Road from Detection to Breast Cancer Treatment in India
Breast Cancer Treatment in The World
1. 1.15 million new cases
2. Incidence increasing in most countries
3. 4,70, 000 deaths annually
4. Half of the global burden in low- and medium-resourced countries
Trends since 1950 in age-standardized death rates comparing breast and selected other types of cancer, among women
EBCTCG, Lancet, 2010
1. How can we increase the survival rates in Breast Cancer in India?
2. Does screening have a role to play?
3. Early Detection/Diagnosis and Optimal Treatment is the only way to increase the survival rates.
4. Yes, screening has a big role to play in this goal
What is Screening?
1. Screening is the application of a test to an asymptomatic population to determine who is likely to have the disease and who is not likely to have disease.
What Do We Gain From Screening???
1. Cancer screening ? secondary prevention - earlier therapeutic intervention is possible through screening an asymptomatic population to identify cancer at an earlier stage than it would have been in the absence of screening.
Components Of Breast Screening?
1. Clinical breast examination
2. Screening Mammography
3. Screening breast MRI (in selected cases)
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1. Use a low-dose x-ray system to examine breasts
2. Digital mammography replaces x-ray film by solid-state detectors that convert x-rays into electrical signals. These signals are used to produce images that can be displayed on a computer screen (similar to digital cameras)
3. Mammography can show changes in the breast up to two years before a physician can feel them
4. Screening mammography refers to routine mammographic images in asymptomatic women has resulted in shift in both incidence and stage of patients presenting with breast cancer
5. Overall sensitivity: 75% (>90% in fatty breasts)
6. It is inexpensive and widely available
7. Mammography is the only screening test which has been shown to reduce deaths due to breast cancer
8. 20-40% mortality reduction for women in the screened groups vs. control groups
9. Consists of two views of each breast
b. mediolateral oblique
10. The BIRADS (Breast Imaging Reporting and Data Systems) classification system has been widely adopted as classifying mammograms with respect to appropriate follow up and intervention
Views Seen on Mammogram
RCC LCC RMLO LMLO
What Does A Mammograms Show?
a. Two of the most important mammographic indicators of breast cancers
c. Microcalcifications: Tiny flecks of calcium – like grains of salt – in the soft tissue of the breast that can sometimes indicate an early cancer.
Detection of Malignant Masses
1. Malignant masses have a more speculated appearance
1. Use as screening tool remains controversial
a. Low specificity, higher cost, lack of availability
b. Low sensitivity for calcifications of DCIS
c. Diagnostic test for evaluation of mammographic and palpable abnormalities
d. Can differentiate cystic from solid
e. Characterize solid masses
f. Evaluate the axilla for metastatic disease
g. First exam for patients less than age 30
Breast MRI Screening
• Breast MRI is more sensitive than mammography in detecting breast cancer, however it is less specific and results in high false positive rates
• Therefore, careful patient selection for additional MRI screening is required
• NCCN has recommended Screening MRI in women at high risk of breast cancer:
• # Women with a pedigree s/o or with a known genetic predisposition (BRCA1/2) mutation carrier or HBOC, starting at 25 years or individualized based on earliest age of onset in family
• # Women who received thoracic irradiation b/w 10-30 years
Appearance of Lesson on MRI
Take Home Message
1. Early Diagnosis and Treatment forms the basis of better and improved survival
2. Breast screening has a very important role in achieving this goal.
3. Clinical Breast Examination and Mammography are the most effective screening tools.
4. All the suspicious lesions or findings in screening should be investigated thoroughly.