Breast CancerDr. Rohan KhandelwalMS, MRCS (Edin.), FIBDPreviously at University of MarylandConsultant – Breast Onco-SurgeonDepartment of Breast DiseasesW Pratiksha HospitalGurgaon

Welcome to the World of Women’s Well-being

• Latest ICMR Data – Breast cancer is the most common cancer among Indian women

• Affects one in 21 Indian women during their lifetime

• By 2025, one in 8 will be affected (Western figures)

BURDEN OF BREAST CANCER IN INDIA

• Age – incidence increases with age• Family History (more family members affected –

more the risk)• Genetic Mutations (BRCA)• Early Menarche (early menarche <12 years)• Late Menopause• Increased breast density

NON MODIFIABLE RISK FACTORS

Testing for BRCA Mutations: Recommendations • Relatives of a patient with known deleterious BRCA

mutations• Non-Ashkenazi Jewish women should be tested if one of

the following risk factors is present:1. Two first-degree relatives with breast cancer, one of

whom was diagnosed before 50 years of age2. At least two first- or second-degree relatives with breast

cancer or ovarian cancer, regardless of age at diagnosis3. A combination of breast and ovarian cancers among

first- and second-degree relatives4. A first-degree relative with bilateral breast cancer5. A male relative with a history of breast cancer

BRCA TESTING – ANGELINA JOLIE EFFECT

• Obesity (lack of physical activity; fatty food)• Smoking• Alcohol consumption• Hormone replacement therapy• Age at first live birth

MODIFIABLE RISK FACTORS

Symptoms

• Not all lumps are malignant

• Fibroadenoma - most common cause of a breast lump

• Rarely – fibroadenomas can be associated with malignancy

• Usually malignant lumps - painless in the initial stages

• But malignancy should be ruled out in patients with breast pain

UNUSUAL FACTS!!

METHODS FOR EARLY DETECTION

• Breast Self Examination (BSE)

• Clinical Examination by Breast Surgeon

• Screening Mammography

BREAST SELF EXAMINATION

• Opportunity for woman to become familiar with her breasts

• Monthly exam of the breasts and underarm area

• May discover any early changes

• Begin at age 20, continue monthly

WHEN TO DO BSE• Menstruating women- 5 to 7 days after the

beginning of their period• Menopausal women - same date each month• Pregnant women – same date each month• Takes about 10 minutes• Perform BSE at least once a month• Examine all breast tissue & underarm area

BreastSelf

Exam(BSE)

CLINICAL EXAMINATION

• Performed by an experienced breast surgeon • Annually for women over 35 years of age• At least every 3 years for women between 20 and 35 years of

age• More frequent examination for high risk patients

SCREENING MAMMOGRAPHY

• X-ray of the breast• Has led to a 30%

reduction in deaths due to breast cancer

• Helps in early diagnosis

• Normal mammogram does not rule out possibility of cancer completely

SCREENING MAMMOGRAPHY

Women (asymptomatic) 40 years of age and older should have a mammogram every year

BENEFITS OF SCREENING

05/02/2023 Presentation Title Slide: 17

BREAST CANCER SCREENING METHODS FOR HEALTHY WOMEN

1. Breast Self Exam — Status• Guiding principal “Know your

breasts — they are not land mines”2. Clinical Breast Exam

• Age 20-35: every 3 years• Age after 35: every year

3. Mammography • Age after 40: every year

05/02/2023 Slide: 19

Triple Assessment

History & Clinical

Examination by a Breast

Surgeon

Imaging

<40 yearsUltrasound

>40 yearsMammogram

Biopsy/ FNAC

IF LUMP IS DETECTED

Management

Surgery

Breast Conservation Surgery

Mastectomy with or without

reconstruction

Chemotherapy

Radiotherapy

Hormonal Therapy

BREAST CANCER MANAGEMENT

05/02/2023 Presentation Title Slide: 20

• Most breast cancers run in families• There is nothing you can do to lower your risk of

developing breast cancer• Bras cause breast cancer• Regular mammograms prevent breast cancer• Antiperspirants cause breast cancer• Most breast lumps are cancerous• Oral contraceptive pills increase the risk of cancer

BREAST CANCER – MYTHS

05/02/2023 Presentation Title Slide: 21

TIPS FOR RISK REDUCTION & EARLY DETECTION

1. Regular exercise - at least 30 mins of exercise 4 times a week

2. Avoid smoking3. Avoid alcohol consumption4. Maintain your weight in the

normal range5. Be breast aware - do regular

self examinations6. Clinical breast examination

by an experienced breast surgeon after the age of 35 years (annually)

7. Regular mammograms after 40 years of age

8. If family history of breast cancer is present, consult your oncologist to discuss your risk

3

May 2, 2023

THANK YOU !