Breast Cancer Myth Busted – Biopsy doesn’t lead to spread of tumor

A common problem that I face during my practice is that some patients refuse to get biopsies done when they are detected with a breast lump. The reason behind this misconception is that they feel that the cancer will start to spread after the biopsy.

Patients need to be explained that this is a myth and there is no scientific data to support this misconception. Also patients need to understand that it is not possible for doctors to come to a diagnosis of breast cancer, unless a biopsy is performed.

 

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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.

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.

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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!!

 

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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

8 simple tips to reduce your risk of developing breast cancer and aid in early detection

Recent data has indicated that breast cancer is the now the most common cancer among Indian women. One in 22 Indian women will be affected from this cancer during their lifetime. A healthy lifestyle can help in reducing one’s risk of getting this disease.
I am sharing 8 simple tips, which can help in reducing your risk of developing this disease and also help in early detection.
1. Regular exercise – at least 30 mins of exercise 4 times a week
2. Avoid smoking
3. Avoid alcohol consumption
4. Over-weight and obese individuals have a higher incidence of breast cancer. 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. Although they just take 10 mins, ladies often decide to skip them. The simplest way to remember this is to ‘gift yourself a mammogram’ on your birthday.
8. If there is a family history of breast cancer, do consult your oncologist to discuss your risk of breast cancer.
#BreastCancer #WorldCancerDay #Cancer
breastcancer
Consultant, Breast Onco-Surgeon
Gurgaon, India