Breast Cancer: Lump in breast It is natural for women to feel anxious when they feel or see something unusual in a mammogram. At such a time, a question immediately comes to mind, that is, “I don't have cancer, do I?” A doctor's examination and imaging tests provide some important clues; But a biopsy often gives a clear answer to this question. A mammogram may show a suspicious shadow or change in the breast. But what exactly it is, how it looks and how to treat it, is understood from biopsy. Without a biopsy we are only guessing Dr. Kunjal Leela, Head of Department and Consultant, Surgical Pathology, Metropolis Healthcare Limited has given detailed information.(Photo courtesy – istock)
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Increasing incidence of breast cancer
Breast cancer is the most common cancer among women worldwide and in India. According to GLOBOCAN 2024 data, an estimated 2,37,231 new cases of breast cancer are diagnosed in India every year. This is 15.2 percent of the total new cancer cases in the country. In India, this cancer usually occurs between the ages of 40 and 50 years. Compared to Western countries, it appears almost ten years earlier in India. Unfortunately, almost half of women still come to the doctor with stage III or IV cancer due to fear or lack of regular screening. This statistic highlights the importance of awareness, timely diagnosis and timely medical check-up.
What checks should be done?
Certain tests and precautions are important for early detection of cancer. Self-examination of the breasts should be done every month after 7 to 10 days after the onset of menstruation. After the age of 30, a breast examination should be done by a doctor every year. A mammogram is recommended after the age of 40. Mammograms can detect cancer up to two years before a lump is felt in the breast. Ultrasound may be useful for women who are younger and have dense breast tissue. Women with a BRCA mutation or a strong family history of breast cancer may be advised to have an MRI.
If the imaging test reports BIRADS 4 or 5, i.e. cancer is suspected, a biopsy is advised. In addition, a new lump that persists for a long time, a bloody discharge from the nipple, thickening or dimpling of the breast skin, as well as suspicious lumps in the armpit, may also require a biopsy.
Core Needle Biopsy is often done. The procedure is performed under local anesthesia and with the help of ultrasound. In this, 3 to 4 small samples of tissue are taken from the breast lump. This process is completed in about 15 minutes. No stitches are required and you can go home the same day. A vacuum-assisted biopsy or a surgical biopsy may also be needed in certain situations. Always remember one thing, a biopsy does not spread the cancer.
Now the question is, what happens next to this small sample taken for biopsy? Here the role of pathologist is very important. The tissue sample taken from the biopsy is immediately preserved in formalin and sent to the laboratory. This tissue is processed in the lab and then histopathology examination is done. This test determines if the tissue is normal and non-cancerous, if there are any abnormal or changes that increase the risk of future cancer, or if there are actual cancer cells. If there is cancer, its type and grade, i.e. how aggressive it may be, is also assessed. Based on all these things, the direction of further treatment of the patient is decided. Sometimes special tests called Immunohistochemistry (IHC) are needed to make an accurate diagnosis.
Another important group of IHC tests includes tests for ER, PgR, HER2neu, and Ki-67. These tests are very important in understanding what factors are responsible for the growth of cancer and how fast the cancer cells are growing. 60 to 70 percent of breast cancer patients are ER/PgR positive. Such patients may benefit from hormonal therapy and in some cases chemotherapy may be avoided. 20 to 25 percent of patients are HER2neu positive. Such patients can be treated with a specially targeted injection called Trastuzumab. Ki-67 is a marker of cell proliferation. That is, information about how fast the cancer cells are dividing is obtained from this test. Based on all these reports the doctor can decide the right treatment according to the type of cancer of each patient.
It is very important to perform these tests in every invasive breast cancer. Therefore, instead of doing these tests one after the other, it is recommended to combine them (Reflex Testing) at the beginning. This can save significant time for diagnosis and treatment can be started sooner.
In some selected cases molecular or genomic tests are done to get more information. The HER2neu gene test can sometimes help clarify previous test results. Some other tests can predict the risk of cancer recurrence or what the next treatment should be.
Gene testing is done in some early stages of cancer. This test gives a score that indicates the likelihood of cancer recurrence. If the score is low, it may be safe to avoid chemotherapy and only take treatment in pill form. If the score is high, chemotherapy may be beneficial. These tests have helped many women avoid unnecessary chemotherapy and its side effects.
Other factors such as BRCA1/2, PIK3CA and PD-L1 are also investigated in patients with advanced or triple negative breast cancer. These tests help determine whether a patient can be given targeted treatments such as PARP Inhibitors or Immunotherapy.
The final pathology report combines the findings of the examination under the microscope and the findings of other specialized tests. The team of doctors then combine these reports, imaging tests, the patient's medical condition and the findings of other tests to decide on a further treatment plan.
In short, a small biopsy sample taken in just 15 minutes can determine the direction of treatment for years to come. Important decisions such as whether or not to have surgery, whether to give pills, injections or whether chemotherapy is needed depend on the information obtained from this small sample.
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Therefore, a biopsy is not a sign of something bad, but an important step towards getting a clearer picture of the disease. Timely checkup and accurate diagnosis helps to reduce fear and uncertainty in the mind. Because only on the basis of proper information, the doctor can give the right treatment to the patient at the right time.