breast cancer

DR.ANANDA SELVAKUMAR. MD CONSULTANT RADIATION ONCOLOGIST MEENAKSHI MISSION HOSPITAL & RESEARCH CENTRE

Breast cancer became the commonest among urban scenario…becoming common in the rural areas too.(Lifestyle changes…?)

According to ICMR statistics nearly one lakh breast cancers being diagnosed in india every year. More than 70% of them are diagnosed in advanced stage.

In India……..

In India……..

One out of every 22 Indian women is likely to get breast cancer during her lifetime.

One Indian woman succumbs to breast cancer every ten minutes.

In India…….

Breast cancer is becoming more common in younger women, with almost 50% of patients being women under 50.

Younger women are showing an increased incidence of HER2+, a particularly aggressive form of breast cancer.

Sorry to say……..

Being a women itself a high risk factor to get BREAST CANCER.

Smoking kills…

Don’t worry guys…..We are on top in LUNG CANCER.

One step forward and two steps back….?

Treatment of breast cancer has changed all over the world in all their aspects. ( surgery, radiation therapy, chemotherapy hormonal therapy & targeted therapy).

Although the western countries are having higher incidence than ours…..we are on the top in mortality rates.

The reason

Shall we move on…?

Any GOOD NEWS….????

Care for cure

Early detection is the only prevention.

Risk Factors

Modifiable risk factorsa. Exercise.b. Low fat diet.c. Avoiding alcohol consumption.d. Avoiding hormonal replacement

therapy.

Risk Factors

Non modifiable risk factors

a. Sex and Increasing age.b. Genetic predisposition.c. Strong family history.d. Early menarche & Late menopause.e. Nulliparity.f. Age at first child birth.

Do or Die….?

Normal Risk :a. Age 20 to 40 years - Clinical breast

examination (every 1-3 years) and breast awareness.

b. >40 years - Annual Mammogram, annual clinical examination and breast awareness.

Do or Die….?

High risk : (Positive family history or Genetic predisposition…etc)

a. Frequent clinical examination (every 6 – 12 months).

b. Annual mammogram.c. Breast awareness.

Breast awareness…???

Women should be familiar with their breasts and they should report to their physician , if they are getting any changes in it.

Periodic breast self examination (BSE) should cover inspection and palpation of both breast, axillas and lower neck in various postures (erect, supine and bending forward).

Breast awareness…???

Pre-menopausal women may find BSE more informative in immediate post menstrual period ( Breast will feel soft and non tender ).

Radiation therapy

Radiation therapy :A. Neo-adjuvant?..................Yes!

B. Adjuvant?• Post mastectomy?..............Yes!• Post breast conservation?...........Yes!

C. Metastatic?......................Yes!

Even in early breast cancer?

YES………even I can do more here..!

Breast conservation

Breast conservation is one of the mile stones in the management of breast cancer.

Radiation therapy plays the pivotal role on it.

We have a very solid evidence to promote breast conservation in early breast cancer (Lumpectomy with WBI ), and the results are equal with mastectomy.

Breast conservation

Organ conservation

Radiation therapy plays a vital role in most of the organ conserving protocols like cancers of breast, head & neck, anal, bladder, prostate, esophageal, lung, cervix, extremity sarcomas, and child hood tumors like RMS.

The conformal techniques like 3D-CRT, IMRT,IGRT, & SBRT are more useful in delivering adequate dose to the tumor and lesser dose to the normal tissues.

How it works…?

Removing the tumor alone and sterilizing the remaining breast with radiation therapy is possible in all eligible early breast cancers.

Anything more…?

In a highly selected low risk patients, in spite of treating their entire breast with radiation after lumpectomy , we can treat the lumpectomy cavity with 2 cm margins…!

Bcz….most of the recurrence in this setup happens 1-2 cm in and around the lumpectomy cavity.

APBI

This technique is called accelerated partial breast irradiation.

Small volume….higher dose…..and less treatment duration is possible here.

It can be done with conformal EBRT, or HDR BRACHYTHERAPY.

Conformal 3DCRT

Brachytherapy

Breast conservation….really matters…..?

Breast conservation not only maintains the appearance, it also maintains the confidence level, & relation ships in family and working environments.

Even breast feeding is not contraindicated in a conserved breast.

Survival of the fittest

Even more powerful than mind and body is the power of the spirit, the third element for our survival.

5 year relative survival

Localized disease - 99%

Loco regional disease -84%

Metastatic disease – 23%

5 year relative survival

The 5-year relative survival rate is lower among women diagnosed with breast cancer before age 40 (84%) compared to women diagnosed at 40 years of age or older (90%).

This may be due to tumours diagnosed at younger ages being more aggressive and/or less responsive to treatment

Four in one rule - Radiation

By avoiding four loco regional recurrences in 10 years, we can avoid one breast cancer death in subsequent 15 years .

Many thanks for ur patience