Generally, in diagnosing of breast cancer, your physician might do the following:
a)    ask about family and personal medical history.
b)    conduct a physical examination, mammogram or other procedures.
c)    suggest further tests or biopsy. Screening for breast cancer before the appearance of symptoms is vital and in most cases treatments can work if cancer is detected early.

Probably the most common causes of breast cancer are hormonal and / or genetic factors. We have been able to develop staging systems to categorize the extent of cancerous growth and develop treatment methods accordingly. Depending on how the cancer has spread and what kind of cancer it is, various treatment options are available like surgery, mastectomy, radiation therapy, hormonal therapy and chemotherapy.

Few recommended tests by physician for breast cancer diagnosis are mentioned below:

a) Clinical breast examination:
In this examination, the physician feels both breasts for lumps and checks for other problems. If there is a lump, the physician will feel its shape, size and texture. It is also important to check for its movement. Cancerous lumps feel differently than benign ones. Benign lumps are likely to be movable, smooth, soft and round, whereas cancerous ones are oddly shaped and feel firmly attached in the breast.

b) Diagnostic Mammogram:
It is more detailed than screening mammogram where a breast x ray is conducted. Doctors normally use them for diagnosing the causes of unusual breast changes, pain, lump, nipple discharge or thickening.

c) Ultrasound:
Sound waves beyond normal human hearing range are sent in this method.  The waves are bounced off tissues and fed into a computer. The computer analyses the echo and creates a picture which is viewed on a screen. The picture can show if a lump is filled with liquid or is solid. A fluid filled sac is a cyst. These are cells that do not have cancer. But a solid mass might be. This examination can be used along with a mammogram.

d) Magnetic Resonance Imaging or MRI:
To the computer a powerful magnet is attached in this method. MRI provides a complete picture. A doctor can see these pictures on the computer screen or print them. MRI can be used with a mammogram.

e) Biopsy:
It is usually done by a specialist or surgeon who is specialised in the field of breast diseases. Tissue or fluid from breast is taken out from breast to investigate for cancer. A clinical breast exam might not be able to detect few suspicious cases. In such cases the doctor might prescribe imaging procedures like ultrasound guided, stereo tactic or needle localised biopsy to remove the tissue. Following ways can be used to remove tissue from breast:

1) Fine needle aspiration:
A thin needle is used to remove fluid from the  lump in the breast. If cells are found in this fluid, it is forwarded to a pathologist for microscopic examination. If it does not contain any cells it isn’t referred to a pathologist.

2) Core Biopsy:
In this type of biopsy a tissue from the breast is extracted by usage of a thick needle and then forwarded to a pathology laboratory for detection of cancer cells. This technique is also known as needle biopsy.

3) Surgical biopsy:
In this type of biopsy a sample tissue from the breast is taken out for cancer detection and sent to the pathology laboratory. There are two types of surgical biopsies, excisional and incisional. In incisional, a sample of the lump is taken and in excisional entire lump is taken for examination.

Cancers can be classified into two types based on location within tissue. If cancer cells are in the duct lining then it is known as ductal carcinoma and if it they are in the lobules then it’s called lobular carcinoma.

Additional Tests
There are few more lab tests which have to be done once cancer is diagnosed.

a) Hormones receptor test:
Estrogen and progesterone hormones help some cells grow. This test detects the presence of hormones in the cancerous tissues.

b) HER2:
In this test detection of  HER2/neu gene or HER2 protein is done. Increase in this protein or excess gene copies in the tissue might increase the chances of a relapse of breast cancer post treatment.

Radiation is important as it is able to reduce the recurrence of cancer after surgery. A surgeon cannot guarantee that every last cancer cell is removed by surgery. Any cell that is removed can eventually form a new lump. It’s been scientifically proven that people undergoing radiation therapy are more likely to remain cancer free and tend to live longer. It can be used in treating breast cancer at any stage and even if the cancer has spread to other body parts.

Radiation can be delivered in two different ways: external and internal.

• External radiation:
  The radiation is delivered by a linear accelerator from outside the body. Treatment can take several weeks. A patient might have to receive treatment 5 days a week up to several weeks.
• Internal radiation:
  In this radiation type, radioactive substances are put directly in the breast inside plastic implants. The implants are removed before the patient is discharged from the hospital.

Are there any side effects to Radiotherapy?

Side effects of radiation therapy depend upon the type and dose of radiation. It mostly affects the skin that is exposed to radiation. The exposed area might become red, itchy, tender, dry, and sore and possibly peel. However these changes are gradual and occur only in patches. The breast might feel tight and heavy. Radiation therapy can cause inflammation, permanent pigmentation or burns to the skin. In some case it can cause diarrhoea. It can also decrease the white cells that protect our body from infection which adversely affect the immune system. Towards the completion of the treatment skin might turn moist. It’s recommended to expose this skin to as much air as possible to heal it.

Here are a few tips to lessen the effects of radiation on skin and help it recover after treatment:
a) Wearing loose cotton clothes,
b) Using warm water instead of hot water for showering,
c) Using mild soaps that are less fragrant,
d) Avoid skin to skin contact,
e) Regularly use cornstarch to absorb moisture and minimize friction from breast areas.
f) Use moisturizers like A&D, Aquaphor, Radiacare or Eucerin.
g) Using Aloe Vera help in mild pinkness, burns and itchiness caused to the skin.
h) Apply sun block of SPF30 and above and avoid being exposed to sun.

Radiation therapy is not recommended in following cases:
a) The body part has already undergone radiation before,
b) Patient is also suffering from connective tissue disease like vasculitis or scleroderma. This makes the patient more sensitive towards radiation.
c) Person is pregnant,
d) Daily commitment to the schedule of radiation therapy is not possible.

There are few myths about radiation therapy:
a) It is a painful process: Generally patients do not feel any pain while the machine is
delivering radiation. It’s possible that the skin might become dry, red and itchy over a period of time.
b) The person will become radioactive: This risk is not present in case of external radiation. In case of internal radiation during the treatment, the patient is secluded and kept in a private room in the hospital.
c) Hair loss will occur: Hair loss is a side effect of chemotherapy and not radiation.

The adverse effect of radiation may not be pleasant but it can be treated or controlled. In many cases there are not even permanent. Location and amount of radiation plays an important role in the adverse effect of radiation therapy.

Different stages are involved in different therapy. Chemotherapy means use of drugs to kill cancer cells. This therapy is recommended by doctors for people suffering from inoperable IIIC or stage IIIB cancer. Inoperable IIIC type of cancer cannot be treated with a surgery and Stage IIIB cancer is a cancer which is inflammatory. It’s a systemic therapy, which means it could affect the entire body as the drug passes through the blood stream.

While treating breast cancer with chemotherapy, a combination of various drugs is used. The drugs could be administered either through pills or injections. This way the drug can enter the bloodstream and can reach all parts of the body. This way it not only targets the cancerous tumor but also those parts where the cancer might have spread. Chemotherapy can be done on women with breast cancer in a hospital, clinic or at home. Few patients might need to be hospitalized during the course.

With the advancement in science and research being carried around worldwide there has been a marked reduction in side effects of chemotherapy today as compared to few years ago. Still there are certain side effects of chemotherapy but these basically depend upon the dosage and the type of drugs. These drugs attack rapidly dividing cells like cancer cells. But they can also harm other rapidly dividing cells in the body. Few healthy cell types that suffer the side effects of chemotherapy are as follows:

• Blood cells: These protect the body from micro organism thus providing immunity, help in clotting of blood, and carrying oxygen to all body parts. Side effects of chemotherapy are   reduction in immunity against infections, prolonged time to heal wounds, nausea and   fatigue. Few women might also develop leukemia or blood cancer due to prolonged chemotherapy.
• Hair-root cells: Chemotherapy could result in hair loss. The patient’s hair will grow however it might show a different texture and color.
• Inner lining of digestive tract: Chemotherapy might lead to poor appetite, diarrhea, vomiting, nausea or lip and mouth sores.
• Bone cells: Chemotherapy might affect the bone cells and lead to osteoporosis.

A doctor can suggest ways to reduce the side effects of chemotherapy. Apart from these there are other contra indications of chemotherapy like numbness or tingling sensation in feet or hands. The problem generally stops once treatment is discontinued. In some women drugs used for treating breast cancer might weaken the heart. Few drugs might cause damage to the ovaries. Hormone production by ovaries might cease. Menstrual periods might be irregular or stop completely. Some symptoms of menopause like hot flashes and dryness of vagina may appear. Some women might loose their fertility. For women over 35 years of age this could be permanent.

On the other hand, a woman might remain fertile while undergoing chemotherapy and might also able to conceive later. Further studies are needed to identify the side of effects of chemotherapy on an unborn child. A doctor should be consulted for birth control before starting chemotherapy.

Each person’s chemotherapy regimen is unique and no two people will react the same way to one treatment. Every person is suggested a tailor made treatment plan depending on various cancer factors like, size of tumor, lymph node involvement, grade, oncogene expression and hormone receptor status.

Depending on the advancement of the breast cancer chemotherapy is used to achieve various goals:

1. Curing of cancer
2. Keeping a control check on cancer so that it does not spread to the other parts of the body
3. Reliving the symptoms of cancer such as pain, so that patient can live more contentedly.

There are times when the only chemotherapy is to be given to the patient depending on the stage of cancer that he suffers but this treatment can also be given with the combination of other therapies like surgical, radiation etc. Chemotherapy when used before radiation or surgical therapy helps the tumor shrink. This is also defined as neo-adjuvant therapy. When this therapy is used after the surgical radiation therapy it’s called adjuvant therapy. It destroys any cancer cells that remain after the above procedures. In fact it helps in making biological and radiation therapy work better and destroys any reoccurrences of cancer cells.

The staging of breast cancer helps the health provider understand and organize the cancer characteristics so that:-

1. These cancerous cells are better understood and the patient can accordingly be provided with the treatment.
2. The prediction of the outcome of the disease is better understood.
3. Provide a description of severity of the cancer to the doctors and nurses worldwide who will help them compare the treatment and understand better.

The different stages of breast cancer are as follows:-

• Stage 0

  This stage is also used explain non invasive breast cancer. In this stage no evidence has been found that the cancer or non cancer abnormal cells have invaded tissues of the other parts of the body. It divided into 2 types LCIS (Lobular carcinoma in situ) and DCIS (Ductal carcinoma in situ).

  • In LCIS, a lobule is lined by abnormal cell. This rarely becomes invasive cancer. If LCIS is present in one breast there are high chances of the other breast getting infected.
  • In DCIS, a duct is lined by abnormal cells. This is also known as intraductal carcinoma. DCIS rarely becomes invasive cancer if treatment is not given.

• Stage I

  This stage explains the beginning stage of invasive breast cancer as to how the cells invade to different adjoining tissues. The tumors usually measures up to 2 cm. The cancer cells do not spread beyond the breast and no lymph nodes are implicated.

• Stage II

  In this stage the tumor usually doesn’t measure more than 2 cm (equivalent to three quarter of an inch). In this stage the breast cancer can spread to the lymph nodes underneath the arm (axillary lymph nodes). This stage is divided in to two categories:

  • Stage IIA which is known as invasive breast cancer where no tumor as such is found but the cancer cells are present in the lymph nodes underneath the arm (axillary lymph nodes) or the tumor has spread to the lymph nodes underneath the arm (axillary lymph nodes) and can be less than 2 cm or the tumor has not spread to the lymph nodes underneath the arm (axillary lymph nodes) but is more than 2cm (not more than 5cm).
  • Stage IIB explains invasive breast cancer where the tumor has not spread to the lymph nodes underneath the arm (axillary lymph nodes but is more than 2cm (not more than 5cm) or is bigger than 5 cm and has not spread to the lymph nodes underneath the arm (axillary lymph nodes) or the tumor has spread to the lymph nodes.

• Stage III

  In this stage the breast cancer is locally advanced. This stage is further divided in to IIIA, IIIB and IIIC:

  • Stage IIIA
    The breast cancer is smaller than 2 inches ( 5 cm) and has either spread to the lymph nodes underneath the arm which attach one another or to other structure or has spread to the lymph node that is at the back of the breast bone or the tumor in the breast is more than 2inches (5cm) and has either spread to the lymph nodes underneath the arm which attached to one another or to any other structure or the tumor in the breast has spread to the lymph node that is at the back of the breast bone.
  • Stage IIIB
    In this stage the tumor in the breast of any size has grown inside the skin of the breast or chest wall. It may be linked with lumps (nodules) or swelling of the breast in the breast skin. The tumor could have either spread to the lymph nodes underneath the arm or to the lymph nodes at the back of the breast bone. The rare type of breast cancer is inflammatory breast cancer. In this case, the breast looks swollen and red as the cancer cells block the vessels of the lymph inside the skin of the breast. When this type of breast cancer is diagnosed it is usually a less advanced Stage IIIB breast cancer but can reach the advanced stage if not treated on time.
  • Stage IIIC
    The tumor in this type of breast cancer can be of any size and can spread to the lymph nodes at the back of the breast bone and arm underneath or to lymph nodes above or below the collar bone.

• Stage IV

  This type of breast cancer is known as distant metastatic cancer. In this stage the caner has spread to the other parts of the patient’s body like the lungs, liver or bones.
  Recurrent or reoccurrence of breast cancer means that the tumor in the breast has relapsed when it was not detected. It could relapse in the chest wall or breast.

The stages of breast cancer can be described as follows:

• If the patient is on stage 0, I, II, or some stage of III then it’s defined as early stage.
• If the patient is on either stage III or IV then it’s defined as Stage IV.

The doctors determine the level of cancer by using staging system. The TNM staging system is the most common staging system. The cancer can be explained by three characters:

• size (T denotes for tumor) which is further categories as TX, T0, Tis and T1-T4
• lymph node involved (N denotes node) which is further categories as NX, N0 and N1- N3
• whether it has relapsed or metastasized (M denotes metastasis) which is further categories as MX, M0 and M1

Once the T, N, and M are characterized, the pathologist combines them, this is known as stage grouping, and the overall stage is assigned.

There has been an increase in the awareness levels about breast cancer in women in the past few decades and many people nowadays are undergoing mammography screening. This has resulted in detecting the cancer at the early stages and increase in the survival rates of breast cancer patients. Still it is the most common form of cancer in the world resulting in the highest number of recorded cancer deaths in women between the age group of 45 to 55 years. While the total recorded male deaths due to breast cancer is considered low or almost 1%.

The most common causes of breast cancer are hormonal and/or human genetic factors. Doctors have been able to develop staging systems to categorise the extent of cancerous growth and develop treatment methods accordingly. Depending on the extent of spread of the cancer and its type, there are various treatment options available like surgery, mastectomy, radiation therapy, hormonal therapy and chemotherapy.

To understand breast cancer better, it is important to understand how any cancer develops. Cancer is triggered by the mutations of genes that are responsible for cell division and growth. Cells are the basic units of life which form tissues and organs. Normally, cells follow a fixed chain of events of birth, growth and death which is controlled by the genes in the nucleus of the cell. But over a period of time, certain genes might mutate, altering the growth pattern of cells resulting in uncontrolled growth of these cells. These cells further divide producing cells like themselves and forming tumors. Tumors could be of two types, malignant or benign. Benign tumors are not dangerous, grow slowly and do not spread to other body parts. Malignant tumors are dangerous and cause cancer; they can spread to other body parts and eventually prove fatal.
Breast cancer is caused due to a malignant tumor that develops from breast cells. Each breast is made up of 15 to 20 lobes containing many smaller lobules. These contain tiny milk producing glands. Milk flows from lobules to nipples through small ducts. The space between lobules and ducts is filled with fat. Lymph vessels are present in the breasts too. These vessels lead to lymph nodes which are small round organs near the underarm, in the chest, above the collarbone and in other body parts. These nodes can also trap bacteria, cancerous cells and other harmful matters.

The spreading of cancer to other body parts is called metastasis. Cancer can spread to almost any body part through the nymph nodes like brain, lungs, liver and bones. The cells in the new tumor are similar in structure to the ones in the breast. Hence, treatments for these are along the lines of breast cancer if it originated as breast cancer.

The exact reasons for developing breast cancer are unknown however certain groups are more prone to develop it easier than others. Studies have shown that following reasons are associated with the development of breast cancer:

1. Age: Women above the age of 60 have a high risk of developing breast cancer. It is less common before menopause.
2. Past history: If one breast had cancer the chances of developing it in the second one increase.
3. Family history: If the mother’s or father’s side has a history of breast cancer then the chances of breast cancer increase.
4. Lifestyle: Few lifestyle factors like drinking, smoking and lack of exercise increase the risk of developing breast cancer.
5. Taking DES (diethylstilbestrol): Some women who were given DES during pregnancy from 1940 to 1971 are found to be at a higher risk for breast cancer.

Apart from the above there are other reasons like diet, breast changes, gene changes, reproductive and menstrual history, race and radiation therapy to the chest, certain substances in the environment  are found to be contributors towards breast cancer however further studies are needed to conclusively prove their contribution.

Screening for breast cancer before the appearance of symptoms is vital and in most cases, treatments can work only if cancer is detected early enough. The following tests are recommended for screening of breast cancer: Mammogram screening, clinical breast examination and breast self examination. A qualified doctor should be consulted before proceeding with any of these tests:

• Mammography: Mammogram is an X- ray picture of the breasts.  Mammograms can detect lumps in breast prior to it being felt. It can also detect tiny specks of calcium called micro-calcifications. Lumps and specks can be caused due to cancer and require further investigations. A mammogram can be followed up with more X-rays or also a biopsy to tell conclusively if cancer is present. However mammograms might always be unable to give the correct diagnosis. Also increased exposure to radiation through mammograms might be harmful.
• Clinical breast examination: A clinical breast exam is conducted by a health care provider. It usually consists of checking the breasts for any abnormal signs, dimpling, rash or fluids from nipples. The lymph nodes close to the breast are checked if they are enlarged. This breast exam normally may take up to 10 minutes.
• Breast self-examination: Women in the high risk groups mentioned above may self examine their breasts monthly. It should be noted that aging, menstrual cycle, pregnancy, menopause or taking of hormones or birth control pills might make the breast feel little uneven and lumpy. A health care provider should be immediately contacted for unusual changes in the breasts.

There are steps a person can proactively take to stay healthy like regular exercise, eating balanced diet, limiting smoking and alcohol. However one must know that breast cancer cannot be 100% prevented by these as it is also caused by genetic reasons.