breast cancer at glance

1. Breast cancer
PRESENTED BY :- RAJNISH KUMAR
(RESEARCH SCHOLOR, SOCIAL WORK,
(MGKVP, VARANASI)

2. Introduction
 Breast cancer is a disease in which cells in the breast grow out of control. There are different kinds
of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer.
Breast cancer can begin in different parts of the breast. A breast is made up of three main parts:
lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are
tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty
tissue) surrounds and holds everything together. Most breast cancers begin in the ducts or
lobules.
 According to WHO Breast cancer is the most frequent cancer among women, impacting 2.1
million women each year, and also causes the greatest number of cancer-related deaths among
women. In 2018, it is estimated that 627,000 women died from breast cancer – that is
approximately 15% of all cancer deaths among women. While breast cancer rates are higher
among women in more developed regions, rates are increasing in nearly every region globally.
 One woman dies of cervical cancer every 8 minutes in India . For every 2 women newly
diagnosed with breast cancer, one woman dies of it in India

3. Continue ….
 It is reported that with every four minutes, an Indian woman is diagnosed with breast cancer. Breast
cancer is on the rise, both in rural and urban India. A 2018 report of Breast Cancer statistics recorded
1,62,468 new registered cases and 87,090 reported deaths.
 Cancer survival becomes more difficult in higher stages of its growth, and more than 50% of Indian
women suffer from stage 3 and 4 of breast cancer.
 With the latest study reports, India’s highest cancer rate is listed in the state of Kerala. Other states with
high cancer rates in India include Mizoram, Haryana, Delhi and Karnataka. Mizoram accounted for the
highest cancer death rates in the country, followed by Kerala and Haryana.
 The Indian Council for Medical Research recently published a report which stated that in
2016 the total number of new cancer cases is expected to be about 14.5 lakhs. This figure will
likely increase to 17.3 lakhs in 2020.

4. Types of Breast Cancer
 1. Metastatic Breast Cancer- Metastatic breast cancer is
also classified as Stage 4 breast cancer. The cancer has
spread to other parts of the body. This usually includes the
lungs, liver, bones or brain.
 Symptoms :- Here are some symptoms that vary by locations
commonly associated with breast cancer metastasis.
 Severe, progressive pain, Swelling in bone. Bones that are
more easily fractured or broken.
 Persistent, progressively worsening headache or pressure to
the head, Vision disturbances, Seizures, Vomiting or nausea,
Behavioral changes or personality changes
 Jaundice, Itchy skin or rash, Abnormally high enzymes in the
liver, Abdominal pain, appetite loss, nausea, and vomiting

5. 2. Ductal Carcinoma In Situ
 Ductal carcinoma in situ (DCIS) is a non-invasive
cancer where abnormal cells have been found in the
lining of the breast milk duct. The atypical cells have
not spread outside of the ducts into the surrounding
breast tissue. Ductal carcinoma in situ is very early
cancer that is highly treatable, but if it’s left
untreated or undetected, it can spread into the
surrounding breast tissue. The earliest stages of
cancers are called “carcinoma in situ.” Carcinoma
means “cancer” and in situ means “in the original
place.”

6. 3.Invasive Ductal Carcinoma
 The abnormal cancer cells that began forming in the milk
ducts have spread beyond the ducts into other parts of
the breast tissue. Invasive cancer cells can also spread to
other parts of the body. It is also sometimes called
infiltrative ductal carcinoma.
 IDC is the most common type of breast cancer, making
up nearly 70- 80% of all breast cancer diagnoses.
 IDC is also the type of breast cancer that can most
commonly affects men.

7. 4. Triple Negative Breast Cancer
 A diagnosis of triple negative breast cancer means that the
three most common types of receptors known to fuel most
breast cancer growth–estrogen, progesterone, and the
HER-2/neu gene– are not present in the cancer tumor. This
means that the breast cancer cells have tested negative for
hormone epidermal growth factor receptor 2 (HER-2),
estrogen receptors (ER), and progesterone receptors (PR).
 Triple negative breast cancer occurs in about 10-20% of
diagnosed breast cancers and is more likely to affect younger
people, African Americans, Hispanics, and/or those with a
BRCA1 gene mutation.

8. 5. Inflammatory Breast Cancer
 Inflammatory breast cancer is an aggressive and fast
growing breast cancer in which cancer cells infiltrate
the skin and lymph vessels of the breast. It often
produces no distinct tumor or lump that can be felt
and isolated within the breast. But when the lymph
vessels become blocked by the breast cancer
cells, symptoms begin to appear.
 Early IBC symptoms may include persistent itching
and the appearance of a rash or small irritation
similar to an insect bite. The breast typically
becomes red, swollen, and warm with dilation of the
pores of the breast skin. The skin may appear pitted
like an orange peel, and nipple changes such as
inversion, flattening, or dimpling may occur.

9. Cancer statistics world wide
Breast

10. Increasing Incidence of BC in Younger
Age Groups (30s and 40s)
2
7
22
36
33
4
16
28
30
22
0
5
10
15
20
25
30
35
40
20 to 30 30 to 40 40 to 50 50 to 60 60 +
Breast cancer in India
25 years back
present situtaion
The horizontal line lower down represents
the age groups: 20 to 30 years, 30 to 40 yrs
and so on. And the vertical line represents
the percentage of cases. The Red colour
represents the incidence 25 years
back, and yellow colour represents the
situation today. 25 years back, out of every 100
breast cancer patients, 2% were in 20 to 30
years age group, 7% were in 30 to 40 and so on.
69% of the patients were above 50 years of age.
Presently, 4% are in 20 to 30 yrs age group,
16% are in 30 to 40, 28% are in 40 to 50 age
group. So, almost 48% patients are below 50.
An increasing numbers of patients are in the 25
to 40 years of age, and this definitely is a very
disturbing trend.

11. Psychosocial Support to Women with
Breast Cancer
 Most women experience at least some psychosocial distress during the course of their
breast cancer diagnosis and treatment. The level of distress varies from woman to
woman and, within an individual, over the course of diagnosis and treatment. Cancer-
related distress can be expected to dissipate with time for the majority of individuals
diagnosed with cancer. Psychosocial distress can be related to physical problems like
illness or disability, psychological problems, and family issues and social concerns such
as those related to employment, insurance, and supportive care access.

12. PSYCHOSOCIAL NEEDS OF WOMEN
BY PHASE OF CARE
Some of the most common psychosocial concerns reported by women with breast cancer include:
 Fear of recurrence,
 Physical symptoms such as fatigue, trouble sleeping, or pain,
 Body image disruption,
 Sexual dysfunction,
 Treatment-related anxieties,
 Intrusive thoughts about illness/persistent anxiety,
 Marital/partner communication
 Feelings of vulnerability, and Existential concerns regarding mortality

13. Continued….
 The breast cancer experience has several distinct phases, each characterized by a unique set of
psychosocial concerns. The psychosocial impact of breast cancer must also be understood in the
context of other issues that affect women's coping, quality of life, and well-being, such as
socioeconomic factors and cultural factors, the availability of social support, access to health care,
and the presence of other chronic illness or life crises.
 As the diagnostic phase is completed and treatment decisions are made, the patient and family
face new experiences that will affect them psychosocially. These include hospitalization, surgery,
insertion of a central line, starting chemotherapy or other treatments, and frequent doctor visits.
An urgency often exists to begin treatment, and no matter how much education the patient
receives, he or she still may feel unprepared to enter this unfamiliar world. Each type of treatment
creates its own psychosocial impact.

14. Treatment
 Primary Treatment :- Once the treatment plan is decided, women with breast cancer may experience
some relief of anxiety and distress, but new fears may arise in anticipating and receiving the planned
treatment. Surgery, particularly lumpectomy and axillary dissection, is often done as an outpatient or
short stay procedure.
 Adjuvant Therapy:- There is a wide range of adjuvant therapies—from tamoxifen as a single agent,
to complex chemotherapy regimens with or without tamoxifen, to newer hormonal therapies. Most
adjuvant chemotherapy is well tolerated, and women often continue many of their usual activities
(childcare, household activities, paid employment) albeit often on a reduced schedule, especially
modified by treatment administration.
 Tamoxifen therapy may be used by itself or in combination with adjuvant chemotherapy in some
women. While the medical evidence for its benefits in improving survival and preventing breast
cancer recurrence is overwhelming, in the eyes of many women it is still seen as a controversial and
potentially toxic therapy.

15. Post treatment
 At the end of primary breast cancer treatment—whether it is at the conclusion of 6
weeks of radiation therapy or after 4–6 months of adjuvant chemotherapy—most
women experience a mixture of elation, fear, and uncertainty (reviewed in Rowland and
Massie, 1998). Although they have mastered the many aspects of their treatment
regimen, they have little preparation and information to guide them in their recovery
from treatment. This is coupled with their planned discharge from intensive interaction
with the health-care system. No longer do they have daily or periodic visits to the
treatment center. The post-treatment transitional period is a time of considerable
psychosocial distress. The paradoxical increase in anxiety has been observed at the end
of both radiation and systemic chemotherapy.

16. Research findings
 Breast cancer is the most prevalent cancer in the world (4.4 million survivors up to 5 years
following diagnosis) and the second most common cause of cancer related mortality in women
wide world (Parkin et al., 2005). It also accounts for 23% (1.38 million) of the total new cancer
cases and 14% (458,400) of the total cancer deaths in 2008 and ranks second most common
cancer overall (10.9% of all cancers) but ranks fifth as cause of death (Ferlay et al., 2010).
 Breast cancer is common in women both in the developed and the developing countries,
comprising 16% of all female cancers. Although it is thought to be a common cancer in the
developed countries, a majority (69%) of all breast cancer deaths occurs in developing world.
Indeed, increase life expectancy, increase urbanization and adoption of western lifestyles have
increased the incidence of breast cancer in the developing countries (Kanavos, 2006).
 A report by Stewart et al (Stewart and Kleigues, 2003), mentioned that many of the new cancer
cases are now occurring among women from low and middle income countries, where the
incidence is increasing by as much as 5% per each year and there are about three fourths of
breast cancer deaths occurring worldwide. Of the 411,000 breast cancer deaths around the world
in 2002, 221,000 (54%) occurred in low- and middle-income countries (LMCs).

17. Continued….
 Cigarette smoke is very rich in carcinogens and reactive oxygen species and may be considered
as one with high risk in breast cancer (Mitruen et al., 2003).
 In one study of 211 women with advanced breast cancer, 27 percent were categorized as
probable cases of anxiety and/or depression. Among the 155 women who completed an
assessment 1 to 3 months later, 13 percent were classified as being persistently anxious or
depressed (Hopwood et al., 1991a).
 Breast cancer is common in women both in the developed and the developing countries,
comprising 16% of all female cancers. Although it is thought to be a common cancer in the
developed countries, a majority (69%) of all breast cancer deaths occurs in developing world
(Kanavos, 2006).
 Currently, majority of all breast cancers worldwide are the ductal and lobular subtypes .However,
the ductal subtype accounting acounts for the majority of the diagnosed cases ,constituting for
about 40–75% (Rakha et al., 2006).

18. Summary
 Indian women need to be aware of both modifiable and non-modifiable risk factors for breast
cancer to adopt appropriate practices for prevention. There is an urgent call for more effective
nation- and state-wide cancer literacy programmes, as well as engagements with community-level
organisations and the health system. With wide variations in the state-level burden, a
coordinated, intensive health promotion intervention programme on risk factors, prevention,
screening and management for breast cancer is prudent. Factors that appear to predispose
women for psychosocial distress include younger age, a history of pre-existing depression or
psychological distress, other serious comorbid conditions, and inadequate social support. Training
on the latest evidence regarding breast cancer risk factors should be offered to healthcare
providers and community workers to raise their cancer literacy so they can then transmit this
knowledge to other sections of the society. Whether women with breast cancer have higher rates
of psychosocial distress than others with cancer is also not known, although there is some
evidence that distress is greater in cancers with poorer prognoses. Continuing medical education
programmes with enhanced emphasis on breast cancer in the curricula of nursing at institutional
level and other healthcare training institutions should be a priority for women’s health in the
country.

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