BREAST CANCER –BREAST HEALTH--------
DR NITIN KHUNTETA
MBBS, MS ( GEN. SURGERY),
M Ch (SURGICAL ONCOLOGY),
DNB (SURGICAL ONCOLOGY).
CONSULTANT SURGICAL ONCOLOGIST, Bhagwan Mahaveer Cancer hospital & Research Centre, Jaipur

The incidence of breast cancer in India is on the rise and is rapidly becoming the number one cancer in females pushing the cervical cancer to the second spot.
The rise is being documented mainly in the metros. It is reported that one in 22 women in India is likely to suffer from cancer during her lifetime, while the figure is definitely more in America with one in eight being a victim of this deadly cancer.
Breast cancer is the most common form of cancer among women. According to a study by International Agency for Research on Cancer (IARC), there will be approximately 250,000 new cases of breast cancer in India by 2015. At present, India reports around 100,000 new cases annually.
Globally, every three minutes a woman is diagnosed with breast cancer in the world, amounting to one million cases annually. The incidence could go up by 50 percent to 1.5 million by 2020, says the World Cancer Report.
The chances of survival and cures for breast cancer is as high as 90 percent after complete treatment.
Breast cancer will become an epidemic in India in near future. Before it becomes the epidemic we should take appropriate measures to prevent development of breast cancer.
AVOIDING THE RISK FACTORS DECREASES THE CHANCE OF DEVELOPMENT OF BREAST CANCER ---
The rise in the incidence of breast cancer is due to changing lifestyles, i.e marrying late, the average child bearing age has increased to 30 and sometimes even beyond that, early weaning from breast feeding, the use of combined estrogen and progestin hormone replacement therapy (HRT) , obesity & lack of physical activity.
THE SMALLER THE CANCER IN BODY THE HIGER CHANCE OF CURE------ There are four stages of breast cancer. Stage 1 to 4. For to diagnose at earlier stage the following recommendation should be followed—
 Screening mammography---mammography is so far the only screening method that has been consistently proven to reduce deaths from breast cancer. It is considered the gold standard of screening, while breast self examination is, at best, a supplement to regular mammograms and breast exams by a doctor.
RECOMMENDATIONS—
• Women age 40 and older should have a screening mammogram every year, and should continue to do so for as long as they are in good health.
• Women at moderately increased risk (15% to 20% lifetime risk) should have their yearly mammogram.
• Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year.
• Schedule the mammogram when the breasts are not tender or swollen to help reduce discomfort and to assure a good picture. Try to avoid the week just before the menstrual period.
• On the day of the exam, don’t wear deodorant or antiperspirant; some of these contain substances that can interfere with the reading of the mammogram by appearing on the x-ray film as white spots.
• Discuss any new findings or problems in your breasts with your doctor or nurse before having a mammogram.
• To bring previously done mammograms so that they can be compared to the new ones.

 Breast self examination-------Goal- to report any breast changes to a doctor or nurse right away.
• Systematic step-by-step approach to examining the look and feel of one’s breasts.
• What to look-- lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, a discharge other than breast milk, or a change in the size of one breast,
• Best time for a woman to examine her breasts is when the breasts are not tender or swollen.
• Women who are pregnant, breast feeding, or have breast implants can also choose to examine their breasts regularly.
• Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional.

 Clinical breast examination.---- Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. After age 40, women should have a breast exam by a health professional every year.
 ACS RECOMMENDATIONS—
• Women age 40 and older should have a screening mammogram every year, and should continue to do so for as long as they are in good health.
• Women at moderately increased risk (15% to 20% lifetime risk) should have their yearly mammogram.
• Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year.
The treatment protocol for breast cancer depends on the stage of the cancer & general physical condition of the patient.
Surgery is the main modality for early & locally advanced breast cancer.
The two types of surgery to treat breast cancer are:
1--Surgery to remove the entire breast & axillary lymph nodes i.e radical mastectomy.
2--Surgery to remove just the area of the breast that contains cancer & axillary dissection (breast-conserving surgery) followed by radiation treatment.
Studies now show that breast-conserving surgery followed by radiation therapy is as good as mastectomy in treating early-stage breast cancer (Breast Conservation Trials, NSABP B-06).
Breast conservation surgery is not recommended in patients with---
Two or more tumors in separate areas of breast, H/O prior therapeutic irradiation to the breast, Pregnancy, Women with certain connective tissue diseases. e.g systemic scleroderma, lupus erythematosus, polymyositis, dermatomyositis, and mixed-connective tissue disorders. Women with a tumor larger than 5 cm (2 inches) that doesn't shrink very much with chemotherapy in small & medium size breast.
After breast conserving cancer surgery & subsequent radiotherapy, up to 50 to 60 % of woman have a residual deformity that requires surgical correction, by performing immediate remodelling of the breast at the same time as cancer removal. Plastic surgical techniques (oncoplastic & flap surgery ) should be integrated with the original operation .