prepared for public

1.  DR.ANANDA SELVAKUMAR. MD
 CONSULTANT RADIATION ONCOLOGIST
 MEENAKSHI MISSION HOSPITAL & RESEARCH CENTRE

2.  Breast cancer became the commonest
among urban scenario…becoming common
in the rural areas too.(Lifestyle changes…?)
 According to ICMR statistics nearly one lakh
breast cancers being diagnosed in india every
year. More than 70% of them are diagnosed
in advanced stage.

3.  One out of every 22 Indian women is likely to
get breast cancer during her lifetime.
 One Indian woman succumbs to breast
cancer every ten minutes.

4.  Breast cancer is becoming more common in
younger women, with almost 50% of patients
being women under 50.
 Younger women are showing an increased
incidence of HER2+, a particularly aggressive
form of breast cancer.

5.  Being a women itself a high risk factor to get
BREAST CANCER.

6.  Don’t worry guys…..We are on top in LUNG
CANCER.

7.  Treatment of breast cancer has changed all
over the world in all their aspects. ( surgery,
radiation therapy, chemotherapy hormonal
therapy & targeted therapy).
 Although the western countries are having
higher incidence than ours…..we are on the
top in mortality rates.

9.  Any GOOD NEWS….????

10.  Early detection is the only prevention.

11.  Modifiable risk factors
a. Exercise.
b. Low fat diet.
c. Avoiding alcohol consumption.
d. Avoiding hormonal replacement therapy.

12.  Non modifiable risk factors
a. Sex and Increasing age.
b. Genetic predisposition.
c. Strong family history.
d. Early menarche & Late menopause.
e. Nulliparity.
f. Age at first child birth.

13.  Normal Risk :
a. Age 20 to 40 years - Clinical breast
examination (every 1-3 years) and breast
awareness.
b. >40 years - Annual Mammogram, annual
clinical examination and breast awareness.

14.  High risk : (Positive family history or Genetic
predisposition…etc)
a. Frequent clinical examination (every 6 – 12
months).
b. Annual mammogram.
c. Breast awareness.

15.  Women should be familiar with their breasts
and they should report to their physician , if
they are getting any changes in it.
 Periodic breast self examination (BSE) should
cover inspection and palpation of both
breast, axillas and lower neck in various
postures (erect, supine and bending forward).

16.  Pre-menopausal women may find BSE more
informative in immediate post menstrual
period ( Breast will feel soft and non tender ).

17.  Radiation therapy :
A. Neo-adjuvant?..................Yes!
B. Adjuvant?
• Post mastectomy?..............Yes!
• Post breast conservation?...........Yes!
C. Metastatic?......................Yes!

18.  YES………even I can do more here..!

19.  Breast conservation is one of the mile stones
in the management of breast cancer.
 Radiation therapy plays the pivotal role on it.
 We have a very solid evidence to promote
breast conservation in early breast cancer
(Lumpectomy with WBI ), and the results are
equal with mastectomy.

21.  Radiation therapy plays a vital role in most of
the organ conserving protocols like cancers of
breast, head & neck, anal, bladder, prostate,
esophageal, lung, cervix, extremity sarcomas,
and child hood tumors like RMS.
 The conformal techniques like 3D-CRT,
IMRT,IGRT, & SBRT are more useful in
delivering adequate dose to the tumor and
lesser dose to the normal tissues.

22.  Removing the tumor alone and sterilizing the
remaining breast with radiation therapy is
possible in all eligible early breast cancers.

23.  In a highly selected low risk patients, in spite
of treating their entire breast with radiation
after lumpectomy , we can treat the
lumpectomy cavity with 2 cm margins…!
 Bcz….most of the recurrence in this setup
happens 1-2 cm in and around the
lumpectomy cavity.

24.  This technique is called accelerated partial
breast irradiation.
 Small volume….higher dose…..and less
treatment duration is possible here.
 It can be done with conformal EBRT, or HDR
BRACHYTHERAPY.

27.  Breast conservation not only maintains the
appearance, it also maintains the confidence
level, & relation ships in family and working
environments.
 Even breast feeding is not contraindicated in
a conserved breast.

28. Even more powerful than mind and
body is the power of the spirit, the
third element for our survival.

29.  Localized disease - 99%
 Loco regional disease -84%
 Metastatic disease – 23%

30.  The 5-year relative survival rate is lower
among women diagnosed with breast cancer
before age 40 (84%) compared to women
diagnosed at 40 years of age or older (90%).
 This may be due to tumours diagnosed at
younger ages being more aggressive and/or
less responsive to treatment

31.  By avoiding four loco regional recurrences in
10 years, we can avoid one breast cancer
death in subsequent 15 years .