Exponential increased incidence of breast cancer has put breast cancer as most common cancer in women in urban India and second most common in rural one. It has been most common cancer in women in the world. One in every 20 women poses a risk of developing breast cancer. Five-year survival rate being 60 %, one in every second woman diagnosed of
breast cancer dies because of disease in Urban India like Mumbai.

We are still unaware what exactly causes it, but we now do know the risk factors which potentiates its incidence. To enumerate few among various risk factors are smoking, alcoholism, obesity, late first child, no pregnancies, certain oral contraceptive pills, hormonal replacement therapy and vid D deficiency etc Unlike the belief ,only less than 10 % are hereditary.

The trends and traits are changing in our society for this disease. It’s common in relatively younger women, common age of presentation is late thirties. Aggressive subtypes like Triple negative or HER-2 enriched are more common in our population. Our patients present in relatively late stage. These are probably few of the reasons among many why we are
witnessing poor overall survival as compared to western standards.

Screening investigations are the one which are carried on normal healthy people regularly to detect abnormality before their symptoms. Mammography is the answer to effective screening in Breast Cancer. Its to be carried out once in a every year and half from the age of 40yrs onwards to detect any potential lesions in breast. We don’t have universal screening program in our country due to many resource constraining factors. Its one of main reason why we miss many cases in its early stages. Breast cancer is completely curable when detected early and treated properly on time. Regular Breast Self Examination (BSE) and screening mammography is a key to detect it in early stage. More sophisticated investigations like 3d tomosynthesis, contrast enhanced mammography, ABVS MRI is helping us to detect smallest lesion in even dense breast.

Void of knowledge, inaccessible imaging centers, negligence to your own-self, fear and prejudice of getting detected with cancer, social limitations in male dominated society plays vital role in keeping our women away from screening. There is a real need to change ourselves and our society. Healthier you can lead to healthier families.

Once diagnosed, patients need to be treated with various modalities of treatment. Surgery being the foremost and obligatory modality. It’s not often necessary to sacrifice your breast once diagnosed of cancer. Now, breast can be conserved in majority of cases with utmost oncological safety. With new approaches like neoadjuvant chemotherapy, even locally
advanced tumor can be downsized and offered conservation. We can maintain shape, size, volume and symmetry of your conserved breast even after cancer resection by various oncoplastic techniques by using local tissue transfers and remodeling. When there is no option but complete mastectomy, the various options of immediate whole breast reconstruction can give you your lost breast. Whole breast can be reconstructed either by using implants or your own body tissue.

The tissue as a free microvascular or pedicelled flap is harvested from your other body part especially from the area where there is excess fat deposition /excess bulk. It gives you not only your new Breast but also helps to beautify the body image by contouring donor site. The procedure often is chosen by various factors like desired breast volume, body habitus,
addiction like smoking, comorbidities like diabetes, heart disease and obesity.

Whole breast can be reconstructed as a secondary reconstruction even after completion of your entire cancer therapy like cancer resection, chemotherapy and radiotherapy. Nipple reconstruction, tattooing and fat grafting are some of the techniques to achieve final contouring and utmost cosmesis.

Large ptotic breasts can be reduced to a desired size and shape symmetrically during cancer surgery by reduction mammoplasties.

Sentinel Lymph Node biopsy has given us a ‘magic hond ‘to identify those who really require axillary (armpit) clearance and those who don’t. Thus we can avoid unnecessary axillary clearance and hence its unavoidable morbidity like upper arm edema (swelling of upper limb due to accumulated lymph), lifelong shoulder discomfort. Seroma (collection of
fluid in the armpit cavity) etc.

Ten percent breast cancers are hereditary. BRCA1 /2 are the commonest genes to harbor mutations. The lifetime risk of getting cancer is almost 80% in these mutations. It is important to identify these high risk families. Those who have diagnosed of breast cancer at age less than 45 yrs, all male breast cancers, all ovarian cancers need to be tested for genetic alterations. It needs thorough annual screening with MRI, starting early from age of 25yrs. Prophylactic bilateral mastectomy serves primary prevention in these cases. The risk of cancer can be reduced by almost 90%. By mastectomy and by 50 % by salpingo-ophorectomy at right age. What can be more traumatic mentally to get detected by genetic mutation and losing both breast as a prevention? But immediate whole breast reconstruction can give you your lost look and beauty.

Surgery often needs to be supported by various combinations of chemotherapy, radiotherapy, hormonal therapy, targeted therapy. It depends upon subtype of cancer, stage of disease and patient’s overall general health. It’s always a tailormade approach. Many can avoid these therapies safely and avoid untoward toxicities.

To sum up, Breast cancer is curable not only when detected early but also in advanced stages with proper and timely treatment. Breast cancer doesn’t mean losing life nor even Breast. You can maintain your womanhood and dignity. You can be more beautiful even after Breast Cancer Therapy.

Dr Tushar Jadhav
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