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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 !
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