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Breast cancer

Anand Lab Editor

February 8, 2017

Dr. Vidya. M.N,
MD Pathology
Consultant Pathologist and Head Div Histopathology/ Cytology
Anand Diagnostic Laboratory

Breast cancer is the most common female cancer in the world with an estimated 1.67 million new cancer cases diagnosed in 2012. Annual incidence of breast cancers is nearly 144,000new cases a year and hence has become the most common female cancer in the urban population.

When compared to the Western world the incidence of breast cancer in India is significantly lower. It varies between 5/100,000 females in rural India to 30/100,000 females in Urban India. However, the incidence of breast cancer in the young Indian females is a decade less than that seen in the Western population.

Several life style and genetic factors are implicated as causative factors for breast cancer.

Being a woman is a risk factor that cannot be changed, as an incidence of breast cancers are 100 times more than in men. This is because the female hormones oestrogen and progesterone can promote cancer growth.

As you get older the risk of breast cancer increases.

5 to 10% of breast cancers are hereditary as they result from gene defects/ mutations that are passed on from parents. The most common genes implicated are the BRCA1 and BRCA2 in inherited breast cancers. Women with these mutations inherit breast cancer at a younger age than the normal population with both breasts being involved by cancer. These women can also develop cancers in other organs like ovary and uterus.

Family history of breast cancer increases the risk along with other factors like dense breast tissue and other benign breast diseases.

Lifestyle factors like sedentary life style, obesity, not having children, not breast feeding, alcoholism, long term usage of oral contraceptives and post-menopausal hormone therapy are some of the other factors implicated in the development of breast cancer.

To reduce the risk of breast cancer, the American Cancer Society recommends that adults get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week.

Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years. (Strong Recommendation)as per the American Cancer Society.

Population-wide mammographic screening of asymptomatic women is not feasible in India. Periodic examination by trained heath care workers and Breast Self – Examination are alternatives in our country.

Women should examine their breasts at the same time once every month for any lumps or nipple discharge.

Menstruating women should wait for the menstruation to get over so that the breasts are not tender.

The below picture has been sourced from the internet*

b

When there is a breast lump, all women should undergo the triple test* as follows:

  1. Clinical Examination by experienced clinician, preferably by a breast surgeon.
  2. Breast Imaging: Bilateral Mammogram and or Ultrasound or MRI as appropriate.
  3. Histopathology: FNAC / Core biopsy (Ideal). Excision Biopsy/Incision biopsy if indicated.

 

*Ref: ICMR 2016, Consensus document for management of breast cancer

 

Management of breast cancer depends on the associated co-morbidities and other conditions. With improvements in technology, the focus is more towards breast conservation surgeries.

The management also depends on the hormonal expression of the tumour cells which include ER, PR, Her2/neu receptors and proliferative marker Ki67.

Anti-Her2 treatment is targeted personalized treatment in patients with breast cancer who show overexpression of this gene. This treatment is expensive and hence calls for accurate testing and interpretation of the Her2 receptor study.

Our facility provides for both screening and management of breast cancer.

The screening facilities available are Ultrasound, Mammogram, and FNAC for women.

Fine needle aspiration cytology is performed at our centre for breast lumps along with nipple discharge examinations if any.

An extensive histopathological examination of the excision specimens/core biopsies conducted at our centre with emphasis on the pathological staging of the disease.

Ancillary tests of importance, i.e., IHC for ER, PR, Her2, and Ki67 are done at our centre. We have the facility for testing Her2 gene by FISH to detect gene amplification (in more numbers) so that the patient can opt for Herceptin treatment.

These accurate reports are given with the help of image analysis, aid in the molecular subtyping of the breast tumour so that a precise treatment can be given to the patient.

Awareness of the disease along with maintaining a healthy life style accompanied by routine screening checks is a way forward to deal with breast cancer.

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