The Dedicated Breast Cancer Care Unit  (DBCCU) Concept

The concept of a Dedicated Breast Cancer Care Unit (DBCCU) is becoming increasingly important due to the rising global incidence of cancer, and India is no exception to this trend. Furthermore, there is a concerning increase in the occurrence of breast cancer among younger women, which can have severe physical, emotional, social, and financial impacts. Our DBCCU comprises a team of highly trained specialists and is well-equipped to provide comprehensive care to breast cancer patients. Our unit offers a complete range of services, including cancer screening, diagnosis, treatment, and supportive rehabilitation, all conveniently available in one location. We place a special emphasis on facilitating the speedy return of our patients to their normal lives, recognizing the importance of their physical and emotional well-being.

We at AIMS, are there to resolve all your doubts regarding Breast Cancer:

Are All Breast Lumps Cancerours ?

Not all lumps are cancerous. However, a systematic evaluation is required to rule out breast cancer. Breast diseases are broadly classified as benign (non-cancerous) & malignant (cancerous).

Benign breast diseases:

Breast cysts, Fibroadenomas, Fibroadenosis, Mastalgia (cyclical / non-cyclical) & Mastitis.

Malignant breast diseases:

Malignant cancers are further classified as: Non-invasive (In-situ cancers) & Invasive (Infiltrating cancers). Treatment is based upon the type of cancer, the physical condition of the patient and the stage at presentation. Accordingly, breast cancer may present as early invasive/ non invasive, locally advanced or metastatic breast cancer.

What are the chances of developing Breast Cancer ?

Breast cancer mainly affects women, but it can happen in men as well. The chances of developing cancer increases with age, but no age is exempt.

Certain risk factors have been identified :

• Family history of breast/ ovarian cancer (maternal/ paternal family), more so with cancer arising before the age of 60 years
• BRCA 1/2 gene mutations.
• Early menarche / late menopause (increased fertile window).
• A history of non-child-bearing and non-breastfeeding.
• Previous breast cancer/biopsies.
• Advancing age
• Use of alcohol/ tobacco.

Not all lumps are cancerous. However, a systematic evaluation is required to rule out breast cancer. Breast diseases are broadly classified as benign (non-cancerous) & malignant (cancerous).

Benign breast diseases:

Breast cysts, Fibroadenomas, Fibroadenosis, Mastalgia (cyclical / non-cyclical) & Mastitis.

Malignant breast diseases:

Malignant cancers are further classified as Non-invasive (In-situ cancers) & Invasive (Infiltrating cancers). Treatment is based upon the type of cancer, the physical condition of the patient and the stage at presentation. Accordingly, breast cancer may present as early invasive/ non invasive, locally advanced or metastatic breast cancer.

Breast cancer mainly affects women, but it can happen in men as well. The chances of developing cancer increase with age, but no age is exempt.

Certain risk factors have been identified :

• Family history of breast/ ovarian cancer (maternal/ paternal family), more so with cancer arising before the age of 60 years.
• BRCA 1/2  gene mutations.
• Early menarche &/ late menopause (increased fertile window).
• A history of nonchildbearing and non-breastfeeding.
• Previous breast cancer/ biopsies.
• Advancing age
• Use of alcohol/ tobacco.

 

The presence of a risk factor does not necessarily mean that a woman will always develop breast cancer. However, women with risk factors should undergo regular health checks with a specialist.

The symptoms are initially quite subtle and often missed. However, as the disease progresses, certain signs and symptoms arise:

• A newly palpable lump is the most common symptom. It may or may not be painful.
• Skin retraction or dimpling, more apparent on raising the arms may be present.
• Changes in the skin over the nipple, or nipple retraction
• Bloody or clear nipple discharge may also point to a benign or malignant breast condition.
•  A lump in the armpit

Tomo mammography is an imaging technique that can be used to screen the early signs of breast cancer in women with no symptoms. It helps to reduce false positives that mammograms can give.

In advanced stages of the disease, pain, reddish discoloration or ulceration of the skin over the breast, bone pains, jaundice, haemoptysis and cachexia may develop.

Any unusual changes in the breast should not be ignored and brought to the notice of your doctor as soon as possible.

• A healthy lifestyle & a well balanced diet can help prevent most diseases and cancer is no exception.
• A screening mammogram is recommended in all women above the age of 40 years.
• In women with a family history of breast or ovarian cancer, screening is recommended 10years prior to the age at which the relative was diagnosed.
• High-risk screening in the form of breast ultrasound, MRI is required in younger women.
• BRCA 1 & 2 gene testing is advised after adequate pre-test counseling in women with a strong family history.
• Breast self-examination should be practiced every month, along with a clinical breast examination at least once a year.

• No. But all breast complaints need to be evaluated by a specialist before to rule out cancer.
• A breast lump is evaluated by performing a mammogram and ultrasound.
• Additionally, Breast MRI may be advised for further characterization.
• Diagnosis is confirmed with a core biopsy.
• A PET - CT is advised to rule out metastases.
• Pre- operative investigations are carried out to assess fitness for surgery.

Treatment is based on the type of the disease & stage at presentation. Broadly, treatment of breast cancer includes any or all of these modalities:

1.Surgery:

Modified Radical Mastectomy with/ without immediate/ delayed breast reconstruction or Oncoplastic Breast Conserving Surgery. The choice of breast conservation or reconstruction after mastectomy is discussed with the patient and planned accordingly. Post surgery, the histopathology report is discussed in detail with the patient and adjuvant treatment in the form of chemotherapy, radiation and hormone therapy are planned accordingly. Surgery for benign breast conditions are also carried out based on the symptomatology.

2. Chemotherapy:

Either before (neo- adjuvant chemotherapy) or after surgery, with/ without the use of a chemoport to facilitate chemotherapy administration. This is carried out under the supervision of a Medical Oncologist.

3. Radiotherapy:

Radiotherapy is carried out to the operated breast after breast-conserving surgery or to the chest wall after a mastectomy, based on the findings in the pathology report. Radiation is carried out under the supervision of a radiation oncologist.

4. Hormone Therapy:

In the form of tablets or injectable drugs, Hormone therapy is given based on the histopathology report. In elderly, in firm patients, it may also be used as neo-adjuvant hormone therapy.

Your prognosis is completely dependent on the type of disease, the extent of spread at the time of diagnosis & the response to treatment. Most breast cancers generally respond well to treatment. Non- invasive and early invasive cancers have the best prognosis. However, all breast cancer patients require regular follow- up to assess their well- being and rule out recurrence if any.

A significant number of young women develop amenorrhoea (cessation of menstruation) post chemotherapy. However, it may or may not lead to early menopause. Pregnancy can be planned post treatment completion in selected patients (generally 2 - 3 years post treatment).  Oocyte preservation can be planned after careful consideration of the disease status for future use. Pregnancy in such patients is safe and does not increase the risk of recurrence.

DR. NEEMESH LODH
BREAST SURGICAL ONCOLOGIST
D.N.B. (General Surgery), Fellowship in Breast Diseases & Breast Cancer

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