Cancer & Breast Clinic
Breast cancer screening is the medical screening of asymptomatic, apparently healthy women for breast cancer in an attempt to achieve an earlier diagnosis. The assumption is that early detection will improve outcomes. A number of screening tests have been employed, including clinical and self breast exams, mammography, genetic screening, ultrasound, and magnetic resonance imaging.
Most cancers in the breast originate from the cells that line the milk producing glands and ducts with the cyclical hormonal influence the cells lining the milk glands and the ducts keep replicating normally at a controlled pace, throughout ones reproductive cycle.
During this cell division and replication process, things may go wrong and abnormalities in the cells may occur. The body has a method of removing the abnormal cells from the cell division cycle. Sometimes the abnormal cells survive and continue to proliferate in an uncontrolled fashion. These proliferating abnormal cells also need blood supply and nutrients to grow. As it keeps growing, some of these cells may enter the circulation and have the potential to seed itself and grow in bones, brain, liver and lung resulting in a compromise of function in vital organs like liver or lungs.
It is still not very clear why this happens in some women more than others. About 5-10 % of breast cancers are thought to occur because of inherited genetic mutation. Reproductive risk factors such as early onset of periods, late menopause, infertility, hormone replacement therapy, late first pregnancy, obesity account for about 25 % of breast cancers. The statistical models that are used to estimate a woman’s risk are often based on western statistics and may not be relevant to our population.
The incidence of breast cancer in India is lower than in the west. However rapid industrialisation and changing lifestyle and dietary habits, fertility patterns, etc., are making Indian women more susceptible to the disease. The incidence is increasing in India.
BREAST CANCER DIAGNOSIS: Diagnostic breast imaging includes mammography, breast ultrasound and sometimes Breast MRI. When a women has symptoms that concern her about her breast, a complete history and clinical examination is performed. Based on the information gained a mammogram or ultrasound may be done. Sometimes both are required. These tests help us to ascertain the diagnosis and decide on appropriate management. Many require only reassurance that the symptom does not indicate cancer. A good breast imaging is crucial to decide further course of action and treatment planning and these tests are better done by specialists in this domain.
BREAST SURGERY: Breast conservation surgery is an alternative to remove the whole breast (Mastectomy).
The cancerous lump can be removed with a margin of normal tissue around it (called wide local excision or lumpectomy). This leaves the majority of the breast untouched (breast conserving surgery).
Type of the cancer, size of the lump, size of the breast, multiplicity of the tumor, location of the tumor, lymphnodal involvement, access to follow up treatment with radiotherapy, access to follow up care are some of the factors that influence the choice of surgery ( ie Breast conservation surgery or Mastectomy ) Breast conserving surgery is usually followed up with radiotherapy to the breast.
Other treatments like chemotherapy or hormone therapy are not influenced by the choice of surgery. The need for chemo or hormone therapy is usually based on factors such as tumour size, nodal status, grade, hormone receptor status, Her2 and Ki67 scores, age and physical condition of the patient.
Facts at a glance