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    Thursday , May 19, 2016

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   Publication: newindianexpress.com , Agency:Bureau
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Evolving technology in breast cancer diagnosis and management

 Breast cancer is now the most common cancer among urban Indian women. As per PBCR (Population Based Cancer Registry) breast cancer accounts for 25% to 32% of all female cancers in urban India. This implies, practically, one fourth (or even approaching one thirds) of all female cancer cases are breast cancer.

A fact of greater concern for the Indian population is that one of every two women diagnosed with breast cancer dies of it. Since a lot of patients in India are diagnosed at later stages, they do not survive long, irrespective of the best treatment they get, and hence the mortality is fairly high.

Breast health awareness implies that women should be aware of the commonly occurring symptoms of breast cancer such as a painless palpable lump in the breast or underarm, nipple inversion, spontaneous bloody or clear nipple discharge, change in size of breast or skin dimpling.  Typically, there is no pain associated with breast cancer. Therefore, women often do not realise the above mentioned symptoms until it is too late.

If a woman experiences any of the above symptoms, she should immediately consult her physician and undergo a diagnostic mammogram which is a specialised X-ray of the breast. If the mammogram is abnormal the radiologist will recommend an ultrasound for further characterisation of the mammographic abnormality followed by imaging guided breast biopsy for accurate pathology diagnosis, which confirms the diagnosis.

Pathology diagnosis or tissue diagnosis plays a crucial role in diagnosis and management of breast cancer. There are several types of breast biopsy techniques such as Fine Needle Aspiration Biopsy (FNAB), Trucut or Core Needle Biopsy (CNB) and Vacuum Assisted Biopsy (VAB). The selection of the biopsy technique depends on availability of resources and characteristics of the breast lesion.

Apart from conventional methods of tissue sampling such as FNAB and CNB, VAB is a newer biopsy technique that is slowly but surely gaining momentum in clinical practice. VAB is based on the vacuum technology whereby with a single entry the device not only cuts through the targeted point in the lesion but also part of the lesion surrounding the targeted area by virtue of its ability to suck in and cut through a zone around the target. This ensures a bigger sample and hence accurate and timely diagnosis.

Another advancement in the treatment of breast cancer is the revolution in surgical management. Previously if a woman was diagnosed with breast cancer, she would have to undergo mastectomy irrespective of the stage, i.e. she would lose her entire breast. To address this, two ground-breaking technologies have recently been introduced in India. One is the Breast Tissue Marker and the second is the Hook Wire Localisation Needle.

The Breast Tissue Marker is small in size - about the size of a sesame seed and is made of titanium, a "biocompatible metal". The marker is placed at the site of the lesion from where imaging guided biopsy samples have been obtained. These markers are not only identified on mammogram by virtue of their radio opacity but also have a permanent ultrasound visibility.

Therefore, stage 1 and stage 2 breast cancers can be identified. The marker clips help identify the site of the cancerous lesions in early breast cancer as well as post chemotherapy residual disease. Once the marker clips are identified on imaging, a pre-operative hook wire is placed at the site of pre-operative planning, such that the breast Oncosurgeon is able to conserve maximum healthy breast tissue with good cosmetic outcome at the time of open surgery.

Dr. Shilpa Lad is a specialised radiologist in Breast Imaging and Interventions who has trained and worked in Toronto and Ottawa, Canada and is currently practising at NM Medical Center, Mumbai, India.

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Date: Thursday , May 19, 2016
Publication: newindianexpress.com, Agency: Bureau
Edition: Internet, Page No: 0, Location: Internet, Size(sq.cms): 0