Importance of maintaining a pain diary in Breast Pain

Breast pain (or mastalgia) is common problem faced by women at least once during their lifetime. It can range from mild pain to a chronic debilitating condition, which can even push a patient to the verge of depression. In fact, in the last one month, I have encountered two such patients, who have stopped socializing because of excruciating breast pain.

Mastalgia has varied causes and it can broadly be divided into cyclical & non cyclical causes. Cyclical mastalgia (breast pain) usually occurs because of hormonal fluctuations and the intensity of pain varies according to the menstrual cycle. On the other hand non-cyclical mastalgia usually occurs because of musculo-skeletal causes and the pain persists all throughout the month.

For the correct diagnosis and management of breast pain, it is important for the doctor to know certain points regarding the pain like:

  1. duration of pain
  2. location – restricted to one point or spread over the entire breast
  3. intensity of pain
  4. fluctuation in intensity of pain over a few days
  5. Radiation of the pain – is the pain running to some other site from the breast
  6. Is there a lump associated with the pain? Usually breast cancer does not lead to pain in the initial phases
  7. what makes the pain better
  8. what makes the pain worse

 

These facts along with clinical examination and an ultrasound/ mammography help the doctor in determining the cause of breast pain. The above mentioned points can easily be maintained in a “pain diary”, which is something which I ask all my patients to maintain.

Following is a format which I hand over to them and ask them to maintain it regularly for a period of 30-40 days.

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This information helps me in:

  • Assessing the cause of pain
  • Judging the response to therapy

So the next time you visit your doctor with complaints of breast pain, make sure you maintain a ‘pain diary’, so that your treatment can proceed smoothly.

 

Article by:

Dr. Rohan Khandelwal

Consultant, Department of Breast Diseases & Cancer Care

W- Pratiksha Hospital, Gurgaon

 

How to interpret an ER/PR report in Breast Cancer

All human cells have some receptors present on their surface. Normal human breast cells respond to the female hormones i.e. estrogen & progesterone, therefore they carry estrogen (ER) and progesterone receptors (PR).

Like healthy breast cells, majority of the breast cancer cells also possess ER & PR receptors. Every breast cancer is different and knowing the fact whether the breast cancer is positive for ER, PR receptors, has an important bearing on the management of the patient’s disease. If a patient’s breast cancer shows these receptors, then they can be subjected to hormonal therapy, which can control the tumor growth by blocking these receptors.

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Sometimes during the course of treatment, the breast cancer cells which are ER, PR positive initially can lose the receptors and become ER, PR negative and they stop responding hormonal therapy. Rarely, the opposite of this is true as well.

Considering this background, it is important that a lady knows how to interpret the hormone receptor status report & understand the implications in breast cancer management based on this report.

Most laboratories used a special method to stain these receptors known as IHC (immunohisto-chemistry). Each lab has their own way of analyzing these receptors, which is why I am covering the most commonly used methods:

  • A percentage that tells you how many cells out of 100 stain positive for hormone receptors.You will see a number between 0% (none have receptors) and 100% (all have receptors).

 

  • Allred score between 0 and 8. This system looks at what percentage of cells test positive for hormone receptors along with the intensity of staining. This information is then combined to score the sample on a scale from 0 to 8. The higher the score, the more receptors were found and the easier they were to see in the sample.

 

  • Positive or negative report

 

Different labs have different cutoff points for calling the cancer either positive or negative. For example, if less than 10% of your cells — or fewer than 1 in 10 — stain positive, one lab might call this a negative result. Another lab might consider this positive, even though it is a low result. Some studies have shown that even cancers with low numbers of hormone receptors may respond to hormonal therapy. A score of “0” means that the patient is hormone receptor negative and will not benefit from hormonal therapy.

Some points to remember

Once the report is declared, your oncologist with discuss your hormone receptor report with you and these are some points, which will help you in understanding your report:

  • ER+/PR+:Majority (65%) of the Breast cancers are ER, PR positive and these patients are candidates for hormonal therapy.
  • ER positive but PR negative OR ER negative but PR positive:Around 10-13% patients fall in these two categories. Despite one of the receptors being negative, these patients are still candidates for hormonal therapy.
  • ER-/PR-:Around 20% patients fall in this category and they are not considered to be candidates for hormonal therapy.

 

If your test result is positive for ER/ PR, you should discuss the role of hormonal therapy with your oncologists. Hormonal therapy helps in preventing the recurrence of disease in patients with localized breast cancer whereas it keeps the tumor growth under control in patients with metastatic breast carcinoma.

 

Article by:

Dr. Rohan Khandelwal

Consultant, Breast Onco-Surgeon

W Pratiksha Hospital,

Gurgaon, India

Girl Power 

Proud of you #SakshiMalik. The six minutes in the ring were just a small part of the fight, which started right from birth in a state where the incidence of female foeticide is extremely high and a girl child is looked down upon. Your grit and determination to overcome all odds and win this medal is really commendable. Hats off to you! #SaveTheGirlChild

From scratch to becoming one of the top 100 Oncology blogs in the world

After a hectic day of work in Bangalore, I was having a casual discussion with Dr. Sumer Sethi, who is one of the most influential doctors on the internet & a great motivator. During our discussion, he encouraged me to start writing a blog about my experiences as a Breast Surgeon. Breast Surgery was a relatively new branch at that time and Dr. Sethi was of the opinion that a blog would be a great medium to create awareness about Breast Cancer & my experiences as a Surgeon. That is when ‘Random Reflections of a Breast Surgeon‘ was born.

Initially, it was quite difficult for me to take out time to write blogs but gradually it became a habit and I started enjoying it. In due course of time, the blog became really popular among patients suffering from Breast diseases and medical students aspiring to become surgeons.

Every now and then, encouraging messages from patients, well-wishers and students have motivated me to keep on pushing the boundaries of my blog. The latest recognition by Feedspot of nominating my blog as one of the Top 100 Oncology Blogs in the World has just strengthened my resolve to continue spreading my experiences with the world.

In the last few months, I have started encouraging patients/ students/ doctors to share their experiences on my blog and if anyone is interested in highlighting their work, you can email it to me on rohankhandelwal@gmail.com. Also for patients, I have also launched by new website – http://www.breasthealth.in , which provides details about all Breast Diseases & their management.

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Breastfeeding – a simple way to keep breast cancer at bay!

Breastfeeding has been known to reduce the risk of breast cancer and this effect is more pronounced in pre-menopausal women.

In an analysis of 47 studies, mothers who breastfed for a total duration of more than one year (all pregnancies combined) had a lower chance of developing breast cancer as compared to those who never breastfed.

Mothers who breastfed for more than two years got about twice the benefit as compared to those who breastfed only for one year.

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Better half of a Breast Cancer Patient

Family has a huge role to play in supporting a breast cancer patient during her treatment and the most important member is the patient’s husband. My views regarding the role of a Breast Cancer Husband were recently highlighted in Health Spectrum Magazine.

 

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As a Breast Cancer surgeon, I have seen a dramatic shift (towards good) in the family’s attitude towards Breast Cancer. In my initial years of training/ practice, I had encountered patients, who were deserted by their husbands after the diagnosis.

Nowadays, the scenario is quite different. I see husbands accompanying their wives for all their hospital visits and chemotherapy sessions. This is definitely helping patients cope with their disease in a better manner and I am hoping this trend continues in the future.

Endopredict vs Oncotype Dx for Breast Cancer

A new test, called EndoPredict, can predict the risk of a woman’s breast cancer spreading within 10 years of diagnosis more accurately than the current Oncotype Dx test. Also, research found that the results can be made available more quickly.
 
A study, published in the Journal of the National Cancer Institute, compared EndoPredict with Oncotype DX. Both tests can predict whether breast cancer will spread in women with oestrogen receptor positive, HER2 negative (ER+/HER2-) disease. This is a sub-type of breast cancer that accounts for about two-thirds of all cases.
 
The new EndoPredict test analyses eight different genes found in a sample of a patient’s tumour. This information, as well as the size of the patient’s tumour and their nodal status – whether the cancer has spread from the breast to their lymph nodes – are then used to determine the patient’s risk of their breast cancer spreading in the next 10 years.
 
An ‘EPclin’ score categorises patients into low- and high-risk groups. Patients placed in the high-risk group would be recommended to have chemotherapy, but those in the low-risk group could be spared this treatment – and the debilitating side effects associated with it.
 
In the study it was found that EndoPredict was more accurate and the results were available faster as compared to the conventional Oncotype Dx test.
 
Points to remember:
1. EndoPredict is meant for early breast cancers which are ER, PR positive (same as Oncotype Dx)
2. It analyses 8 genes as compared to 21 in Onctoype Dx