The incidence of breast cancer in India is increasing at an alarming rate and more and more ladies are being detected with this disease in their 30’s and 40’s.
Breast cancer not only affects the physical appearance of the patient but also has a huge impact on their mental and psychological well being. In addition to the patient, the family also becomes part of the treatment.
Once patients finish their treatment, it is important for them to get back to their daily routine, so that they can keep their mind off the disease. Family, friends and strong support group play a huge role in this aspect of a breast cancer warrior’s journey.
To celebrate these warriors, we recently organised a support group meeting at W Pratiksha Hospital, Gurgaon, which was well attended by many breast cancer patients and their families.
A seroma is accumulation of clear fluid in the body after surgery. It is a common complication which can occur in the underarm area (axilla) after breast or axillary surgery. In fact, axillary seromas have been seen even after axillary lymph node biopsy or sentinel lymph node biopsy for breast cancer
To prevent seroma formation, surgeons insert drains after breast and axillary surgery ( both cancerous and non cancerous). Drains are usually removed once the output falls below 40 cc for two consecutive days. Early removal of drains is a common cause which can predispose to seroma formation after breast cancer surgery.
Patients usually develop fluid collections within 5-7 days after surgery and they present with pain and swelling in the axillary region. Diagnosis of a seroma can be made by your breast cancer surgeon and in case of any doubt, an axillary ultrasound can confirm the diagnosis (image)
Management of an axillary seroma is relatively simple. They can be aspirated under local anaesthesia. Patients might require 2-3 aspirations before the seroma subsides.
Sometimes fluid collections can become infected and can give rise to pus formation in the axillary region. These situations can be avoided if seromas are detected and aspirated in time.
Information provided by:
Dr. Rohan Khandelwal
Consultant, Breast Surgeon
W Pratiksha Hospital, Gurgaon
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
Image highlighting the boundaries of axillary clearance
The latest edition of eHealth Magazine highlighted my views regarding Electronic Health Records ( EHR’s). I have been regularly using EHR’s since I entered practice and I personally feel that all doctors should use it, as they simplify data collection and analysis.
Another big advantage in our country is that patients often forget or lose their medical documents. In that case EHR’s can help doctors in retrieving the patient’s medical information and treat them in a better manner.
American Cancer Society has recently revised the breast cancer screening guidelines and they were featured in the a recent article in JAMA.
The most significant change has been the age of starting mammographic screening, which has been increased from 40 to 45 years. This change has been made after taking into account the lower incidence rate of breast cancer in this age group. Another factor which led to the delay in initiating screening was the higher number of false positive mammograms observed within this age group.
- Women with an average risk for breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation).
- Women aged 45 to 54 years should be screened annually (qualified recommendation).
- Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation).
- Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation).
- Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).
- The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation)
These guidelines are quite different from those of the US Preventive Services Task Force (USPSTF) and this is a cause of concern & confusion among patients. The following table highlights the differences between the two guidelines:
|Mammography Screening Parameter
|Starting age (y)
||Annually to age 54 y, then biennially
||Biennially, beginning at age 50 y
|Stopping age (y)
||For as long as a woman is in good health and has a life expectancy of at least 10 y
|Total lifetime mammograms if screening continued to age 74 y (n)
|Lifetime risk of dying of breast cancer (%)
|Lifetime risk of dying of breast cancer with no screening is 2.7%.
Do these guidelines affect Indian patients?
Well, firstly India has no screening guidelines and only opportunistic screening is practiced by a very small segment of the population. Secondly, there are some studies which say that Indian breast cancer occurs at an earlier age and therefore screening should be initiated early.
These questions be answered if proper trials on this topic are carried out in the country. For the time being, we should lay more stress on creating awareness regarding breast cancer.
The Pink City (Jaipur) hosted BRASCON 2015, an international breast surgery conference which attracted leading breast surgeons from not only India but also UK. It included a live operative workshop and was attended by more than 400 delegates.
I had the pleasure of presenting an invited talk on “Management of Non Palpable Breast Lesions”, which is a very interesting topic because with the increase in opportunistic screening in our country, we are seeing more and more non palpable lesions and there are special techniques required to manage these lesions.
In my talk, I spoke about my experience regarding wire guided localization (WGT) and ROLL (radio-guided occult lesion localization), both of which are the standard techniques to manage such lesions.
Many British Breast Surgeons were happy to see that we were performing such surgeries in India as well and they appreciated my operative videos.