1. What is Breast Cancer?
A group of rapidly dividing cells that may form a lump or mass of extra tissue in the breast is called as breast cancer. Under normal circumstances majority of cells in the human body multiply in a regulated manner phasing out the old ones and replacing them with new normal cells.
Cancer is a group of diseases in which cells lose the ability to regulate their own growth and multiply out of control. Usually, cancer is named after the body part in which it originated; thus, breast cancer refers to the erratic growth and proliferation of cells that originate in the breast tissue.
2. What are the survival rates of breast cancer?
There are statistics available that sum up survival rates by breast cancer stage. The following are based on studies of a 5 year survival rate.
- Stage 0: 100%
- Stage I: 95%
- Stage IIA: 92%
- Stage IIB: 81%
- Stage IIIA: 67%
- Stage IIIB: 54%
- Stage IV: 20%
These statistics are from the American College of Surgeons National Cancer Data Base and are based on patients diagnosed from 1995-1998.
3. Am I at Risk of Breast Cancer?
Ideally both men and women can get breast cancer. But more than 99% of the cases occur in women. The greatest risk factors for developing breast cancer are the ‘FEMALE’ sex and increasing ‘AGE’.
People who think they may be at risk should discuss this with their doctor. Risk factors for breast cancer include the following:
- Older age.
- Menstruating at an early age.
- Older age at first birth or never having given birth.
- A personal history of breast cancer or benign (noncancer) breast disease.
- A mother or sister with breast cancer.
- Treatment with radiation therapy to the breast/chest.
- Breast tissue that is dense on a mammogram.
- Taking hormones such as estrogen and progesterone after menopause (not oral contraceptive pills).
- Drinking alcoholic beverages.
4. What are the tests available for detection and diagnosis breast cancer?
The simplest method of reaching a definitive diagnosis is by performing a “Triple Test”. A triple test includes a thorough Clinical Examination, a Fine Needle Aspiration Cytology (FNAC) or Core Biopsy (CB) of the lump and a Mammography (of both breasts). If all three of the afore-mentioned tests are suggestive of cancer, the accuracy of diagnosis is almost 100%. Two or more of the above, if suspicious for malignancy, mandate at least an excision biopsy (surgical removal of the lump) for histological confirmation of cancer or otherwise. Of the above, clinical examination carries maximum weight i.e. even if mammography and FNAC suggest benign pathology, a breast lump that feels clinically suspicious requires to be biopsied before declaring it benign.
A mammogram helps in many ways. It can detect impalpable lumps in the same breast or opposite breast and necessitate revision of the treatment plan. It can detect impalpable DCIS (seen as pleomorphic microcalcification) in the breast and can help in altering the decision to perform a breast conserving surgery in those patients. Contrary to wide-spread belief, the radiation emitted from a mammography machine is not harmful to patients.
5. If I get Breast Cancer how long will I live?
The greatest misconception that the common person has about cancer is that all patients eventually die of cancer. It is very important to realize that breast cancer is one of the most curable cancers in the human body. All patients who are cured live a normal life to their entire lifespan. As for those who relapse (recur), it is known that 90% of relapses occur within the first 3 years and after relapse the average survival is approximately 2 years.
6. What are the treatment options for a person suffering from breast Cancer?
Treatment of breast cancer involves a multidisciplinary approach. Patients suffering from breast cancer have the option of being treated by one or all of Surgery, Radiation Therapy (RT), Chemotherapy (CT), Hormonal Therapy (HT) and Biological Therapy (BT). The choice of treatment depends on the type and location of the cancer, whether the disease has spread, the patient’s age and general health, and other factors.
Surgery for breast cancer essentially includes two procedures; either modified radical mastectomy (MRM) or breast conservation therapy (BCT). A modified radical mastectomy (MRM) involves removal of the entire breast (with nipple and areola) along with the lymph nodes in the axilla. This treatment is reserved for patients with extensive disease (large tumours not responding to pre-operative chemotherapy) or patients with DCIS (which tends to be diffuse and involves the entire breast). The majority of patients (patients with small tumours or with large tumours downsized using pre-operative chemotherapy) undergo breast conservation therapy (BCT). BCT includes lumpectomy (removal of the breast lump with a 1 cm margin of normal breast around), axillary lymph-node dissection followed by radiotherapy to the entire breast with a boost to the lumpectomy site. This technique offers survival and relapse rates similar to a mastectomy, while at the same time preserving the breast which helps maintain the patient’s self-image, self-esteem and quality of life. Patients undergoing mastectomy also can be offered whole breast reconstruction that can be successfully performed using microvascular surgical techniques.
Radiation Therapy (RT) is given to all patients undergoing BCT to minimize chances of relapse in the remainder of the surgically untreated breast. However a few patients undergoing MRM also require to be treated with RT if the tumour is large (over 5 cm) or locally advanced or if more than three of the dissected axillary nodes harbour cancer. If RT is withheld in such patients there is a substantial risk that the disease will recur at the site of operation. The axilla (armpit) is not routinely radiated (except in certain circumstances) owing to the huge morbidity associated with it.
Apart from surgery and radiation therapy (both of which act locally) many patients also require treatment with agents that get distributed to all parts of the body via the blood circulation in order to tackle any microscopic disease that may be present there. This is called as systemic therapy. Systemic therapy is indicated in all patients who have established metastatic disease or in those who have a significant risk of relapse in distant organs (lungs, liver etc). In general, patients with tumours more than a couple of centimeters in size or with lymph nodes involved by disease have been shown to benefit after adjuvant systemic therapy. Systemic therapy can be provided using either cytotoxic chemotherapy (CT) or hormonal therapy (HT) or both sequentially. Standard CT protocols (first-line, second-line etc.) using a variety of chemotherapeutic drugs can be successfully administered to appropriate patients. Available evidence recommends a maximum of six cycles of chemotherapy per regimen or schedule. Hormonal therapy is beneficial only in a select group of patients whose tumors are hormone-receptor (Estrogen receptor or Progesterone receptor) positive. As part of hormonal therapy, a variety of drugs are available today, each with its own established indication. Ovarian ablation (by surgical removal or radiotherapy) can be considered as a line of hormonal treatment in premenopausal women above 40 years of age with hormone-receptor positive breast cancer. Temporary ovarian suppression (using injectable drugs given monthly for two years) can be offered to young patients with hormone-receptor positive early breast cancer who choose to maintain their fertility.
7. Can Breast Cancer happen to me only after 35yrs of age?
Not necessarily. One can have Breast Cancer even before that age but the chances are very slim. Internationally it has been seen that for over the last three decades the incidence rate has been stable in women under 50 years of age but is rapidly increasing over 50 years of age.
8. If my family member has BC does that mean I will also have it?
If any female relative in your family (including your grandmother, mother, aunt, sister, or daughter) has had breast cancer, you have a higher risk of getting it, too. Your risk doubles if the woman is your mother, sister, or daughter. And it’s even higher if your relative had cancer in both breasts or was diagnosed before she went through menopause. Research has shown that there is a genetic link between women in the same family who have breast cancer. If breast cancer runs in your family, you can have genetic testing to find out if you have that abnormal gene. If you do, you can explore options to help prevent the disease. But just because you have the abnormal gene doesn’t mean you’ll get breast cancer. Therefore, it’s best to have genetic counseling first to know whether or not to get tested and to know what to do following testing. Some women choose to have one or both breasts surgically removed. Another method of reducing the risk of developing breast cancer in such women is by performing a prophylactic bilateral oophorectomy (removal of ovaries) that reduces risk of developing both breast and ovarian cancer. Since surgery carries its own set of risks, talk about it with your doctor before making a decision.
9. What is screening for breast cancer?
Screening is the checking for the presence of breast cancer in order
to catch it early for treatment. Screening mammography has come in a big way in the west and has even been promoted as a perfect screening tool in our country. Over 88% of the female population within India is under 50 years of age (i.e. pre-menopausal) and we need to understand that the sensitivity of mammography in premenopausal patients, at best, is only 60%. This means that at least forty out of a hundred premenopausal women with breast cancer undergoing mammography will have normal mammograms and a false sense of security. Thus mammography cannot be considered as a screening method for all age groups in India. In postmenopausal women screening can be employed but definitely not in women less than 50 years of age (premenopausal). In our country breast self examination (performed monthly) and a clinical breast examination (performed annually) continue to be the best screening methods. However international screening recommendations mandate annual screening mammography for women over forty years of age.
10. What are the signs of breast cancer?
Breast cancer isn’t always detected with the naked eye. Its early signs are often hidden within your breast tissues. Changes to your breasts that you do see may not be the result of breast cancer at all. Lumps and bumps may come and go, as your hormones ebb and flow as you age. Breast skin may change texture due to sunburn, radiation treatments, or infections that cause rashes. So how would you know for sure whether or not a lump, skin rash, skin dimpling or nipple discharge is benign or cancerous? Sometimes a small tumor in the breast gets diagnosed after picking out a node in the armpit. You will need help from your medical professionals to get a clear diagnosis.
11. At what Stage of cancer am I?
Staging is the process physicians use to assess the size and location of a patient’s cancer. Identifying the cancer stage is one of the most important factors in selecting treatment options. Several tests may be performed to help stage breast cancer including clinical breast exams, mammogram, biopsy, and certain imaging tests such as an isotope bone scan, CT scan of chest abdomen and pelvis and Liver function tests. These tests are not performed on every patient but only those who have extensive disease within the breast i.e. breast lump more than 5 cm or tumour involving skin or presence of large matted axillary or neck nodes.
12. What is special about KDAH? Why should I only visit KDAH and not any other hospital or clinic?
The Kokilaben Hospital Comprehensive Breast Care Unit is a dedicated service that has been created to specifically diagnose and treat the entire spectrum of conditions affecting the mammary gland. The breast unit has been designed on the guidelines laid down by the European Union Society of Mastology (EUSOMA) and is based on two fundamental principles – Evidence Based Medicine and Multidisciplinary Approach.
Evidence Based Medicine – Over the years a lot of research has been carried out in the field of breast diseases, both benign and malignant, spanning diagnosis to treatment. It is important for all clinicians to keep up with this vast reservoir of knowledge, understand it and translate it into practice guidelines that are applicable in day-to-day clinical practice. This is called evidence based medicine. At the Kokilaben Hospital, we follow the model of evidence based medicine so that our patients can receive the highest level of care in surgery, chemotherapy or radiotherapy that is prevalent in the world e.g. In the field of breast cancer management, the next step of individualizing treatment for each and every patient has already been taken using new molecular predictors of recurrence by techniques such as microarrays and RT-PCR. Such advances in technology have allowed us to quantify the risk of relapse for an individual patient and tailor her therapy accurately e.g. avoid chemotherapy in patients who are at low risks of relapse on these new assays. Such advances in management are practiced on a regular basis in the Breast unit at the Kokilaben Hospital.
Multidisciplinary Approach – The days of surgeons treating breast cancer patients on their own are long gone. Today, centers of excellence all over the world treat their patients based using multidisciplinary teams. With growing awareness about breast cancer more and more patients are being diagnosed in early stages and consequently cure rates have risen to up to 85 -90%. This has made post-treatment quality of life and rehabilitation very important and relevant in addition to treatment issues.
The Kokilaben Hospital Breast Unit Team – At the Kokilaben Hospital, the breast unit multidisciplinary team includes a
- Breast Surgeon (specializing in benign and malignant diseases of the breast) – Dr Mandar Nadkarni, Dr Archana Shetty
- Plastic Surgeon – Dr Quazi Ahmed
- Medical Oncologist – Dr Sandeep Goyle, Dr Imran Shaikh, Dr Sewanti Limaye
- Radiation Oncologist – Dr Kaustava Talapatra, Dr Pranav Chadha
- Breast Radiologist – Dr Sheffali Shah Sardar, Dr Jigna Rathod, Dr Rolly Choudhary
- Breast Pathologist – Dr Bijal Kulkarni, Dr Meenal Hastak, Dr Nevitha Athikari
- Psychologist/counselor – Ms Priyadarshini
- Psychiatrist – Dr Shaunak Ajinkya
- Rehabilitation Therapist (occupational and physiotherapist) – Dr Abhishek Srivastava
- Breast Nurses
Each member of the team is an expert in his/her line of specialty and being a team encourages healthy interaction amongst all members in making and executing therapeutic decisions for individual patients. The main purpose of multidisciplinary team is to impart the best possible ‘state of art’ care to the patient from diagnosis to treatment and even post-treatment rehabilitation.
Information is designed for educational purposes only. Any decisions should be made in conjunction with your physician or therapist. We will not be liable for any complications, injuries or other medical accidents arising from or in connection with, the use of or reliance upon, any information in this brochure.
For further information and Doctor Appointment
You may call the hospital number +91-22-30999999/30666666. A convenient appointment date and time will be given to you. You can visit the hospital website www.kokilabenhospital.com