Breast cancer is the most common invasive cancer in females and it’s being documented in increasingly younger age groups. Several factors are involved in causing breast cancer. It has a significant morbidity and mortality rate.

Generally speaking, breast cancer can be divided into four stages, for easy understanding of the general public. Stage 1: when the disease is confined to the breasts only, Stage 2: when disease extends to Axilla of the same side, Stage 3: when disease extends to the neck and Stage 4: when disease extends to Liver, Lungs, Bones and other distant areas of the body.

The actual dilemma of our society is the late presentation of the disease. This holds true not only for the remote and far-flung areas of the country, even ladies from well-developed cities often present quite late, when the disease is advanced. One should keep in mind that stage 1 and 2 are curable if the patient complies with treatment advised by the surgeon. She can easily get rid of disease and lead as good a healthy life as if she never had breast cancer. If a patient presents in stages 3 and 4, the disease is not curable and only palliative treatment is given to the patient, the ultimate result of treatment in these patients, becomes variable and patient might develop complications, despite optimum treatment. It has been seen that even ladies belonging to well off and educated families, feel embarrassed and present to the surgeon with advanced disease.

The treatment of breast cancer involves a multidisciplinary approach, involving general surgeon,oncologist, radiologist, and plastic surgeon, sometimes psychiatrists as well. The treatment depends upon stage and type of cancer, because some types are very aggressive and lesion, even when small in size, can be lethal. Generally speaking, treatment consists of surgery, chemotherapy, radiation therapy and hormonal therapy. Conventional surgical treatment usually involves removal of the whole breast, along with clearance of corresponding Axilla, but now in suitable cases, tumor can be removed without sacrificing the whole breast, this is called breast conservation surgery. Even if the whole of the breast has to be removed, it can be reconstructed, at the same time or subsequently, by plastic surgery, thus, alleviating the stigma, cosmetically. Therefore, the public should be made well aware of the symptoms and progression of this disease. Patients should report immediately to a surgeon upon feeling a lump in the breast or discharge from the nipple.

Sometimes patients waste their time going to irrelevant persons. The first person to whom the patient should report is a surgeon who would then decide what investigations are needed and whether surgical treatment or chemotherapy or radiotherapy is first needed.

Breast self-examination should be carried out regularly, starting from the twenties particularly after age 35, and in those ladies who have a family history of breast cancer. Common symptoms are discrete lump or lumpiness in the breast, nipple discharge, retraction of nipple, redness and induration of skin of breast or any common disease like abscess or pus, resistant to normal treatment. These patients should always be investigated to rule out cancer. Common investigations include ultrasound below the age of 35, mammography above the age of 35 years and FNAC or excision biopsy, but on the top of all is a clinical examination by a qualified surgeon. Out of all cancers, 1% is seen in the male breast, which is often very aggressive. Here it is worth mentioning that now quite a significant number of Lady Surgeons are also available.

PROF. DR EHSAN UR REHMAN,

Islamabad.