Breast Cancer

Breast Carcinoma
PRESENTED BY:
DR.ASISH KUMAR SAHA
PHARM.D INTERN
DEPT OF PHARMACY PRACTICE
JSS COLLEGE OF PHARMACY, OOTY
General Surgery Unit
Government Head Quarters
Hospital, Udhagamandalam
1CASE PRESENTATION: BREAST CARCINOMA

Contents
✓Introduction
✓Epidemiology
✓Causes and risk factors
✓Symptoms
✓Diagnosis
✓Treatment
✓Case Discussion
✓Reference

What Is Breast Cancer?
Breast cancer starts when cells in the breast begin to grow out of control. These
cells usually form a tumor that can often be seen on an x-ray or felt as a lump.
The tumor is malignant (cancer) if the cells can grow into (invade) surrounding
tissues or spread (metastasize) to distant areas of the body. Breast cancer occurs
almost entirely in women, but men can get breast cancer, too.

The Breast-Anatomy
❑The breasts are made of fat,
glands, and connective (fibrous)
tissue
❑The breast has several lobes,
which are divided into lobules and
end in the milk glands
❑Tiny ducts run from the many tiny
glands, connect together, and end
in the nipple

The Breast-Anatomy
❑These ducts are where 78% of breast
cancers occur. This is known as infiltrating
ductal cancer.
❑Cancer developing in the lobules is
termed infiltrating lobular cancer. About
10-15% of breast cancers are of this type.
❑Another type of breast cancer is
inflammatory breast cancer (Often
Misdiagnosed and dangerous)

The Breast-Anatomy

Epidemiology
❑According to Globocan 2012, India along with United States and
China collectively accounts for almost one third of the global breast
cancer burden.
❑India is facing challenging situation due to 11.54% increases in
incidence and 13.82% increase in mortality due to breast cancer
during 2008–2012.
❑Breast cancer attains top rank even in individual registries
(Mumbai, Bangalore, Chennai, New Delhi and Dibrugarh) in females
during the period of 2012–2014

Epidemiology

Causes and Risks
❑Personal or family history
❑Not having children
❑Having first child after age 30
❑Radiation therapy to chest/upper body
❑Overweight or obese
❑Age
❑Late menopause
❑Diets high in saturated fat
❑Sex
❑Estrogen replacement therapy

Relative Risks

Symptoms
❑Early breast cancer has little or no symptoms. It is not painful.
❑Breast discharge, especially if only from one breast
❑Sunken nipple
❑Redness, changes in texture, and puckering. Usually caused by skin
disease but sometimes can be associated with breast cancer.
❑Lumps on or around breast. Most lumps are not cancerous
❑Other lumps around the under arm or collarbone which don’t go
away

CASE PRESENTATION: BREAST CARCINOMA 12
Scirrhous carcinoma-with
nipple retraction
Medullary carcinoma-common
in middle age
Inflammatory
carcinoma-stage T4D
Another case of
Inflammatory carcinoma
Various Types of Carcinomas

Stages of Breast Cancer
The stages 0-IV
◦ Stage 0 is noninvasive breast cancer, that is, carcinoma in situ with no affected
lymph nodes or metastasis. This is the most favorable stage to find breast
cancer.
◦ Stage I is breast cancer that is less than three quarters of an inch in diameter
and has not spread from the breast.
◦ Stage II is breast cancer that is fairly small in size but has spread to lymph
nodes in the armpit OR cancer that is somewhat larger but has not spread to
the lymph nodes.

Stages of Breast Cancer
The stages 0-IV
◦ Stage III is breast cancer of a larger size (greater than 2 inches in
diameter), with greater lymph node involvement, or of the
inflammatory type. Spreading to other areas around the breast.
◦ Stage IV is metastatic breast cancer: a tumor of any size or type
that has metastasized to another part of the body (ex. bones,
lungs, liver, brain). This is the least favorable stage to find breast
cancer.

Metastasis
❑The most common place for breast cancer to metastasize
is into the lymph nodes under the arm or above the
collarbone on the same side as the cancer.
❑Brain
❑Bones
❑Liver

Difference between LCIS & DCIS

Stage Grouping
STAGE GROUPING
Stage 0 Tis N0 M0
Stage I T1 N0 M0
Stage IIA T0 N1 M0
T1 N1 M0
T2 N0 M0
Stage IIB T2 N1 M0
T3 N0 M0
Stage IIIA T0, T1, T2 N2 M0
T3 N1, N2 M0
Stage IIIB T4 N0-2 M0
Stage IIIC Any T N3 M0
Stage IV Any T Any N M1

BRCA1/BRCA2
❑BRCA1 is located on chromosome
17
❑BRCA2 is located on Chromosome
13
❑Having a single copy of either
mutated gene appears to confer
about an 80% chance of developing
breast cancer.

What does BRCA1 & BRCA2 do?
❑Both genes help mediate damage to cell’s DNA.
❑These genes are tentatively linked to an increased risk for also pancreatic, prostate,
and ovarian cancer.
❑Women who have the BRCA1 gene tend to develop breast cancer at an early age
❑Possible BRCA carriers are females whose mother and grandmother have had breast
cancer

HER-2/neu
❑Growth-stimulating protein
❑Normal cells express a small amount
on their plasma membranes
❑On surface of breast cancer cells
❑Sends messages from cell to “growth
factors” outside cell
❑Overabundant on surface of cancer
cells in 30% of women with breast
cancer

Diagnosis-Clinical Examination
Early detection is the key!
I. Hands by side of patient
1. Nipple
◦ Bloody discharge
◦ Centrally retracted nipple
2. Areola: Presence of peau d’ orange indicates the tumor infiltrating the areola
3. Skin over the breast
◦ Puckering or dimpling of skin
4. Lump
5. Edema of the arm is due to lymphatic blockage caused by lymph nodes in
the axilla

II. Hands raised above the head
oPeau d’ orange (on elevation of hands), becomes more prominent.
III. Bending forward
oIn cases of carcinoma infiltrating the chest wall, the breast will not fall; forward on bending.
❖Palpation
1. Local rise of temperature and tenderness
2. Describe the lump: hard and irregular or soft.
3. Intrinsic mobility
4. Plane of the swelling
•Pectoralis major contraction test
•Serratus anterior contraction

Investigations
1. Complete blood picture: Hb% may be decreased
2. Increased ALP levels in the blood suggest bone metastasis or liver metastasis.
3. Mammography
4. FNAC (Fine Needle Aspiration Cytology)
5. Trucut biopsy: If FNAC is –ive, a trucut biopsy or vacuum-assisted biopsy (VAB) using
11 gauge biopsy [robe can be taken.
6. Incisional biopsy

7. Image guided biopsy in indeterminate lesions
A. Ultrasound guided biopsy
B. Wire Localisation
C. Stereotactic biopsy
D. Mammotome
8. Chest X-ray
9. Abdominal ultrasonography

10. Bone scan
11. Steroid hormone receptors- immunohistochemistry (ER/PR & HER-2/neu receptor)
*IHC & DNA microarrays: New marker for cellular proliferation has been identified and named as
Ki 67.
12.USG of breast lump
13.MRI
14. Bone marrow aspiration

Treatment
❖Radiation
❖Chemotherapy
❖Vaccines
❖Surgery
❖Hormonal therapy
❖Tamoxifen is the most commonly prescribed hormone treatment.

HER-2/neu Vaccine
❑Targets HER-2/neu protein
❑Made from small protein pieces likely to trigger an immune response
❑Helps to increase white blood cell counts
❑Monthly shots for six months
❑No serious side effects

Trastuzumab
❑Type of biologic therapy
❑Breast cancer treatment drug
❑Monoclonal antibody therapy
❑Blocks HER-2/neu
❑Effective in metastatic HER-2/neu positive breast cancer
❑Little effect with HER-2/neu negative breast cancer

Surgery
Lumpectomy
◦ removal of the cancerous tissue and a surrounding area of normal tissue
Simple mastectomy
◦ removes the entire breast but no other structures
Modified radical mastectomy
◦ removes the breast and the underarm lymph nodes
Radical mastectomy
◦ removal of the breast and the underlying chest wall muscles, as well as the underarm contents.
◦ This surgery is no longer done because current therapies are less disfiguring and have fewer
complications.

Lumpectomy (Wide local excision)
Local wide excision is done-if the skin is
involved, it is also removed, undermining of
the flaps is not required
Local wide excision is in progress. 1cm of the
normal breast tissue of the cancerous lesion
is all that is necessary

Patey Mastectomy (MRM)
This is the most acceptable and most widely practised surgery. In this , the entire breast
including nipple and areola are removed with, pectoralis minor, followed by axillary
block dissection should include node clearance up to level III.
o Level I: Extends from axillary tail to the lateral border of the pectoralis minor.
oLevel II: Extends from lateral border of the pectoralis minor to medial border of the
pectoralis minor.
oLevel III: Up to the apex of axilla.

Modified Radical Mastectomy
Classical MRM incision which includes nipple
areola complex and slightly extending into axilla
to facilitate axillary block dissection
Patey mastectomy specimen: In this operation,
entire breast including axillary tail with all the
axillary group of lymph nodes and pectoralis minor
are removed

Complications of MRM
1. Seroma/lymph collection: (30 -50%) in spite of adequate drainage of the cest wall and axilla,
drainage occurs for about 5-10 days.
2. Secondary infection: It manifests as redness, discharge, fever, etc. Appropriate antibiotics are
necessary.
3. Flap necrosis: True mastectomy requires elevation of both upper and lower flaps. Thus it
predisposes to flap necrosis. This requires debridement, antibiotics, suturing and rarely skin
grafting also.
4. Haemorrhage (Not common)
5. Pain and numbness in the axilla, medial side of arm: Due to irritation of intercostobrachial
nerve. Generally subsided in few days. They requires simple analgesics.
6. Shoulder dysfunction can occur especially when the pectoral muscles are injured or retracted
resulting in haematoma or when pectoralis muscles are removed. It improves over a period of
time. Incidence 8-10%.

7. Injury/thrombosis of axillary veins. It manifests as severe pain in the hand and swelling.
Treated by low molecular weight heparin.
8. Injury to axillary vein, needs to be repaired by 5 or 6-0 prolene sutures.
9. Winging scapula is due to injury to long thoracic nerve of bell. The good anatomical
knowledge is essential to prevent this complication.
10. Lymphoedema of the arm appears a few months later.

Lymphoedema right upper limb-troublesome
complication after axillary block dissection-
more after radiotherapy to axilla
Postmastectomy lymphoedema

Breast Reconstruction
*The ideal candidate for breast reconstruction is a patient who has undergone modified radical
mastectomy.
Mastectomy results in following changes in woman:
oPsychological stress
oMood disturbances and anxiety
oIncreased consciousness about clothes
oDecreased sexual interest and satisfaction
oNegative body image

Reconstruction:
oImproves self confidence
oBetter social life
oDecreases concern about cancer
oBetter sexual life
oFeel “whole again”
Timing: Immediate or delayed.
*Immediate reconstruction: Should be done if no contraindications. It has been proven psychological benefits and
patient satisfaction, it is cost effective, it does not delay adjuvant treatment and recurrence detection.
Breast Reconstruction

Breast Reconstruction with TRAM FLAP
Mastectomy site is
marked
TRAM flap is done TRAM flap is raised-flap
design: Zone I-IV
TRAM flap is shown with its blood
supply

Mastectomy bed-pectoralis muscle fibres
Breast Reconstruction with TRAM FLAP
Healing after 20 days

BR with LD FLAP
Latissimus dorsi (LD) flap is marked Latissimus dorsi (LD) flap is raised Latissimus dorsi (LD) flap is brought to
the mastectomy site

Breast
Reconstruction
with LD FLAP
with SILICON
IMPLANT
42 CASE PRESENTATION: BREAST CARCINOMA
Silicon implant
Silicon implant placed
Silicon implant placed in the
subpectoral pocket
Wound closed after implant

Treatment Algorithm for LABC

Treatment Algorithm for MBC

Real Case

Subjective
A 63 years female patient got admitted to female surgical ward with complaints of swelling in
right breast, presence of lump in the right breast. Has no complaints of pain or nipple discharge.
Date of Admission: 04/07/2018
Past Medical History: K/C/o SHT for 12 years, Menopause before 12 years.
Past Medication History: Tab. Losartan at morning for last 12 years.
Special History: No previous history of breast cancer.
Family History: Brother had a lump in right shoulder.
Allergies (Drug): Nil
Allergies (Food): Nil

Objective
Laboratory Investigations Reports
Parameters Obtained value Normal Range
Haemoglobin (Hb) 13.2g/dL 12-16g/dL
WBC 7900 4500-11000/µl
Polymorphs 68% 40-65%
Lymphocytes 26% 30-50%
Monocytes 6% 2-4%
Platelet count (Pt) 277 150-400 x 103/mm3
RBC’s 4.5 4.2-5.4 x 106/mm3
Hct 39.2 38-45%
MCV 92.2 76-96 m3
MCH 31.1 27-31 pg/cell

Objective
Laboratory Investigations Reports
MCHC 33.7% 32-36%
RBS 44 <200 mg/dL
Blood Urea NA 10-30 mg/dL
Serum Creatinine 1.2 0.4-1.2 mg/dL
AST (SGOT) 30 0-35 U/L
ALT (SGPT) 12 0-35 U/L
ALP 225 <240 U/L

Assessment
Date Day On Examination Patient complaints Drug(s) Prescribed Dose Frequency
4/07/18 1 BP: 160/90mmHg
140/90mmHg (6:00pm)
CVS NAD
RS
Swelling of right Breast - - -
5/05/18 2 BP: 140/90mmHg
T: 94.4℉
PR: 88 beats/mt
RR: 22/mt
CVS NAD
RS
P/A: Soft; BS+
Swelling of right Breast Tab. Vit. B Complex od
6/07/18 3 BP:120/80mmHg
T:98.4℉
PR: 86beats/mt
RR:24/mt
CVS NAD
RS
P/A: Soft; BS+
Swelling of right Breast Tab. Vit. B Complex
Tab. Ranitidine
Anaesthetist opinion for MRM
R.Breast
150mg
od
bd

07/07/18 4 BP: 140/100mmHg
T: 98.4℉
PR: 76 beats/mt
RR: 22/mt
CVS NAD
RS
P/A: Soft; BS+
Nil at oral
Inj. Taxim IV
IVF-NS
1gm
1 pint
BD
8/07/18 5 BP: 110/70mmHg
CVS NAD
RS
P/A: Soft; BS+
Tab. Vit. B Complex
Tab. Ranitidine 150mg
OD
BD
9/07/18 6 BP:130/90mmHg
T:98.4℉
PR: 78beats/mt
RR:22/mt
CVS NAD
RS
P/A: Soft; BS+
Operative Notes:
▲Right Breast Carcinoma
Syr: Modified Radical
Mastectomy
Elliptical incision on either
side of the right breast,
tumour removed, mastectomy
done. Suction drain for blood
placed and closed with layer.
Specimen send for biopsy.
Nil per oral for 6hrs
IVF-DNS
RL
Inj. Cefotaxime IV
Inj. Diclofenac IM
Inj. Ranitidine IV
2 pint
2 pint
1gm
100mg
50mg
BD
BD
BD

10/07/18 7 BP: 120/80mmHg
T: 98.4℉
PR: 74 beats/mt
RR: 24/mt
CVS NAD
RS
P/A: Soft; BS+
Normal Diet
Inj. Cefotaxime IV
Inj. Metronidazole IV
Inj. Diclofenac IM
Inj. Ranitidine IV
Tab. Chymoral Forte
1gm
500mg
25mg
50mg
bd
bd
bd
bd
bd
11/07/18 8 BP: 140/90mmHg
T: 98.4℉
PR: 64 beats/mt
RR: 24/mt
CVS NAD
RS
P/A: Soft; BS+
Inj. Ceftriaxone IV
Inj. Diclofenac IM
Tab. Diclofenac
Cap. Omeprazole
Tab. Vit C
1gm
25mg
50mg
20mg
300mg
bd
sos
bd
bd
od
12/07/18 9 BP:130/90mmHg
T:98.4℉
PR: 74beats/mt
RR:22/mt
CVS NAD
RS
P/A: Soft; BS+
DT-125ml
Wound healthy
Repeat All

13/07/18 10 BP:120/80mmHg
T:98.4℉
PR: 84beats/mt
RR:24/mt
CVS NAD
RS
P/A: Soft; BS+
DT-98ml
Wound healthy
Repeat All
14/07/18 11 BP:120/80mmHg
T:98.4℉
PR: 74beats/mt
RR:26/mt
CVS NAD
RS
P/A: Soft; BS+
DT-81ml
Wound healthy
Inj Ceftriaxone IV
Tab. Diclofenac
Tab. Ranitidine
1gm
50mg
150mg
BD
BD
BD
15/07/18 12 BP:140/80mmHg
T:98.4℉
PR: 72beats/mt
RR:24/mt
CVS NAD
RS
P/A: Soft; BS+
DT-70ml
Wound healthy
Repeat All

16/07/18 13 BP:120/80mmHg
T:98.4℉
PR: 84beats/mt
RR:24/mt
CVS NAD
RS
P/A: Soft; BS+
DT-55ml
Wound healthy
Cap. Amoxicillin
Tab. Paracetamol
Cap. Omeprazole
Tab. Vit B Complex
Tab. Vit. C
250mg
500mg
20mg
300mg
2tds
tds
bd
od
od
17/07/18 14 BP:120/80mmHg
T:98.4℉
PR: 78beats/mt
RR:22/mt
CVS NAD
RS
P/A: Soft; BS+
DT-65ml
Wound healthy
Cap. Amoxicillin
Tab. Metronidazole
Cap. Omeprazole
Tab. Vit B Complex
Tab. Chymoral forte
250mg
200mg
20mg
2tds
2bd
bd
od
bd
18/07/18 15 BP:140/80mmHg
T:98.4℉
PR: 72beats/mt
RR:24/mt
CVS NAD
RS
P/A: Soft; BS+
DT-50ml
Wound healthy
Cap. Amoxicillin
Tab. Metronidazole
Cap. Omeprazole
Tab. Vit B Complex
Tab. Diclofenac
250mg
200mg
20mg
50mg
2tds
2bd
bd
od
bd

19/07/18 15 BP:120/80mmHg
T:98.4℉
PR: 76beats/mt
RR:22/mt
CVS NAD
RS
P/A: Soft; BS+
DT-70ml
Wound healthy
Cap. Amoxicillin
Tab. Metronidazole
Tab Ranitidine
Tab. Vit B Complex
Tab. Diclofenac
250mg
200mg
150mg
50mg
2tds
2bd
bd
od
bd
20/07/18 16 BP:100/70mmHg
T:98.4℉
PR: 82beats/mt
RR:26/mt
CVS NAD
RS
P/A: Soft; BS+
DT-60ml
Wound healthy
Cap. Amoxicillin
Tab. Metronidazole
Tab. Ranitidine
Tab. Vit B Complex
Tab. Diclofenac
250mg
200mg
150mg
50mg
2tds
2bd
bd
od
bd
21/07/18 17 BP:130/80mmHg
T:98.4℉
PR: 82beats/mt
RR:22/mt
CVS NAD
RS
P/A: Soft; BS+
DT-65ml
Wound healthy
*Drain removed
**Sutures removed
Cap. Amoxicillin
Tab. Metronidazole
Tab. Ranitidine
Tab. Diclofenac
250mg
200mg
150mg
50mg
2tds
2bd
bd
bd

22/07/18 15 BP: 130/80mmHg
T: 98.4℉
PR: 80/mt
RR:22/mt
Patient conscious
Oriented
Afebrile
No pallor
CVS: S1S2+
RS: B/LAE+
P/A: soft; BS+
Wound healthy
Cap. Amoxicillin
Tab. Metronidazole
Tab. Diclofenac
Tab. Ranitidine
250mg
200mg
50mg
150mg
2tds
2bd
Bd
bd
Patient got discharged.
Discharge Summary:
Patient was advised to come for review on Wednesday.
Patient was asked to collect HPE report after 15 days.
Patient was advised to take the prescribed drugs for 5 days.
Cap. Amoxicillin
Tab. Metronidazole
Tab. Diclofenac
Tab. Ranitidine
250mg
200mg
50mg
150mg
2tds
2bd
Bd
bd

Intervention
1. On 16/07/2018 (13th Day): Paracetamol was given for pain management, right choice of drug
for surgical pain management is Diclofenac (Tab. Diclofenac 50mg twice).
2. Genetic Test for *BRCA1/BRCA2 should be advised to get a clear picture of the patient cancer
profile, which will in turn help to select the appropriate Chemotherapy regimen.
3. Genetic Test for ER should be advised to select the appropriate Hormonal Therapy regimen.
4. Test for HER2 gene should also be advised.
*Cost for BRCA1/BRCA2 genetic test in India is INR 18,725

Pharmaceutical Care Plan
❖Cancer Therapy
❖Side effects or consequences of the cancer therapy
❖Complications of the problem associated with cancer (e.g. pain)
❖Comorbidities

*Adjuvant
Treatment
Systemic
Therapy
Adjuvant
Hormonal
Therapy
Adjuvant
Chemotherapy
Radiotherapy Brachytherapy
Cancer Treatment Plan
*Post Surgical Treatment
#Should be started when the wound get adequately healed

Cancer Treatment Plan
I. Adjuvant Hormonal Therapy- Tamoxifen 20mg for 5years, to be started
only after completion of chemotherapy.
II. Adjuvant Chemotherapy-
1. Cyclophosphamide 500 mg/m2 IV, day 1
2. *Adriamycin (Doxirubicin) 50 mg/m2 IV continuous over 72 hours
3. Fluorouracil 500 mg/m2 IV, days 1 and 4
Every 21 days x 6 cycles
*Adriamycin has cardiotoxic effects, if the patients shows such effects
then it may be replaced by Epirubicin 100 mg/m2 IV bolus, day 1

Monitoring Parameters
Drug Name Side effects Monitoring Parameters
Cyclophosphamide ❑ Renal toxicity (haemorrhagic cystitis in high dose and or long term
therapy). May be minimised by adequate hydration and/or with mesna).
Haematologic toxicities (anaemia, neutropenia, thrombocytopenia).
❑ GI toxicities (moderate to high: nausea and vomiting, mucositis,
diarrhoea).
❑ Skin toxicities (alopecia, hyperpigmentation of nail or skin).
❑ Cardiotoxicities: With high dose HSCT therapy (arrhythmias, cardiac
tamponade, CHF, haemorrhagic myocarditis, myocardial necrosis).
❑ Pulmonary toxicity (high dose therapy: pulmonary fibrosis).
❑ Hepatotoxicity (high dose therapy: veno-occlusive liver disease).
❑ Nasal congestion due to rapid administration of cyclophosphamide.
CBC, RFT, Cardiac
function

Drug Name Side effects Monitoring Parameters
Adriamycin
(Doxorubicin)
❑ Cardiotoxicity (ECG changes, cardiomyopathy, arrhythmia). Cardiac
assessment should be done at baseline and throughout therapy
❑ Haematologic toxicity (leucopenia).
❑ GI toxicities (high to moderate: nausea and vomiting, mucositis, diarrhoea).
❑ Skin toxicities (alopecia, hyperpigmentation of nail beds).
❑ General (urine discoloration: urine maybe pink or reddish for 1-2 days after
therapy).
❑ Metabolism and nutrition disorders (hyperuricaemia).
Cr, CBC w/ diff, Plt, LFTs at
baseline, then
periodically; Ca; K; PO4;
serum uric acid
Fluorouracil ❑ GI toxicities (low: nausea and vomiting, mucositis, diarrhoea, heart burn).
❑ Skin toxicities (alopecia, dermatitis, dry skin, low: hand-foot skin reaction)
❑ Haematologic toxicities (thrombocytopenia, anaemia).
❑ Cardiotoxicity (arrhythmias, chest pain).
❑ Ocular toxicities (excessive lacrimation, blurred vision, photophobia, eye
irritation).
CBC prior to each
treatment cycle, ECG;
prior to each
administration
Monitoring Parameters

❑ The patient was advised to take adequate rest.
❑*The patient was advised to do general exercise after she becomes able to do so (e.g.
Shoulder blade squeeze, Side bends, Chest wall stretch, etc)
❑ Fruits and vegetables rich in ascorbic acid, i.e., Broccoli, orange, pineapples, etc.
❑The patient was advised not to carry heavy loads.
Patient Counselling
*Patient attender was explained about the exercise procedures.

Patient Counselling
General Counselling Points for Patient During Chemotherapy
Patient should be advised to:
a) Avoid crowded areas.
b) Wear protective mask.
c) Go to the nearest hospital if there are signs of fever, prolonged bleeding or unexplained fatigue.
d) Avoid uncooked food, eat a well-balanced diet and drink plenty of water.
f) Get plenty of rest and sleep.
g) Perform daily activities and exercise as tolerated.

i) Discuss with the doctor or pharmacist before taking any other medicines, vitamins, mineral
supplements, traditional or complementary medicines. Some may seriously interfere with the
treatment that has been prescribed.
j) Discuss with the healthcare provider regarding side effects encountered during chemotherapy.
Patient Counselling

Brand Names
Drug name Brand name (India) Mgf By: Price (₹):
Doxorubicin Adriamycin Pfizer 717.0
Cyclophosphamide Cydoxan Alkem 68.0
Fluorouracil 5-Flucel Celon 90.0
Tamoxifen Moxifen Vhb Life Sciences Inc 18.0

Take Away Points
✓However innocent looking the breast lump may be, it can be malignant
unless proved otherwise.
✓BC with BRAC1 tends to be ER negative/BC with BRAC2 tends to be ER
positive
✓Getting first child before 30 years of age and breast feeding upto 3 years may
act as a shield to breast cancer.
✓Self screening may be the best preventive method for breast cancer.

References
1. BRCA1 and BRCA2 mutations in a population-based study of male breast cancer
Basham VM, Lipscombe JM, Ward JM, Gayther SA, Ponder BAJ, Easton DF, Pharoah PDP
Breast Cancer Res 2002, 4:R2 (21 November 2001)
2. Dewitt Publishing. Breast Cancer: emerging risk factors. New York Times 2003
3. American Cancer Society, Cancer facts and figures. 2003
4. Jennifer Couzin. The twists and turns in BRCA’s pathway. Science VOL 302 October 24, 2003
5. Campiglio. M, S. Menard, S. M. Pupa, and E. Tagliabue. 2003. Biologic and therapeutic role of
HER2 in cancer. Oncogene. 22(42): 6570-6578.
6. “Phase I Clinical Trial of Breast Cancer Vaccine.” www.medicalnewstoday.com
7. American Cancer Society www.cancer.org
8. Herceptin Drug Information www.herceptin.com
9. National Alliance of Breast Cancer Organizations www.nabco.org

References
10. National Breast Cancer Coalition www.natlbcc.org
11. National Breast Cancer Foundation www.nationalbreastcancer.org
12. National Cancer Institute http://cancer.gov
13. OncoLink www.oncolink.upenn.edu
14. Shreshtha MALVIA, Sarangadhara Appalaraju BAGADI, Uma S. DUBEY and Sunita SAXENA. Epidemiology of
breast cancer in Indian women. Asia-Pacific Journal of Clinical Oncology 2017; 13: 289–295
15. Breast Cancer Treatment Guidelines, (Approved at Provincial Breast Cancer Guideline Meeting from March 8
- 10, 2012)
16. Joseph T.DiPiro, et al, Breast Cancer. Pharmacotherapy Handbook. 9th edition. 619-630
17. https://www.fda.gov/drugs/informationondrugs/approveddrugs/ucm279174.htm accessed on 20/07/2018
18. Manipal Manual of Surgery; K Rajgopal Shenoy, Anitha Shenoy; 4th Edition, Breast; Pg: 337.

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