www.breasthealth.in.W Pratiksha Hospital provide the best cancer treatment in Delhi NCR.

1. Breast Cancer
Dr. Rohan
Khandelwal
MS, MRCS (Edin.), FIBD
Previously at University of
Maryland
Consultant – Breast Onco-
Surgeon
Department of Breast
Diseases
W Pratiksha Hospital
Gurgaon

2. Welcome to the
World of
Women’s Well-
being

3. • Latest ICMR Data
– Breast cancer is
the most common
cancer among
Indian women
• Affects one in 21
Indian women
during their
lifetime
• By 2025, one in 8
will be affected
(Western figures)
BURDEN OF BREAST CANCER IN INDIA

5. • Age – incidence increases with age
• Family History (more family members affected –
more the risk)
• Genetic Mutations (BRCA)
• Early Menarche (early menarche <12 years)
• Late Menopause
• Increased breast density
NON MODIFIABLE RISK FACTORS

6. Testing for BRCA Mutations: Recommendations
• Relatives of a patient with known deleterious BRCA
mutations
• Non-Ashkenazi Jewish women should be tested if one of
the following risk factors is present:
1. Two first-degree relatives with breast cancer, one of
whom was diagnosed before 50 years of age
2. At least two first- or second-degree relatives with breast
cancer or ovarian cancer, regardless of age at diagnosis
3. A combination of breast and ovarian cancers among
first- and second-degree relatives
4. A first-degree relative with bilateral breast cancer
5. A male relative with a history of breast cancer
BRCA TESTING – ANGELINA JOLIE EFFECT

7. • Obesity (lack of physical activity; fatty food)
• Smoking
• Alcohol consumption
• Hormone replacement therapy
• Age at first live birth
MODIFIABLE RISK FACTORS

8. Symptoms

9. • Not all lumps are malignant
• Fibroadenoma - most common
cause of a breast lump
• Rarely – fibroadenomas can be
associated with malignancy
• Usually malignant lumps -
painless in the initial stages
• But malignancy should be ruled
out in patients with breast pain
UNUSUAL FACTS!!

10. METHODS FOR EARLY DETECTION
• Breast Self Examination (BSE)
• Clinical Examination by Breast Surgeon
• Screening Mammography

11. BREAST SELF EXAMINATION
• Opportunity for woman to become
familiar with her breasts
• Monthly exam of the breasts and
underarm area
• May discover any early changes
• Begin at age 20, continue monthly

12. WHEN TO DO BSE
• Menstruating women- 5 to 7 days after the beginning of their period
• Menopausal women - same date each month
• Pregnant women – same date each month
• Takes about 10 minutes
• Perform BSE at least once a month
• Examine all breast tissue & underarm area

14. CLINICAL EXAMINATION
• Performed by an experienced breast surgeon
• Annually for women over 35 years of age
• At least every 3 years for women between 20 and 35 years of
age
• More frequent examination for high risk patients

15. SCREENING MAMMOGRAPHY
• X-ray of the breast
• Has led to a 30%
reduction in deaths due to
breast cancer
• Helps in early diagnosis
• Normal mammogram does
not rule out possibility of
cancer completely

16. SCREENING MAMMOGRAPHY
Women (asymptomatic) 40 years of age
and older should have a mammogram
every year

17. BENEFITS OF SCREENING
6/13/2016 Presentation Title Slide: 17

18. BREAST CANCER SCREENING METHODS
FOR HEALTHY WOMEN
1. Breast Self Exam — Status
• Guiding principal “Know your breasts — they are
not land mines”
2. Clinical Breast Exam
• Age 20-35: every 3 years
• Age after 35: every year
3. Mammography
• Age after 40: every year

19. Triple
Assessment
History &
Clinical
Examination by
a Breast
Surgeon
Imaging
<40 years
Ultrasound
>40 years
Mammogram
Biopsy/ FNAC
IF LUMP IS DETECTED
13-06-2016 19

20. Management
Surgery
Breast
Conservation
Surgery
Mastectomy
with or without
reconstruction
Chemotherap
y
Radiotherapy
Hormonal
Therapy
BREAST CANCER MANAGEMENT
6/13/2016 Presentation Title Slide: 20

21. • Most breast cancers run in families
• There is nothing you can do to lower your risk of developing breast cancer
• Bras cause breast cancer
• Regular mammograms prevent breast cancer
• Antiperspirants cause breast cancer
• Most breast lumps are cancerous
• Oral contraceptive pills increase the risk of cancer
BREAST CANCER – MYTHS
6/13/2016 Presentation Title Slide: 21

22. TIPS FOR RISK REDUCTION & EARLY DETECTION
1. Regular exercise - at least 30 mins of
exercise 4 times a week
2. Avoid smoking
3. Avoid alcohol consumption
4. Maintain your weight in the normal range
5. Be breast aware - do regular self
examinations
6. Clinical breast examination by an
experienced breast surgeon after the age
of 35 years (annually)
7. Regular mammograms after 40 years of
age
8. If family history of breast cancer is
present, consult your oncologist to
discuss your risk
3

23. 13 June 2016
THANK YOU !