Interesting Mammogram #4 

47 year old lady with complaints of bilateral breast pain since 3 months. Pain was non cyclical and relieved by oral paracetamol. She had a hysterectomy 6 years back and she was a known asthmatic.

On examination, she has multiple tender nodules in both the breasts, localised in the peri-areolar region. 

Mammogram revealed multiple, well defined, rounded densities in both the breasts with a rim of calcification around them (refer to figures). 

Multiple round densities in the breast


Ultrasound done revealed dense fibroglandular tissue with multiple sub-centimetric cysts in the breasts. 

Differential – 1. Multiple oil cysts with calcification 

2. Cysts secondary to fibroadenosis

Case managed by:

Dr Rohan Khandelwal

Consultant, Department of Breast Diseases and Cancer Care

W Pratiksha Hospital, Gurgaon  

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

5 common myths regarding breast cancer!!

Breast cancer is one of the most misunderstood diseases and there are many myths & half – truths surrounding the disease. Whether it’s the symptoms to watch out for or the best age to get a mammogram, what you think of as fact may actually be completely false. Some patients swear that wearing an under-wired bra can cause breast cancer, but the reality is that there is no scientific support for this claim. On the other hand, if you think you’re not at risk because there’s no history of breast cancer in your family, you might be mistaken. Read on to find out how to separate fact from fiction so you can stay safe.

Myth #1: If you have a family history of breast cancer, you are likely to develop breast cancer, too.

The Truth!!

While women who have a family history of breast cancer are in a higher risk group, most women who have breast cancer have no family history. Statistically only about 10% of individuals diagnosed with breast cancer have a family history of this disease.

  • If you have a first degree relative with breast cancer: If you have a mother, daughter, or sister who developed breast cancer below the age of 50, you should consider some form of regular diagnostic breast imaging starting 10 years before the age of your relative’s diagnosis.
  • If you have a second degree relative with breast cancer: If you have had a grandmother or aunt who was diagnosed with breast cancer, your risk increases slightly, but it is not in the same risk category as those who have a first degree relative with breast cancer.
  • If you have multiple generations diagnosed with breast cancer on the same side of the family, or if there are several individuals who are first degree relatives to one another, or several family members diagnosed under age 50, the probability increases that there is a breast cancer gene contributing to the cause of this familial history.

Myth #2: Breast cancer always appears as a lump

The truth!!
Approximately 10% of those diagnosed with breast cancer have no lumps, pain or other indications of a problem in their breasts.
And among lumps that are detected, 80 to 85% are benign. They’re often cysts or benign tumors called fibroadenomas. That said, any lump or breast symptom (especially from the list below) that does not go away should be checked by a breast surgeon:

  • A change in how the breast or nipple feels or looks
  • A lump or thickening in or near the breast or in the underarm area
  • Breast pain or nipple tenderness
  • A change in the size or shape of the breast
  • A nipple or skin that turns inward into the breast
  • Feeling warm to the touch
  • Scaly, red, or swollen skin of the breast, areola, or nipple, perhaps with ridges or pitting that resembles an orange peel
  • Nipple discharge

Myth #3: Deodorant and antiperspirants cause breast cancer.
The truth!!
One email rumor claimed that antiperspirant prevents you from sweating out toxins, which can then accumulate in the lymph nodes and cause breast cancer. But in 2002, researchers at the Fred Hutchinson Cancer Research Center in Seattle conducted a study to address this rumor—and found no link between deodorant or antiperspirant and breast cancer.

A second rumor speculated that certain chemicals in antiperspirants, such as aluminum and parabens, may cause breast cancer because there is a lower prevalence of the disease in developing countries where women don’t use these products. However, toxins are not usually released through sweat, and in Europe, where antiperspirants are not widely used, the rate of breast cancer is higher than it is in the United States. Finally, although a 2004 study found parabens in the tissue of breast cancer tumors, so far no studies have shown that these or any other chemicals in deodorants and antiperspirants cause breast cancer.

Myth #4: Wearing a bra increases your cancer risk.

The truth!

There is no good scientific or clinical basis to support the claim that plain or underwire bras cause breast cancer.
This rumor appears to have started after a book called Dressed to Kill suggested that bras obstruct toxin-laden lymph fluid from flowing out of the breast. However, this was speculation based on a survey and no scientific evidence. Since then, major medical institutions, such as the National Cancer Institute and the ACS, have refuted the claim.

Myth #5: Young women don’t get breast cancer.
The truth!!

While it’s true the disease is more common in postmenopausal women, breast cancer can affect people of any age.
In fact, women under 50 account for 25% of all breast cancer cases, and they tend to have higher mortality rates. This may be partly explained by the fact that younger women tend to have denser breasts, which makes it harder to spot lumps during mammograms. Because of this, it’s a good idea to perform monthly self- breast exams starting at age 20, have a clinical exam by a doctor every 3 years, and speak with your doctor about whether you should start mammographic screening at age 40.

images

Have you been properly investigated before a breast augmentation??

Breast augmentation has become a very common procedure in India now and more and more ladies are opting for such surgeries. Many surgeons are also luring patients by giving them attractive packages.

In order to save some money, many times, pre-operative imaging of the breast (ultrasound or mammogram) is being avoided and the result is that lesions like cancer are being missed in some of these patients.

I have come across three such patients in the last 6 months. One of them was a 32 year old business executive, who had undergone a breast augmentation 4 months back and she presented with a lump in her left breast. I was surprised to find a 2×3 cm lump in her breast, which had all the features of malignancy. A tru-cut biopsy confirmed her worst fears and she was devastated after the diagnosis. Her initial response was one of disbelief and anger towards the doctor, who had not investigated her properly before the augmentation procedure.

In these patients, the management of cancer also becomes tricky because of the presence of the implant. Therefore, my request to all patients planning to undergo a cosmetic breast procedure, is to  ALWAYS get a pre-operative imaging assessment done and consult a trained breast surgeon, who can guide you properly.

Steps which should be take before deciding on a cosmetic breast procedure:

  1. Consultation with a breast surgeon – understanding the procedure, complications and possible outcome. Discussing your risk of breast cancer with the surgeon
  2. Clinical Examination to rule out any lumps
  3. Radiological investigations – USG, Mammogram, MRI (in certain situations like dense breast tissue in a young patient)
  4. Biopsy of any lesion detected on imaging

2013_04_24_15_00_32_739_Mango_MRI_12_450

Interesting Mammograms #3

Case 1: 44 year old lady with a rapidly enlarging lump in the right breast of 6 months duration. On examination, she had a 3×3 cm hard lump in the lower half of her right breast. Surprisingly, she had a 5×5 cm hard, fixed axillary lymph node.

Reason of sharing this mammogram: bulky axillary lymphadenopathy with the lymph nodes being larger than the primary.

20130705_162845

 

Case 2: Patient had a lesion in the left breast, which was biopsied. Wanted to point out the steri-strip (artifact) after biopsy.

Pre- biopsy
IMG_20140910_144444

Post- biopsy
IMG_20140910_144305

 

Information provided by:

Dr. Rohan Khandelwal

Consultant, Breast Oncosurgeon

W Pratiksha Hospital

Interesting Mammogram #2

Case: 45 year old lady that presented with a painless, progressive breast lump on the left side of 7 months duration.

On examination: A10x10 cms firm, mobile lump involving the entire left breast was palpable. There were dilated veins overlying the lump with no palpable axillary lymphadenopathy.

Mammogram is shown below:

image

image

Mammogram was suggestive of an encapsulated lesion with smooth margins, probably a phyllodes tumor.

Tru-cut : Phyllodes tumor
HPE: Benign phyllodes

Learning objective: Benign encapsulated tumor on mammogram suggestive of phyllodes. Capsule is visualized as a radiolucent halo around the lump.

 

Information provided by:

Dr. Rohan Khandelwal

Consultant, Breast Oncosurgeon

W Pratiksha Hospital

Interesting Mammograms #1

Mammography is a vital tool used for screening & diagnosing breast lumps (benign & malignant). In this new thread, I will be sharing some interesting mammograms every week, which I see in my practice.

Case #1

Calcified Fibroadenoma in a 32 year old lady.

H/o lump in the left breast for the last 12 years. Not increasing in size & Painless.

X-ray mammography revealed an area of dense calficification (macrocalcification) at 9-10 o’ clock position.

Calcified Fibroadenoma

 

 

Case # 2: 

X-ray mammogram highlighting the difference between benign & malignant lymph nodes in the axilla.

History: 45 year old lady with an enlarging right breast lump x 4 months

On examination: 4×4 cm hard breast lump in the upper outer quadrant of the right breast with palpable axillary LN.

Mammogram showing the primary lesion (cancerous growth) in the right breast and malignant axillary LN on the right side (rounded LN with loss of fatty hilum).

Benign LN can be seen in the left axilla (with preserved fatty hilum).

Primary & nodes

 

The second mammography picture highlights the difference between malignant (right) & benign (left) lymph nodes in the axilla

Nodes

 

Information provided by:

Dr. Rohan Khandelwal

Consultant, Breast Oncosurgeon

W Pratiksha Hospital