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october 2012

Breast cancer can catch you young!

Dr Anil Kamath
Youth is the best time of human life. It’s that carefree stage when a person need not worry about one’s health. But, around us are also some unfortunate souls whose prime of life is consumed by life-threatening diseases. Breast cancer easily figures among these diseases.

What was once considered a disease of old age, is now seeing a shift, and is increasingly affecting younger women.

Precedence Of Breast Cancer
It is not uncommon nowadays for practising oncologists to see women in their late twenties and thirties suffering with breast cancer. There can hardly be any comparison in the physical and mental makeup, the aims and aspirations and the life priorities between a woman of 30 and a woman of 70. With modern day advances, doctors are, to a certain extent, able to cater to these requirements without compromising on the aim or results of treatment. That said, there are significant differences in the approach to treatment of younger patients with breast cancer and older ones.

Diagnosis Of The Disease
When a young woman walks into a clinic and complains of a lump in the breast, the doctor’s first thought of assessment is fibroadenoma, a benign lump, which is quite common in women. This proves itself to be true in majority of cases. Most fibroadenomas do not require any biopsy. Recommending a biopsy or the removal of fibroadenoma in every woman who presents with the case would be overkill and therefore it can be just left alone. However, onece in a while, a young woman’s cancer detection gets delayed because the doctor initially assumes it to be a case of fibroadenoma. This is where the clinical acumen of the doctor plays a pivotal role.

A doctor should be able to suspect the lumps that are ‘wolves in sheep’s clothing’ and order additional investigations like ultrasound of the breast. If the doctor is not sufficiently experienced in dealing with breast cancer, it would be prudent on his/ her part to refer all women with breast lumps to an oncologist for evaluation.

Why Young Women?
When a woman aged between 20 and 30 is diagnosed with breast cancer, oncologists spend thought and effort on whether it could be a hereditary case. A detailed family history helps in clarifying the issue. In specific cases when the oncologist suspects that there could be a defective gene running in the family, tests can be done to ascertain the same.

Most fibroadenomas do not require any biopsy. A doctor should be able to suspect the lumps that are ‘wolves in sheep’s clothing’. If not sufficiently experienced in dealing with breast cancer, it would be prudent on the doctor’s part to refer all women with breast lumps to an oncologist for evaluation.

Treatment Issues & Variations

It is only obvious that the reaction to diagnosis of breast cancer in younger and older women is bound to be quite different. While most young women are worried about body disfigurement which can occur as a result of breast surgery and their reproductive health, the older ones worry about the length and side effects of the treatment and whether their body will be able to bear it. Modern day oncologists are like tailors who can cut and stitch according to the wishes and needs of the patients.

The traditional treatments – surgery, chemotherapy and radiation can be modified to suit individual patients. Women not willing to lose their breasts can now explore advanced treatment options where only the lump is widely excised preserving the remaining part of the breast.

Radiation is given to prevent the spread or recurrence of the cancer in the remaining part of the breast. When the lump is large and breast conservation is not possible, the size of the lump can be reduced by giving chemotherapy first. For women in whom the breast cannot be preserved, plastic surgeons can reconstruct the breast by transferring tissue from the abdomen or the back.

While the majority of younger women prefer these methods, older women usually prefer to keep the treatment short by going for full breast removal and avoiding radiation therapy.

The process of chemotherapy too has to be modified according to the age of the patient. Chemotherapy generally has suppressive action on the ovaries. The option of harvesting and freezing the ovum for later use in IVF (in vitro fertilization) has to be discussed with young patients in the reproductive age group.

Unfortunately, breast cancer which occurs in young women tends to be more aggressive than in older ones. The need is to select an appropriate treatment which will reduce the physical and psychological burden of the young patient and aid in ensuring her return to normal life at the end of treatment.
Dr Anil Kamath is Senior Consultant Surgical Oncologist, Apollo Hospitals, Bangalore.