Breast Cancer Specialist in India

Breast Cancer Specialist in India

What to expect during external beam radiation therapy (EBRT)

Radiation treatment in India is usually started after enough time has gone by for your surgery wound to heal, often at least 2 to 3 weeks. EBRT is usually given once a day, 5 days a week, for a set number of weeks.  Or you may go to the radiation center twice a day and get a larger dose of radiation over a shorter period of time. You will need to go to the radiation clinic every day for treatment.

Radiation treatment is a lot like getting an X-ray, but the radiation is stronger. The radiation comes from a large machine. The machine doesn't touch you during the Breast Cancer Specialist in India. The treatments don't hurt and they are quick. The whole process will likely take less than an hour.

Things like lotion, powder, and deodorant can interfere with EBRT. You may be asked not to use them until after treatment.

On the day of treatment, you are carefully put into the right position. If you need to lie in an awkward position, the radiologist may make a mold of your body, which can be used to support you and keep you from moving during treatment. You may see lights from the machine lined up with the marks on your skin. These help the therapist know you are in the right position. The therapist will leave the room while the machine sends radiation to your tumor. During this time, he or she can see you, hear you, and talk to you. When the machine sends radiation to your tumor, you will need to be very still, but you do not have to hold your breath.

The radiation oncologist and the radiation therapist will carefully monitor the intensity and length of each radiation treatment. They will also check the area that is being treated. You will get regular physical exams and blood tests during the course of your treatments.

What to expect during internal radiation therapy

For internal radiation therapy, the radiation is directed from inside the body. The radiation therapist places small thin hollow tube called a catheter directly into the Breast Cancer where the tumor used to be. Radioactive seeds or pellets are then put into the catheter for short periods of time each day. They are then removed when the treatment is over. Internal radiation may be done along with or instead of EBRT. 

Top Cancer Treatment in India

Cancer Treatment in India

Lifestyle and Cancer

Cancer by Choice

Dr Kundan Singh Chufal Senior Consultant Oncology Batra Hospital, New Delhi

Understanding Cancer

Cancer is a large group of diseases (over 200) characterized by uncontrolled growth and spread of abnormal cells.

1.    Cancer cells:

Lose control over growth and multiplication

Do not self-destruct when they become worn out or damaged

Crowd out healthy cells

Early Warning Signs of Cancer

·         C - Change in bowel or bladder habits

·         A - A sore throat that does not heal

·         U - Unusual bleeding or discharge

·         T - Thickening or lump

·         I - Indigestion or difficulty swallowing

·         O - Obvious change in wart or mole

·         N - Nagging cough or hoarseness

What Causes Cancer??

·         Lifestyle

·         Environment

·         Inherited (<15%)

AICR Global Report Recommendations

·    . Be as lean as possible without becoming underweight.

·    2. Be physically active for at least 30 minutes every day.

·    3. Avoid sugary drinks. Limit consumption of energy-dense foods. à due to correlation with obesity

·    4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.

·    5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats. à 11 – 18 oz. per week max

·    . If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day. à 12 oz. beer, 5 Oz wine, 1.5 Oz spirits

·    7. Limit consumption of salty foods and foods processed with salt (sodium).à stomach cancer (also moldy foods due to liver cancer in developing countries)

·    8. Don’t use supplements to protect against cancer.

·    9. It is best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods. à reduce breast cancer in mom and obesity in child

·    10. After treatment, cancer survivors should follow the recommendations for cancer prevention

West ————— India

 Watch Your Weight

·         Research shows that fat cells can act as "hormone pumps," secreting hormones and other growth factors into the bloodstream.

·         If the body's cells are exposed to very high levels of these substances over an extended period, they tend to reproduce more quickly à ? Increase cancer cell growth.

·         Researchers stress that this potentially dangerous condition is reversible!

Physical Activity

·         New Guidelines

·            Minimum 150 min moderate, or 75 min vigorous to reduce risk of chronic disease

·         Ideally aim for more – and necessary if weight loss and maintenance of loss is the goal – 300 min of moderate or 150 minutes of vigorous.

·         Physical activity linked to lower risk of breast, prostate and colorectal cancer

Beyond weight control, fruits and vegetables may exert a protective effect:

Phytonutrients: Prevention in a Plant

·         How do they work?

·         Stimulate enzymes that help the body detoxify

·         Reduce the genetic damage from cancer causing agents

·         May interfere with growth and multiplication of cancer cells

·         Decrease inflammation

If It Stains Your Shirt…

If a fruit or vegetable has a strong smell or taste, it’s probablybiomedically active If it stains your shirt, it’s definitely biomedically active!

Antioxidants

Vitamin A, C, E, Selenium, phytonutrients from plants

Help prevent damage to cells from the attack of free radicals

“But I take antioxidant supplements in pill form, so I’m getting all the antioxidant benefits that way, right?”

Food First …….

Phytonutrients work together to provide a synergistic benefit

Sugar and Cancer – It’s not that simple…..

·         Sugar does not FEED cancer ·         Chronic, excess intake of simple sugar leads to excess production of hormones like insulin, IGF that encourage cellular growth

Insulin and Cancer

·           Excess insulin can promote tumor cell growth

·           Behaviors that increase insulin levels

o    Consumption of refined sugar and flour

o    Overeating

o    Weight gain

o    Sedentary lifestyle

o    Behaviour that reduces insulin levels

o    Physical activity, weight loss, unrefined carbs

o    Lower fasting insulin level at time of Breast cancer   diagnosis is associated with improved survival. 

Mulligan et al. Breast Cancer Res Treat. 2007 Jan 13

Donut vs Orange: It is not necessary to avoid fruit!

·         10 grams sugar ·         0 grams fiber ·         0 phytonutrients

·         62 calories ·         12 grams’ sugar ·         3 grams’ fiber ·         170 phytonutrients

Another reason to mute post-prandial glucose/insulin response!

·         Include fat, protein and fiber with carbohydrates

o   Process sugar more slowly

o   Less insulin released

·         Glycaemic Index: number representing insulin response by body to a particular food

Summary

·         Sugar does “feed” cancer cells – but no differently than it “feeds” the rest of the body’s cells

·         Choose healthier carbohydrate foods

o   Unprocessed/minimally processed

o   Fruits, Vegetables, whole grains

·         Combine foods at meals and

§  snacks

o   Fat and/or protein with

§  carbohydrates

Dietary Fat and Cancer

·         Issue has been raised in colorectal, Breast, pancreatic, prostate cancer, and possibly others

·         AICR Global found no “probable or convincing” connection between cancer and total fat intake (only “limited/suggestive” with post-menopausal breast cancer and lung cancer à weak)

·         Concern in primarily with saturated fat, but it’s hard to tease out what’s a dietary fat effect, calorie effect, affect on weight influence, tied to the source of fat (i.e. high intakes of red and processed meats). 

§  Bottom Line: Encourage Mono’s and Omega 3’s; limit

§  Saturatedand trans fats; portion control

Healthy Eating Plate

·      Aim for ½ plate of plants (preferably vegetables) at lunch and dinner ·      ¼ of plate as lean protein ·      ¼ of plate of complex carbohydrate

Dietary Supplements That May Help Cancer Survivors

·           Vitamin D ·           Omega-3’s ·           Probiotics and calcium (based on individual circumstances)

24,000 Dietary Supplements marketed to Cancer Survivors!

Vitamin D and Cancer
	·         Inverse relationship between Vitamin D and several types of cancer o   Possible anti-angiogenesis and helps keep cell replication normal ·         Goal of serum 25(OH) vitamin D level is > 40 ng/ml. ·         Supplementation is likely necessary. o   1000 IU/day is safe for most people; many need more.
Intake/Exposure ·         Sun Exposure (arms/legs 10-15 min) ·         Fortified Multi-vitamin ·         Fortified Milk ·         3.5oz salmon (fresh, wild) ·         3.5oz salmon (fresh, farmed)	Amount of Vitamin D ▪  3000 – 20,000 IU ▪  400 IU ▪  100 IU ▪  600-1000 IU ▪  100-250 IU

·             Link first hypothesized in 1980s

o   Rate of colon cancer 3x higher in New York than New Mexico

o   Lower exposure to natural light in large cities and areas at higher latitude

o   Research has been mostly observational, few clinical trials

o   “…Vitamin D levels in the blood vary by race, with the season, and possibly with the activity of genes whose products are involved in vitamin D transport and metabolism. These variations complicate the interpretation of studies that measure the concentration of vitamin D in serum at a single point in time.” - OCCAM

Alcohol

Limit alcohol intake < 1 drink/day for women < 2 drinks/day for men Women who consume 1 drink or more/day have an increased risk of breast cancer (10-40% increased risk) Adequate folate intake (400mcg/d) may reduce the increased risk of breast cancer Treatment In India associated with alcohol use

Breast Cancer Treatment in India

Breast Cancer Treatment in India

Breast Cancer Treatment in The World

Breast Cancer Treatment in India
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

Mortality Trends

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)

Mammography In India

Best Breast Cancer Surgeon in India

 

Breast Cancer Treatment in India  

                          

Breast Specialist Doctor in India

Mammography Equipment

Mammography

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

SCREENING MAMMOGRAPHY

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
a. craniocaudal
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
b. Masses
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


Maligent Begins
Ultrasound Screening

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

Screening Guidelines

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.