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Breast Cancer-4


Welcome to part 4 of educational series on breast cancer. In third part, we learned about modifiable risk factors and lifestyle changes.

Question: Now Dr Shah, what can a woman do to Prevent Breast Cancer?

Answer: First of all we need to realize that not all women are at high risk. So the interventions need to be tailored to risk. For some high risk women, very aggressive approach may be required to save life.

Assessment is based on number of risk factors present e.g. any one of the following makes a woman “High Risk”:

  1. known genetic mutation, such as BRCA 1 or 2, p53, PTEN
  2. more than 2 first degree relatives with breast or ovary cancer
  3. lobular carcinoma in situ
  4. history of thoracic irradiation at a very young age

Rest of the women are assessed with a tool called “modified GAIL model”. It is not meant for Indian women, but can serve as an approximate guide.

Que: So you are suggesting that most women are not high risk. Is it safe to assume that they can follow only lifestyle changes?

Ans: NO, lifestyle changes are not enough. Since breast cancer rates are fairly high in Indian women, and seem to be rising, we need to use other measures. These tests are called Screening Tests. These are shown in western studies to be effective in detecting cancer at an early stage, and save life. They include:

  1. Mammogram: a special type of x-ray of breast – every one to two years
  2. Breast examination by a doctor – every year – any doctor can learn this. In the West, it is performed by most doctors, including general practioners.
  3. Breast examination by woman herself – every month

These tests should start after age 50. Some people recommend after age 40. Remember that none of these tests are full proof. Hence one should use them in combination. Screening should be started after discussing its advantages and disadvantages, as it may not be suitable for everyone, especially since there is little data for Indian population.

Que: What exactly is a Mammogram? Is it easily available?

Ans: Mammogram is a type of x-ray and requires a special machine. Very few facilities exist for this however the number is rising. Technically it is one of the most challenging studies to read and interpret properly. There are many false positives and false negatives. If woman has a lump in breast, but mammogram is normal, she should still be evaluated, and if required biopsy should be done.

Also, mammogram is of very little or no value in young women with dense breasts, usually below age 40. In this age group, it can be very misleading and is NOT recommended.

Most radiologists combine sonography with mammography to better evaluate any suspicious areas. Sonography is not recommended as a screening tool by itself. MRI with a special coil has recently been found to be useful as screening tool.

Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA),
Diplomate American Board of Oncology and Hematology.
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad. 079 26754001