October is observed as International Breast Cancer Awareness Month since 2006. The main objectives are: to raise awareness, particularly among women, about the risk factors that increase the possibility of developing breast cancer, to develop an understanding about the methods of prevention and importance of early detection, and providing integrated services to fight breast cancer.

Substantial support for breast cancer awareness and research funding has helped in the diagnosis and treatment of breast cancer. The survival rates have risen and the number of deaths associated with this disease is steadily declining, due largely to factors such as early detection, a new approach to treatment and a better understanding of the disease.

Breast cancer is a disease in which cells in the breast grow out of control. It is the most common cancer in women but is rare in men. About one in 8 women is diagnosed with breast cancer during their lifetime.

Breast cancer has several symptoms. The first noticeable symptom is usually a lump or area of thickened breast tissue. There is sometimes a change in the size or shape of one or both breasts and discharge from either of the nipples which may include blood. There may be a lump or swelling in either of the armpits. Changes to the skin over the breast, such as redness, a newly inverted nipple and rash on or around a nipple, a change in the appearance of the nipple, such as becoming sunken into breast. Pain is not usually a symptom of breast cancer.

One’s lifestyle and hormonal and environmental factors may increase the risk of breast cancer. But it is not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. Breast cancer is caused by a complex interaction of genetic factors and environment.

The known risk factors include: being women, old age, radiation exposure, obesity, beginning of menses at a younger than usual age or stoppage of menses at an older age than usual, never having been pregnant or having one’s first child after 30 years of age, post-menopausal hormone therapy or alcohol drinking. A personal history of cancer in one breast increases the risk of developing cancer in the other breast. If one’s mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, then the risk increases. Still, a majority of people diagnosed with breast cancer have no family history of the disease.

About 5 to 10 percent of breast cancers are linked to gene changes (mutation) passed through generations of a family. A number of inherited mutated genes that can increase the likelihood of breast cancer have been identified. The diagnosis is done by physical examination of breasts, screening (mammography) or taking a small sample of breast tissue (biopsy).

All women over 50 years need screening every three years. A CT scan, chest X-ray and liver ultrasound, bone scan may be needed to check whether the cancer has spread. An MRI of the breast may be needed to clarify the results or assess the extent of the condition within the breast.

Cancer detected at an early stage can be treated before it spreads to other parts of the body. Breast cancer is treated by a combination of surgery, chemotherapy, and radiotherapy. Surgery is usually the first treatment followed by chemotherapy or radiotherapy or, in some cases, hormone or targeted treatment. If breast cancer has spread to other parts of the body then it is not curable, so the aim of the treatment is to relieve symptoms.

Breast cancer can affect daily life. How people cope with the diagnosis and treatment varies from person to person. There are several forms of support available. Family and friends can be a powerful support system, communicating with other people in the same situation, not trying to do too much or overexerting yourself, sparing some time for yourself.

A breast self-examination:

First, look at your breasts in the mirror with shoulders straight and arms on hips, look for breasts’ size, colour and shape. If you see any of the following changes consult your doctor: dimpling, puckering, or bulging of the skin. A nipple that has changed position or an inverted nipple (pushed inward), any fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood). Redness, soreness, rash, or swelling. Now raise your arms above your head and look for the same changes.

Next, feel your breasts while lying down, using the right hand to feel the left breast and then left hand to feel the right breast. Use a firm, smooth touch with finger of hand, keeping the fingers flat and together. Be sure to feel all the tissue from the front to the back of the breasts: for the skin and tissue just beneath use light pressure; medium pressure for tissue in the middle of breasts; firm pressure for the deep tissue. When you reach the deep tissue, you should be able to feel down to ribcage. Finally, feel breasts while standing or sitting.

The more you examine your breasts, the easier it will become to know if something has changed. Do a breast self-examination once a month. Examine several days after the period ends, when breasts are not swollen and tender. After menopause choose a day that is easy to remember, like the first or the last day of the month.

For prevention get rid of drinks containing alcohol. Do exercise daily for 30 minutes, reduce excess weight by reducing the number of calories you eat and slowly increase exercise. Take a balanced diet that includes fruits and vegetables, whole grains, legumes, nuts, olive oil and fish. These may reduce the risk of developing breast cancer.

Women with a very high risk of breast cancer may choose to have their healthy breasts and ovaries surgically removed to reduce the risk of both breast cancer and ovarian cancer.

The female hormone estrogen can sometimes stimulate breast cancer. The ovaries, where eggs are stored, begin to produce estrogen at puberty to regulate periods. Post-menopausal hormone replacement therapy (HRT) may increase the risk of breast cancer. There is no increased risk of breast cancer if you take HRT for less than a year, risk falls after stopping HRT, but some increased risk remains for more than 10 years. Contraceptive pills also increase the risk; it starts decreasing once you stop taking the pill.

Dealing with cancer can be a huge challenge for a patient, her family and friends. It can cause emotional and practical difficulties. The removal of part or all of a breast can be very upsetting. It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. It can also help to talk to someone who also has breast cancer.

Getting back to normal after surgery takes time. During recovery, avoid lifting things, children or heavy shopping bags. One may also be advised not to drive. Radiotherapy and chemotherapy can make one tired. Rarely, the treatment for breast cancer may cause pain and stiffness in arms and shoulders after surgery. Studies have shown women who breastfeed are less likely to develop breast cancer.

The writer is a    physician of long standing