Changing trend of Breast Cancer incidence in India

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Breast Cancer and the age wise distribution in India

This graph depicts the changing trend in the age wise distribution of breast cancer in our country. Over the years, the incidence of breast cancer has increases dramatically and there has been a higher increase in the incidence between 30-40 years of age. This is mainly attributable to the lifestyle changes visible in the Indian society. Another major factor, which is difficult to quantify is the increase in pollution levels.
It is important we realise this change and encourage patients to take corrective measure to control the modifiable risk factors like smoking, alcohol consumption, obesity. Also increased awareness is required, so that these cancers can be detected early.

What is the colour of a doctor’s money??

It can be anything but black! It is basically made of two layers of sodium chloride. The first layer was prepared by the sweat of the medical school. The second was formed slowly after obtaining the so called degree. The denomination of this money is determined by the degree one obtains, slogging it out in a rat race, sometimes also missing out on how their kids grow up. If you are on the surgical side, it has some blood red patches here and there. A physicians’ money may have grey (matter) color sprinkled about. A colleague working in anesthesiology, intervention cardiology or emegency medicine have it soaked in adrenaline. There might be a few dots of yellow on some money. Believe me, no pathologist spills the sample intentionally! Also don’t blame any body if E. Coli grows on some money. So, my friends, a doctor’s money can never be black. And the most amazing thing is that he can keep it minting till Alzeihmer’s or Parkinson’s!

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Post shared from Dr. Deepak Arora – a motivational speaker and a dear friend.

 

 

Unique case of multiple ductal papillomatosis

31 year old  nulliparous lady presented with serous nipple discharge from right breast since 3 months. She had no co-morbid conditions and no family history of cancer.

o/e – she had serous nipple discharge from 3-4 ducts (3,8,10 o clock). There were no palpable lumps in either of the breasts or axillae.

Nipple discharge cytology as negative for malignancy

On USG a very interesting finding was observed – there were ductal papillomas seen in ducts present at 3,8 and 10 ‘o clock position and the 3’o clock duct showed multiple ductal papillomas (3 can be seen in the USG image)

 

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Considering the age of the patient, a decision was taken to carry out three microdochectomies and the HPE revealed benign papillomas in all ducts.

 

Reasons for highlighting this case:

  1. Ductal papillomas are the most common cause of bloody nipple discharge and they arise from the terminal duct lobular units. This patient presented with serous nipple discharge.
  2. Usually ductal papillomas are solitary. Only 10% of intra-ductal papillomas tend to be multiple. This patient had at least 4 papillomas on final HPE.
  3. Multiple papillomatosis are more frequently associated with hyperplasia, atypia, DCIS, sclerosing adenosis, and radial scar but in this case none of the findings were present.

 

 

 

Case by:

Dr. Rohan Khandelwal & Dr. Savita Chopra

Department of Breast Diseases & Cancer Care

W Pratiksha Hospital, Gurgaon

 

 

Excellent video to create Breast Cancer Awareness

One of my patient recently sent me this video created by Sunny Leone to spread Breast Cancer awareness and I feel it is an excellent initiative taken by her against this deadly disease, whose incidence is rapidly rising in our country.

 

 

I personally feel that celebrities have a huge role to play in creating awareness regarding health issues like cancer and more and more should come forward with initiatives like these.

 

 

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.

 

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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