologist puts a needle into the breast lump to withdraw cells from the
breast to be viewed under the microscope. It is an out patient procedure and
does not require admission or general anesthesia.

Q2. What is biopsy?

A2. In this either a piece of the breast lump or the whole of the lump is
removed from body. This tissue is processed by a pathologist and viewed
under microscope. This is the surest method of arriving at a diagnosis of
breast cancer.

Q3. What does an ultrasound examination involve?

A3. In this examination you will be asked to lie on your back and place
your arm above your head so that the breast flattens against your chest.
Next, a contact gel is used to attach transducer, which resembles a
microphone or a computer mouse, to your breast where it emits ultrasound
waves that bounces off the different tissues in the breast creating a live
image that the physician can examine and take pictures of.

Q4. Is there any extra advantage associated with an ultrasound

examination?
A4. Ultrasound examination helps a radiologist differentiate between a
solid lump and a fluid filled cyst.

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Q5. Is MRI also done for diagnosis of breast cancer?
A5. An MRI is used to confirm the results of mammogram and
ultrasound tests. It can be useful for imaging breasts with implants and for
clarifying results in younger women whose breasts are dense. It also helps in
diagnosis when tumors consist of more than one abnormality in the breast
or that have spread into the chest wall.

Q6. If I get an MRI done can I skip mammogram?

A6. If MRI is used, it should be in addition to, not instead of, a
screening mammogram. This is because while an MRI is a more sensitive
test i.e., it's more likely to detect cancer than a mammogram, it may still miss
some cancers that a mammogram would detect.

Q7. What is a PET scan?

A7. PET scan stands for "Positron Emission Tomography." This is a

type of medical imaging that uses a small amount of a radioactive chemical
that is absorbed by specific kinds of body tissue such as cancers or other
particular structures. The chemical is injected and time is allowed for the
chemical to be absorbed. Then the patient is placed next to a special set of
detectors that sense the location of the chemical. The image that results can
give information about the presence and location of cancer cells or other
features. Although positron imaging is very useful in identifying recurrence of
metastatic disease, it is not helpful for identification of non-invasive tumors.

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4(a5) other terminologies related to breast cancer

Q1. What does the word ‘stage’ mean in relation to breast cancers?
A1. The stage of a breast cancer is a measure of how far it has
progressed.
There are several different types of staging commonly recognized for breast
cancer:

Stage 1 – The earliest stage. The cancer is small (usually less than 2 cm in
diameter) and only found in the breast. This is also known as early stage
breast cancer.

Stage 2 – the cancer (usually 2 to 5 cm in diameter) has spread to the lymph

nodes under the arm. This stage also falls under the description of early
stage breast cancer.

Stage 3 – this is when the cancer (now usually greater than 5cm in diameter)
involves other tissue in or near the breast, in addition to the lymph nodes
under the arm. This stage is often described as ‘locally advanced’ breast
cancer.

Stage 4 – this is when the cancer has spread to other parts of the body.
When the cancer has reached this stage, it is referred to as ‘advanced’ or
metastatic breast cancer.

Q2. What does the word “grade” mean in relation to breast cancer?

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 A2. The grade refers to the appearance of the tumor under the
microscope .It is considered to be a guide to how aggressive the tumor is
and how likely it is to spread:
• A 'low' grade (Grade I) is where the breast cancer cells look very like
normal breast cells, with only slightly abnormal changes.
• An 'intermediate' grade (Grade II) is somewhere between the high and
low grades.
• A 'high' grade (Grade III) is where the cells look very abnormal and
show little or no resemblance to normal breast tissue.
Taken together the stage and grade of a breast cancer help doctors to
predict how that cancer might behave, how it might respond to treatment,
and what the chance of cure might be.

Q3. What do I do if my doctor wants to 'watch' my lump for six months?

A3. If your doctor tells you to wait or that you are "too young to have
breast cancer," and does nothing more than a manual breast exam, insist on
a mammogram or other diagnostic test - or get a second opinion from
another doctor. If you have a mammogram but your lump or abnormality
does not show up, insist on further tests. These may include a ultrasound,
magnetic resonance imaging (MRI), needle aspiration or surgical biopsy.
This is important because young women tend to have denser breasts;
therefore, mammograms are not as accurate for younger women.
Mammograms are more accurate in older women.

Q4. What does the term tumor receptor status mean?

A4. To find the tumor receptor status, special tests are done with the
breast tissue taken for biopsy. These tests give the doctor more information

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about the breast cancer. The doctor comes to know about the type of the
cancer, how fast growing the cancer will be and how best it can be treated.
Someone should always get these tests done when advised by doctor.

Q5. What does the term ERPR positive breast cancer mean?
A5. ERPR stands for Estrogen Receptors and Progesterone
Receptors. Estrogen and Progesterone are hormones, which are naturally
made by our body and influence the growth and actions of different cells. If
the breast cancer cells carry large number of hormone receptors, they are
said to be ERPR positive. About 70% of the breast tumors are hormone –
receptor-positive tumors. The result of treatment of these kind of cancers
can be better by use of anti-hormonal therapy.

Q6. Is the treatment for breast cancer any different for hormone
receptor positive tumors?
A6. Women with hormone receptor positive tumors respond well to
treatments that reduce the levels of hormones reaching the tumor. Such
treatments are known as anti-hormonal therapy and include tomoxifen and
aromatase inhibitors.

Q7. What does HER2 mean?

A7. HER2 stands for Human Epidermal growth factor Receptor-2. It is
a receptor that is found on the surface of many cells and is involved in a
cell’s response to the presence of certain growth factors. Trastuzumab is the
only drug approved to be given for this condition. Treatment has to be
started at the earliest as these tumors are fast growing.

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Q8. What does the term triple assessment test mean?
A8. Triple assessment involves:
a. A clinical breast examination by the doctor
b. Imaging of the breast like mammogram or ultrasound

c. Biopsy or taking some tissue for examination under the

microscope.

4(b)Treatment
Press 1 for general treatment for breast cancer
Press 2 for surgery
Press 3 for chemotherapy
Press 4 for Radiotherapy
Press 5 for other kind of therapies

4(b1) General treatment for breast cancer

Q1. What are the treatment options for people diagnosed with breast
cancer?
A1.Treatment options continue to get better. For women with an early
stage of breast cancer, i.e., when the tumor is small and confined to the
breast, treatment might be a lumpectomy i.e., surgical removal of the tumor.
It may possibly be followed by radiation or chemotherapy. In chemotherapy
medications are given over a period of time to kill cancer cells that might
have spread from breast to any other part of body. Sometimes a lumpectomy

26
alone is enough. If the cancer has spread to the lymph nodes under the arm,
then those would be surgically removed as well. In late stages, a
mastectomy (removal of the breast) would be performed. In these cases, the
woman would have some form of chemotherapy and perhaps radiation.
Radiation is a type of high-energy X-ray that can kill cancer cells. All the
modalities of treatment have improved a lot over time. Better surgery is
performed keeping in view the aesthetics of body. These days
Chemotherapy and Radiotherapy are possible with very less side effects.

Q2. What exactly is the difference between chemotherapy and

radiotherapy?
A2. Chemotherapy involves using a combination of drugs that kill, or
slow down, the growth of rapidly multiplying cancer cells. There are many
combinations used to treat breast cancer and they are either given
intravenously or orally. Chemotherapy is given in cycles of treatment
followed by period of recovery. The most common side-effects include
nausea, vomiting, loss of appetite, hair loss, mouth sores, and changes in
the menstrual cycle or a premature menopause. You are also at an
increased risk of infection, bruising or bleeding and fatigue.
Radiation therapy requires high level of radiation to kill cancer cells or
keep them from growing and dividing. When radiation treatment starts you
can expect to receive a small daily dose of radiation over a period of several
days or weeks. Radiation therapy can cause change in the skin area
exposed to radiation, which may become dry, red and itchy. It can cause
nausea in some cases but does not cause hair to fall out.

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Q3. How long must a woman survive after breast cancer to be
considered cancer-free or cured?
A3. According to the National Cancer Institute, the five-year survival
rate for non-metastatic breast cancer i.e., breast cancer that has not spread
beyond the breast) is 80%. Newspapers and television usually translate that
to, "If you've survived for five years, you're cancer-free."
This is a bit misleading. It's true that during the first five years, the risk of
recurrence is highest. But breast cancer can recur even after five years. The
important point to know is that the more time passes, the lower the risk of
recurrence becomes.

4(b2) Surgery
Q1. What is the difference between lumpectomy and mastectomy?
A1. Lumpectomy is the surgical removal of a breast lump and a
surrounding margin of normal breast tissue. Lumpectomy usually does not
significantly alter the physical appearance of the breast. Mastectomy is the
surgical removal of an affected breast and often some or all of the axillary
lymph nodes present in armpit and also chest muscles. Breast
reconstruction is possible in most cases after mastectomy.

Q2. What are the side effects of breast surgery?

A2. The side effects of breast surgery vary from woman to woman. In
general, the recovery period for lumpectomy is shorter than for mastectomy.
Major soreness from breast surgery usually disappears after a few days.
Common side effects that may occur after lumpectomy are:

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 • temporary swelling of the breast
• breast tenderness
• hardness due to scar tissue that forms at the surgical site
• seroma (clear fluid trapped in the wound)
Common side effects that may occur after mastectomy are:
• hematoma (blood trapped in the wound)
• seroma (clear fluid trapped in the wound)
• temporary to permanent limitations of arm/shoulder movement
• (lymphedema) if lymph nodes are removed during the operation, hands
may get swollen due to accumulation of lymph, which is a kind of body
fluid
• numbness in the upper-arm skin
In expert hands side effects could become less.

Q3. What is breast reconstruction?

A3. Breast reconstruction is a surgical procedure to rebuild the contour
of the breast, along with the nipple and areola i.e., the pigmented area
surrounding the nipple, if so desired. Recent advances in reconstructive
techniques have given patients more choices when it comes to breast
reconstruction, including the option to have breast reconstruction during the
same operation in which the breast is removed.

Q4. What are the common types of breast reconstruction?

A4. The two main types of breast reconstruction available to most
mastectomy patients are saline breast implants and muscle flap
reconstruction. Implant surgery usually requires placing a tissue expander in
the intended breast area beneath the skin and chest muscle until the skin is

29
sufficiently stretched before a permanent implant may be placed. Muscle flap
reconstruction involves using a patient’s own tissue to rebuild the contour of
the breast. Tissue may be taken from the back, stomach, or buttocks.

Q5. What are the possible complications of breast reconstruction?

A5. The most common complication with breast implants is capsular
contracture—the scar or capsule around the implant begins to tighten and
squeezes down on the soft implant, causing the breast to feel hard. Capsular
contracture may be treated with additional surgery to remove the scar tissue.
Other less common complications from surgery that may occur during breast
reconstruction are: bleeding, fluid collection, excessive scar tissue, infection,
and problems with anesthesia.

4(b3) Chemotherapy
Q1. What is chemotherapy?
A1. Chemotherapy is treatment with anticancer drugs and is normally
administered intravenously i.e., through the vein or orally in the form of pills
or liquid. Chemotherapy may be used alone or in conjunction with
lumpectomy or mastectomy to treat breast cancer patients. Drugs used in
chemotherapy flow through the bloodstream, affecting the entire body. Its
purpose is to interfere with the DNA synthesis of cancer cells. The
appropriate combination of drugs used during chemotherapy will be
determined by the patient's cancer treatment team, based on the individual
medical situation and cancer tumor characteristics.

Q2. What are the side effects of chemotherapy?

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 A2. The most common side effects of chemotherapy are nausea and
vomiting, hair loss (alopecia), and fatigue. Additional side effects that may
occur in some women include: infection, anemia, increased blood clotting,
mouth sores, nervous system problems, skin and nail problems, kidney and
bladder infections, flu-like symptoms, fluid retention, or irregular menstrual
periods. It is important to remember that side effects vary greatly from
individual to individual. Some patients experience few if any adverse effects
from drug treatment. Generally, most side effects go away after
chemotherapy has ended.

4(b4) Radiotherapy

Q1. What is radiation therapy?

A1. Radiation therapy uses high-energy rays to stop breast cancer
cells from growing and dividing. Radiation deposits energy in the area being
treated. It injures cancer cells by damaging genetic material and inhibiting
growth. Although radiation damages both cancer cells and normal cells,
normal cells are usually able to repair themselves and function properly after
radiation.

Q2. How soon after lumpectomy does radiation therapy usually begin?
A2. Radiation is usually started several weeks after lumpectomy,
allowing ample time for the breast to heal. If the woman is also having
chemotherapy as part of treatment, the physician will sometimes begin
chemotherapy prior to starting radiation therapy.

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Q3. How long do the side effects of radiation therapy usually last?
A3. Common side effects of radiation therapy such as breast soreness,
swelling, reddening of the breast skin, a feeling of heaviness in the breast,
fatigue, and loss of appetite usually go away within four to six weeks after
radiation begins. Other less common side effects of radiation such as slight
darkening of the breast skin, enlargement of the breast skin pores, increased
or decreased sensitivity of the breast skin, a thickening of the breast skin or
tissue, or a change in size of the breast tend to last several months.

4(b5) other kind of therapies

Q1. What are the most commonly used drugs for breast cancer?
A1. Tamoxifen is the gold standard of hormone therapy in breast
cancer with ERPR positive breast cancer .This medication in pill form
interferes with the activity of estrogen. Known as the "antiestrogen,"
tamoxifen is a pill that has been used for more than 20 years to treat patients
with advanced (metastatic or stage IV) breast cancer.

Tamoxifen is also used as an adjuvant (add-on) therapy following

surgical treatment for early (stages I and II) and locally advanced (stage III)
breast cancer and as a means of reducing the risk of ever developing breast
cancer among women at particularly high risk (those with a genetic
predisposition to and a family history of the disease). Tamoxifen is useful in
both premenopausal and postmenopausal women. Tamoxifen is also used
to treat men with breast cancer.

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Q2. What is tamoxifen?
A2. Tamoxifen is a drug commonly used to help treat (and in some
case instances, prevent) breast cancer. By blocking estrogen in the breast,
tamoxifen helps slow the growth and reproduction of breast cancer cells. For
decades, tamoxifen has been used to help treat advanced breast cancer.
More recently, it has been used to treat early stage breast cancer after
breast surgery (lumpectomy or mastectomy). Common side effects of
tamoxifen include hot flashes, irregular menstrual cycles, unusual vaginal
discharge or bleeding, and irritation of skin around vagina.

It may increase the chances of endometrial cancer i.e., cancer of

uterus. In bones it acts as estrogen, i.e., it does not increase the chances of
osteoporosis.

Q3. How long do women have to take tamoxifen?

A3. The prescribed length of time women should take tamoxifen varies
depending on the specific medical situation. Most women take tamoxifen for
two to five years.

5. Cosmesis related questions

Q1. Is it safe to get breast implants?
A1. Undergoing any surgical procedure involves the risk of
complications such as the effects of anesthesia, swelling, redness, bleeding
and pain. In addition, there are potential complications specific to breast
implants. These complications include: deflation, rupturing and the tightening

33
of scar tissue formation around the implant. Feeling in the nipple and breast
can increase or decrease after implant surgery. Infections are harder to treat
when an implant is present than when the infection is in normal body tissue.
If you have breast implants, tell the X-ray personnel about them when you
arrive for mammography. This is because breast implants affect the way
your mammogram will be performed and analyzed.

Q2. When is breast reduction surgery necessary?

A2. Disproportionately large breasts can cause neck and shoulder pain
as well as back pain. In addition, headaches, breast discomfort and skin
irritation are more common. The weight of the breasts pushing down on a
bra can result in grooves in the shoulder area. Women with larger breasts
tend to exercise less, because of both physical discomfort and not having
good choices for exercise clothing. There are also emotional consequences
that can be just as important as the physical issues. Feeling embarrassed
frequently and dissatisfied with body image can alter a woman's
psychological state.

Q3. Are under wire bras harmful?

A3. There have been rumors that under wire bras can increase the risk
of breast cancer. However, there is no evidence that this is true. But when
shopping for a nursing bra, look for cups free of under wire. The wire acts
similarly to a dam under the breast, preventing efficient emptying of the milk
ducts. This can lead to plugged ducts and possible infection (mastitis).

Q4. When do breasts stop growing?

34
 A4. Of course, every girl has her own growth pattern but breasts
typically start to grow around the time of onset of puberty. By age 20 or so,
breasts in most girls are fully developed. During the course of your life, you
will see changes in breast size due to various reasons: pregnancy, lactation,
weight loss/increase, illness, etc. However, it is not possible to control the
rate of breast size changes.

Q5. How to increase my breast size?

A5. There is nothing that can be done for increasing breast size. If
someone is telling you that by using a pill or cream or lotion your breasts will
grow, that is not true. Any products that are marketed as all-natural, herbal
supplements for bust enhancement might not have been tested for their
claims by the Regulatory Agencies. Most marketers will write in the fine print
that "Individual results may vary" and that may basically means that they will
work for no one. Most women are too embarrassed to complain about these
companies or to ask for their money back. So please be careful.

Q6. Are there any exercises to get bigger breasts/for saggy breasts?
A6. No exercise will increase your breast size. However, regular
exercise is critical not only for development of your physique but also to
maintain a healthy lifestyle. Therefore, you should always exercise regularly
to have good overall health that will be reflected in your physique. Women
who exercise regularly and continue to do so after pregnancy and in later
years have perky breasts for a longer period.

Q.7 Are there any food item that I can eat to have larger breasts?

35
 A7. Breasts are essentially fat tissues. Thus, consumption of large
amounts of fats or carbohydrates will result in larger breasts in some cases
but at the same time you will put on weight in all other parts of the body too.
One, there is a likelihood that you might put on weight all over the body, and
two, you will become overweight and that will make you unhealthy. Fat and
carb-rich diet is not recommended at all. Hence, we do not think that food is
a way that you should use to increase breast size.

Q8. What will happen to my breasts if I decide to lose weight?

A8. Chances are that you will lose breast tissue as well. While your
breasts will become smaller but if you exercise using proper techniques,
your body will be more proportionate. Most likely you will look more
attractive even with smaller breasts.

Q9. Should I massage my breasts?

A9. Yes. Breast massage is a good idea for all women no matter what
the breast size.

Q10. What are the risks of plastic surgery/breast implants?

A10. While the technology has improved significantly in recent years,
some complications are still common with breast augmentation surgery for a
small number of women. Many women do not like the scars either but some
new techniques create minimal scar in parts that are not normally seen. A
new procedure also allows 24 hour recovery for breast augmentation
patients.

36
Q. 11. Are small or big breasts better?
A11. There is no simple answer to this. Big breasts are likely to sag
sooner. Small breasted women rarely have saggy breasts even in old age.
However, some women feel more feminine and confident with big breasts
and many men admire such women.

Q12. My mother and sisters are quite large but I am not. Is this normal?
A12. Yes. While genes make a difference, all women have their
individual growth patterns.

Q13. I am in my early teens and my breasts are huge. I get teased all
the time and I just don't feel normal around my peers. What should I
do?
A13. Try to stay in shape and do not become overweight. Other than
that there is little you can do. When you are fully grown up you will start to
like your body.

Q14. I have stretch marks around my breasts. What are stretch marks?
A14. Skin is generally very elastic. However, it is true that due to
extremely rapid weight loss or weight gain or growth, skin sometimes fails to
keep up, particularly when you are no longer a teenager, and you will see
stretch marks.

37
Q.15. Why is one of my breasts bigger than the other? What kind of
exercises can I do to help?
A15. The truth is that one breast is larger than the other just a tiny bit.
So there is nothing to worry. However, if the difference is too much, consult
a doctor.

Q. 16 What is the average breast size?

A16. It is hard to come up with a number since it varies significantly by
race, ethnicity, age, etc.

Q17. After pregnancy and breastfeeding my breasts have sagged.

How can I make them tight?
A17. It is very natural and exercise is the key.

Q18. I am now pregnant and I want to make sure that my breasts do

not sag. Should I breastfeed my baby or not?
A18. Yes, you should. Breast feeding has many good effects on your
body as well as it may protect you and your kids against certain diseases.

Q19. Is it possible for men to have big breasts without being fat?
A19. Yes. The condition is called Gynecomastia, which means
"women-like breasts." Unfortunately no one talks about it, it's actually quite
common. It may affect only one breast or both. Though certain drugs and
medical problems have been linked with male breast overdevelopment, there
is no known cause in the vast majority of cases. However, the good news is

38
that this can be corrected through relatively inexpensive plastic surgery. You
must consult a plastic surgeon.

Q20. How do know if my breasts have sagged? Is there some kind of

way I can measure them so I know how droopy they are?
A20. Stand in front of a mirror without a bra. Take a ruler and measure
your upper arm. Divide it by two. Now position your ruler at this distance on
the upper arm and see where your nipples are. If they are lower than this
point then you have some sagginess. If your nipples are below the fold of
your breasts, that is another sign. But remember that a lot depends on your
cup size, weight, age, etc.

Q21. Is it normal for women to have hair on their breasts?

A21. Well, it is not common but many women have them. It is not a
disorder of any kind. Many women choose laser hair removal to get rid of
them permanently.

6. Services providers
Press 1 for List of hospitals in Delhi & NCR where mammography
facilities are available

Press 2 for List of hospitals in Delhi & NCR that conduct special breast
clinics

Press 3 for List of places where wigs are available

Press 4 for List of providers of breast prosthesis

39
6(a) Hospitals in Delhi & NCR where
mammography facilities are available
1. A.I.I.M.S.
Ansari Nagar, New Delhi.
Tel: 26864851
2. Batra Hospital and Medical Research Center
1, Tughlakbad Industrial Area, M.B.Road
Tel: 26983747
3. B.R.Diagnostics
W-15, Greater Kailash-1
Tel: 26440678, 26488658
4. Col Pant’s Imaging Center
A-22, Green Park
Tel: 26858788
5. Diwan Chand Styapal Aggarwal Imaging & Research Centre
10-B, Kasturba Gandhi Marg
Tel: 23329336, 23329887,23322497,23713004,23713302
6. Dharamshila Cancer Foundation & Research Center
Dharamshila Marg, Vasundhra Enclave
Tel: 2617771/75
7. Guru Teg Bahadur Hospital
Shadara
Tel: 22581845
8. Holy Family Hospital
Okhla
Tel: 268459-00/09

40
9. Indraprastha Apollo Hospital
Sarita Vihar, Delhi-Mathura Road
Tel: 26925801, 26925858
10. Lok Nayak Hospital
Delhi Gate
Tel: 23231621/2400/3400
11. Moolchand Kharaiti Ram Hospital&Ayurvedic Research Institute
Lajpat Nagar-III
Tel: 26833461, 26833404
12. Rajeev Gandhi Cancer & Research Institute
Sector-5, Rohini
Tel:27051011-29
13. Safdarjang Hospital
New Delhi-110029
Tel: 26165060
14. SirGanga Ram Hospital
Rajinder Nagar
Tel: 25735205, 2586143
15. St. Stephens Hospital
Tis Hazari
Tel: 23966021, 23966022

6(b) Hospitals in Delhi & NCR that

conduct special breast clinics
1. IRCH, AIIMS
2. Sir Gangaram hospital

41
3. Dharmshila hospital
4. Rajeev Gandhi Cancer hospital
5. Apollo Hospital
6. Fortis hospital

6(c) places where wigs are available

Saavy wigs

Contact Information

Contact Person Mr. Amit Malhotra

Designation Proprietor

H. NO. 125, BHOLA NATH NAGAR, JHARKHANDI

Address ROAD, OPPOSITE STREET NO. 11, SHAHDARA,
DELHI - 110032, INDIA

Phone Number 91-11-22307066/65926878

Mobile +919911229802

Website http://www.savvy.tradeindia.com

2.

Contact Person Mr. Vivek Mann

834/1, BLOCK-K, MAHIPALPUR, NEW DELHI -

Address
110037, INDIA

42
Phone Number 91-11-26788114

+919818129333
Mobile +919818129333
+919818870333

Fax 91-11-26781200

Website http://www.bipolarinternational.com

3. Tina Wigs & Beauty Saloons

Contact Name : Rohit Jaggi
Address 16A/17, First Flr, Ajmal Khan Road, Karol Bagh
: Delhi/NCR , Delhi
India
110005
Phone No : +91-11-25724141
Cell No : +91-9818145442
4.

Contact Details of Sheen Wigs & Beauty

Saloon
Address 15 A/29, W. E. A, Karol Bagh, Delhi-110005,
City Delhi
Pincode 110005
State Delhi
43
Country India
Phone
 State Delhi
Country India
Phone
011 - 25725568
No

5.

Contact Details of Adrina Wigs & Beauty

Parlour

Address 16 A/17, Ajmal Khan Road, Karol Bagh, Delhi,

City Delhi
Pincode 110005
State Delhi
Country India
Phone No 011 - 25716219

6(d) Providers of breast prosthesis

1. Cancer Patients Aid Association,
H/1572, Chittaranjan Park,
New Delhi- 110 019
(Kiran Hukku)
Tel: 011 2627 0470, 2627 2298

2. Tata memorial cancer hospital, Delhi

44
MASTECTOMEE ASSOCIATION
Address: Sahi Hospital Building, 1A Jangpura Mathura Road, New Delhi -
110024
Phone number: 6410962, 6121856, 3019328

45