Q1. Can I get breast cancer because I did or didn’t do something?

No. There are no specific causes of cancer. We cannot do anything to make one completely immune to cancer, but we can surely take steps to prevent it by modifying our lifestyle and getting screened regularly.

Q2. What are the symptoms that you look for before diagnosing this disease?

This is a simple but effective Illustration which highlights the symptoms of breast cancer. Any lady suffering from such symptoms should visit a breast surgeon immediately.

Illustration source – http://www.roche.com

Q3. What is the treatment procedure that you follow after one has been diagnosed with breast cancer?

Well, there’s no common treatment for all the patients. It varies from patient to patient. It depends on the stage at which the cancer is detected. For early stage detection, it is likely that it can be cured with minimal surgical resection, while in some cases there’s no other option left and affected breast tissue has to be removed aggressively. This is why I promote screening at regular intervals so that cancer can be detected at an early stage and would not become life-threatening.

Q4. What are some myths/misconceptions associated with breast cancer?

1.I can’t get breast cancer because no one in my family ever had it

90% of breast cancer patients don’t have a family history. It means only 10% of cancer cases occur due to abnormal genes passed from one generation to another. Undoubtedly a woman with a family history of breast cancer is at a higher risk but most women who are diagnosed with it don’t have a family history.

2.I am young so I can’t have breast cancer

50% of breast cancer happens in women below 50 years of age. If getting cancer at such a young age is not enough, malignancy in young women is aggressive and less responsive to treatment. Diagnosing young women is difficult since their breast tissue is usually dense and by the time symptoms appear the cancer is already in an advanced stage. Young women tend to ignore warning signs such as breast lumps and discharge. One is never too young to get cancer.

3.I can’t have breast cancer because I am a male

Although rare, males get breast cancer too. They constitute 1% of total breast cancer cases diagnosed. That is about 1 in 1000 of all the cases diagnosed. Males have a small amount of breast tissue too which can turn malignant in their lifetime. So just because you are a male does not mean you can’t get breast cancer.

4.I can’t have breast cancer because I haven’t done anything

There is this myth that people get breast cancer because they have done something like having a certain type of personality because they did something, kept their emotions inside and have been under stress. A number of studies have been done and it has been disapproved that personality traits cause cancer. So whether you are neurotic or laid back , mature or immature, can express your emotions or not; you can get cancer.

Q5. With over 150,000 cases being diagnosed in a year, what do you think the government can do to spread awareness about this disease?

Breast cancer has surpassed cervical cancer as the most common form of cancer in Indian ladies. The occurrence of breast cancer has been on a rise for quite some time now and I feel that now is the right time for the government to take necessary steps in this direction. Though it was heartening to see the screening tests organized by the government for ladies above the age of 30, I feel that Mammography Screening is not the most effective way. One of the devices which the government can explore is the iBreast exam. There are two reasons for choosing iBreastExam over mammography screening- Firstly, it is more cost effective than breast mammography. Secondly and more importantly it is radiation free and is quite efficient in detecting lumps in young patients. Moreover, it is portable, thus improving its extensiveness. I think the government should partner with such players to spread the awareness of breast cancer.

Q6. What has been the most difficult case that you have come across and why?

Sometimes breast cancer tends to surprise us and present in an unusual manner. In India, due to lack of awareness and a stigma attached with breast cancer, females from the rural set-up tend to present with locally advanced breast cancers. I happened to encounter one such case a few years back and managing this case turned out to be quite challenging. We managed to publish this case in the Breast Disease Journal and it generated quite a discussion in all the forums where it was discussed.

A 48- year- old post-menopausal lady presented to the Breast Clinic with complaints of a rapidly enlarging chest swelling for the last 8 months. The lesion had ulcerated one month back and she complained of a foul smelling discharge from the growth. There were no complaints of any lumps in the breast or axillae.

On examination, ulcero-proliferative lesion was seen over the midline of the chest. The lump had restricted mobility over the underlying chest wall. In addition, the patient had multiple, enlarged lymph nodes in both the axillae.

A provisional diagnosis of soft tissue sarcoma of the chest wall was made but the presence of bilateral, hard axillary lymph nodes raised a suspicion of a breast carcinoma. The patient was then subjected to a CECT of the chest, which revealed a fungating soft-tissue mass over the chest with bilateral axillary lymphadenopathy.

Following the imaging tests, an incisional biopsy of the lesion was performed, which to our surprise revealed an invasive ductal carcinoma (grade II) with DCIS. Immunohistochemistry revealed the tumor to be ER and PR positive but HER2 negative.

The patient was started on Chemotherapy at weekly dosage. As none of the breasts had any lesions, they were not addressed during the surgical procedure.  The patient remained symptom-free for 1 year after surgery, after which she was lost to follow-up.

This was an extremely rare presentation of breast cancer and managing this patient was a therapeutic dilemma.

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