Is your waist putting you at risk of Breast Cancer?

Since last decade breast cancer has been on a steady rise in India. It is now the most common cancer in many cities and 2nd common cancer in rural areas, accounting to 25% of all female malignancies. Increased incidence of breast carcinoma has been attributed to a variety of factors including obesity, decreased breastfeeding, alcohol consumption and smoking etc.


Though obesity has been long associated with the prevalence of breast cancer, it has traditionally been measured in BMI, ie the average distribution of fat all through the body. What BMI fails to do is to identify where the fat is actually accumulating.


According to a study published in BMJ, a woman’s waist size is a better predictor of breast cancer than BMI. The fat tissue around waist though more metabolically active, increases the production of estrogen in the body which accelerates the growth of breast tumor.


What does the research say?

Researchers from UCL University college, London studied 98,324 women of >50 postmenopausal age who had no history of breast cancer. These women were made to fill questionnaires detailing their history of health, height, weight, lifestyle and also their skirt sizes. The participants were followed up subsequently over years and their health, lifestyle and skirt sizes were documented. During the follow up 1090 women developed breast cancer.


The result showed that “Between 25 and postmenopausal age, an increase in Skirt Size by one unit every decade increased the risk of postmenopausal breast cancer by 33% while decrease in Skirt Size was associated with lowering of risk.”


The Impact

Expanding waist has been associated with other forms of cancer in the past including that of pancreas, prostate, ovaries and cervix. It’s no surprise that the belly fat also plays a role in breast cancer.  But this result showed that the increase in skirt size, independent of BMI, increased the risk of breast cancer and that fat accumulated around waist is more dangerous than fat accumulated on other parts of the body.


This visceral fat can do more harm to a person’s body than the subcutaneous fat. Causing increased levels of estrogen, insulin resistance and fatty liver.


The Implication

Increase in waist size can be linked with the sedentary lifestyle and unhealthy food habits of this generation. With obesity emerging as a global epidemic, women now have a simple method to check their health and take action against it. Instead of going through the hassle of measuring their weight and height to measure their BMI, women can just measure the size of their waist.


With the discovery of this association between waist size and breast health, women now have the power to change the course of their health. They not only have to be made aware of the importance of their breast health but also informed that they can now take charge of their health and change the course of it.




The Intervention

The only way to reduce belly fat is by doing regular exercise and burning it off. Regular exercising not only reduces the risk of breast cancer but also of other cardiovascular diseases. 30 mins of exercise 3-4 days a week is what is recommended for women.


By simple interventions like regular exercising, abstaining from alcohol and smoking and maintaining a healthy weight a woman can reduce her breast cancer risk by 20%-30%.


Wire Guided Localisation of Non Palpable Breast Lesions

With the increase in opportunistic screening of Breast Cancer in India, more and more impalpable breast lesions are being detected. Wire guided localisation is one method to surgically deal with these lesions.

This video highlights the operative steps of wire guided localization and also the use of a specimen mammogram.


Dr. Rohan Khandelwal

Consultant, Breast Onco-surgeon

W Pratiksha Hospital

Breast Cancer Conquerors

Breast cancer treatment is a long drawn battle for the patient and her family and it is always a joyous moment when they finish their breast cancer treatment.




This special day when they finish their treatment, marks an important phase, when they transition from being a patient to a cancer conqueror/ survivor. In India, despite so many myths surrounding cancer treatment, it is good to see some ladies determined to fight the disease despite all odds. Hats off to their fighting spirit!!



Mondor’s Disease

Mondor’s Disease
1. Type of superficial thrombophlebitis (inflammation of the veins_  which involves the veins of the anterior chest wall & breast
2. Presents like a painful, cord like structure just below the breast (image)
3. Most commonly involved vein is the lateral thoracic vein. Other veins involved are – thoraco-epigastric & rarely superficial epigastric
4. Clinical features – pain along the lateral chest wall and below the breast. Patients may also complain of a cord like structure. Some patients present with just breast pain and the cord is detected by the breast surgeon
5. Benign, non cancerous lesion, which is self-limiting
6. Management – Consult a breast surgeon and get imaging done to rule out any other breast lump.
7. Treatment involves warm compresses and anti-inflammatory medicines. It usually resolves in 4-6 weeks. 
Pic Courtesy:

Why do we need a Mentor?

Years ago a school teacher saw a child playing games in the bushes. The child was no extraordinary, he was a simple child, playing games that kids of his age did. But it was that teacher who recognised the extraordinary and nurtured him to become one of the greatest Kings this land ever saw. It was the under the mentor ship of Chanakya that Chandragupta Maurya was able to establish the Kingdom of Magadha. Without the mentor, the king would have been nothing.

A mentor is a term derived from an old Greek legend in which a king who was heading for a war had to leave his son in the care of his very close friend, instead of leaving him to his wife and Mentor grew up to be a very wise and noble king.

You don’t need a mentor to gain knowledge. You have books and online sources for that. You need a mentor to learn the practical details and proper implementation of knowledge. These intricacies and working knowledge can only and only be taught by a guru or a mentor.

So why do we need a Mentor?
1) Recognising and achieving your potential: Had it not been for Chanakya, Chandragupta would have never realised his potential as a king. It was only after his mentor recognised his true potential, he became what he was. Similarly in life we can achieve what we want by perseverance and hard work, but we need a mentor to know our potential and bring out the best in us.

2) They know the right doors:
Dipa Karmakar made our country proud with her Produnova vault, had it not been for her mentor she would have never known what a Produnova vault is and the intricacies of landing it. She had the talent, but it was her mentor who shaped it and guided her on the path to reach the Olympics.
A teacher knows whats important and what are the shenanigans. They can show you correct ways and the right doors. This makes our journey to success more efficient and easy.

3) Use their pool of experience:
Your mentor knows more than you. They have been around longer and have seen things that you have’t. This means their experiences can tell you the mistakes that have been committed before and guide you towards the correct direction. Our life is too short to make all the mistakes ourselves and learn, it’s better to learn from the past and make a better future. They have walked the walk that you are walking, learn from them.

In the end I would like to quote the famous couplets by Kabir,
Guru govind dono khade, kaake lagu paaye. Balihari guru aapno, govind diyo bataye
“Teacher and Lord are both there, whom to be adore. but teacher you are great, who told us that god is greater”

DEAD POETS SOCIETY, Robin Williams, 1989

Image Source:

This article was written in collaboration with Dr Prerna Motwani, Medical Content Manager, Curofy- India’s largest community of verified doctors and Dr Rohan Khandelwal.

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.

Screen Shot 2016-08-29 at 1.46.01 pm


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