Pune Breast Care

Mammography and Ultrasound are complementary exams. Some information obtained on mammography cannot be obtained on ultrasound and vice-versa. For instance, calcifications are seen better on mammography whereas lymph nodes are better evaluated on ultrasound. So women over 40 years of age often need both tests to complete an accurate diagnostic workup for a breast mass.

The best time to do a self-exam is in the few days after your period when the breast is less tender and lumpy. If you have undergone menopause or a hysterectomy, you can pick any day of the month that’s easy to remember such as the 1st of the month or the day you get your monthly salary.

Repeated breast abscesses can occur in diabetics, smokers and patients with a compromised immune system eg in HIV, patients on steroids and immunosuppresive medications. Some of the conditions mentioned here such as IGM, Zuska's disease and TB can also cause repeated abscesses that do not respond to standard treatments. Abscesses that occur outside the setting of pregnancy and breast feeding, or those that recur after treatment, should be seen by a breast specialist.

A small amount of sticky whitish or green- brown discharge from the nipple that is seen when your press or stimulate the nipples, is normal. Just like skin cells are shed from time to time, dead cells lining the ducts are shed and get liquified, collecting in chambers behind the nipple. When you press around the nipple, this fluid comes out. If your breast discharge is new or unusual, you should see a breast specialist.

Breast cancer most often presents as a painless breast lump. Women often ignore early signs of cancer as the lump does not hurt. Cancer can cause pain once it involves nerves in the area or may cause discomfort from stretching of surrounding tissues. You should not ignore a breast symptom such as swelling or a lump, because it isn't painful.

Breast Pain, described here as 'cyclical mastalgia" is not a warning sign or risk factor for breast cancer.

In the early stages, a woman with a painless breast lump, may not have any changes to appetite, weight or wellbeing. Symptoms of breast cancer include but are not limited to

1) A lump in the breast or armpit

2) Change in shape size or feel of the breast

3) Nipple discharge

4) Retraction (pulling in) of the nipple

5) Dimpling of the skin of the breast

6) Thickening or redness of the skin of the breast

7) Rash around the nipple or areola

A lot of these signs can overlap with those of benign (non cancerous) breast condition. It is hence important to get yourself examined by a specialist and not try to diagnose yourself at home.

Eary breast cancer can exisit even in the absence of any of the symptoms above in which case it is usualy picked up by mammography or other imaging.

Mammography and Ultrasound are complementary exams. Some information obtained on mammography cannot be obtained on ultrasound and vice-versa. For instance, calcifications are seen better on mammography whereas lymph nodes are better evaluated on ultrasound. So women over 40 years of age often need both tests to complete an accurate diagnostic workup for a breast mass.

Around 5-10 percent of breast cancers can be attributed to known genetic mutations. Upto 20 percent cases may be familial even if no mutations are known or found. The vast majority of patients who have breast cancer, have no family history and are called 'sporadic'.

If you are breast feeding, breast feed and regular intervals. If the baby does not take a proper feed from one side, empty the breast manually or using a pump. This avoids stagnation of milk. Avoid cracked nipples as they act as pathways for bacteria to enter the breast tissue. Quit smoking and avoid tobacco as they increase risk of breast abscesses.

If you are breast feeding, breast feed and regular intervals. If the baby does not take a proper feed from one side, empty the breast manually or using a pump. This avoids stagnation of milk. Avoid cracked nipples as they act as pathways for bacteria to enter the breast tissue. Quit smoking and avoid tobacco as they increase risk of breast abscesses.

Breast cancer most often presents as a painless breast lump. Women often ignore early signs of cancer as the lump does not hurt. Cancer can cause pain once it involves nerves in the area or may cause discomfort from stretching of surrounding tissues. You should not ignore a breast symptom such as swelling or a lump, because it isn't painful.

Breast Pain, described here as 'cyclical mastalgia" is not a warning sign or risk factor for breast cancer.

Breast cancer most often presents as a painless breast lump. Women often ignore early signs of cancer as the lump does not hurt. Cancer can cause pain once it involves nerves in the area or may cause discomfort from stretching of surrounding tissues. You should not ignore a breast symptom such as swelling or a lump, because it isn't painful.

Breast Pain, described here as 'cyclical mastalgia" is not a warning sign or risk factor for breast cancer.

We follow the Enhanced Recovery After Surgery (ERAS) protocl for all our breast cancer surgery. Pain is minimised if well controlled early in the surgical treatment. Towards this goal

1.You may be started on medications that reduce pain on the night before surgery.

2.Local anaesthetic in the form of nerve blocks around the surgical area are routinely used for early pain control.

3.Anti-inflammatory medications and paracetamol are used in regular doses after surgery.

With this protocol most of our patients are surprised that when they wake up from anesthesia, they have minimal to no pain. They are able to site up shortly after surgery and able walk on the same day. Read more about ERAS here.

On the morning of your mammogram, take a shower but do not apply talc or anti-perspirants as they can show up on a mammogram.

Carry all old mammography or breast ultrasound reports, films or CDs you may have.

You do not need to fast before the exam and you should be able to drive yourself back and forth from the test. If you're anxious, you may have a friend accompany you.

The best time to do a self-exam is in the few days after your period when the breast is less tender and lumpy. If you have undergone menopause or a hysterectomy, you can pick any day of the month that’s easy to remember such as the 1st of the month or the day you get your monthly salary.

Simple cysts and fibroadenomas do not convert to cancers. The important thing is that a diagnosis of a breast lump as a cyst or fibroadenoma should be accurate. Occasionally breast cancers can resemble such conditions on imaging and a needle aspiration or biopsy may be needed for confirmation. Once confirmed to be benign these conditions are either observed or treated if they are symptomatic, but not due to risk of malignancy.

FNAC only samples a few cells from a breast lesion. Often sampling is inadequate or yields only blood cells or fat. Reports may describe abnormal cells (atypia) which may ot may not represent cancer. FNACs can also cause higher number of 'false negative' reports which can cause delay in diagnosis and treatment. A core needle biopsy which samples pieces of tissue instead of cells, gives a higher accuracy of diagnosis. The procedure is done under local anesthesia in the clinic without necessitating surgery for diagnosis. We hence prefer core biopsy over FNAC.

Yes, Most of the time the bacteria causing a breast infection are already living in the baby's mouth. So you would not pass on the infection to the baby. If you are taking an antibioitic, verify if this antibiotic is safe for the baby if it enters breastmilk and watch for side effects such as diarrhea in the baby. If you have undergone surgical incision and drainage for the absvess, your surgeon will advise you when it is safe to resume breast feeding.

Chemotherapy is one of the pillars of breast cancer treatment. However not every breast cancer patient may need chemotherapy. If you have a tumour is small, has not spread to lymph nodes, is ER+ PR+ i.e. hormone receptor positive and HER2 negative, you may may benefit from a genomic risk assessment of your tumor. These commercially available tests include Oncotype Dx, Mammaprint, Endopredict and others.

If such testing demonstrates your tumor to be at low risk of recurrence, you may be prescribed endocrine therapy alone for 5-10 years. Adding chemotherapy in such situations may provide little or no additional benefit. Contact us for more information on the topic

Yes, Most of the time the bacteria causing a breast infection are already living in the baby's mouth. So you would not pass on the infection to the baby. If you are taking an antibioitic, verify if this antibiotic is safe for the baby if it enters breastmilk and watch for side effects such as diarrhea in the baby. If you have undergone surgical incision and drainage for the absvess, your surgeon will advise you when it is safe to resume breast feeding.

Simple measures you can take include

Reduce consumption of caffeine in tea coffee and sodas.

Wear a comfortable, support bra.

Apply warm or cool compresses when the breasts are painful.

Try vitamin E, evening primrose oil or GLA

See a breast specialist for guidance if you have significant pain.

Mammography and breast ultrasound are complementary tests. One is not necessarily better than the other, as they provide different types of information.

In young women < 40 years of age, we usually start with a breast ultrasound. If needed digital mammography or breast MRI may be used to investigate a problem further.

In women over the age of 40 years we start with a diagnostic mammogram. An ultrasound or needle biopsy may be needed to complete the diagnosis.

It is best to discuss the problem with a breast specialist or breast surgeon who can guide you about appropriate investigations. If you have a concern and the mammogram is normal, do not let it stop you from seeing a specialist. Mammography is not perfect and can miss 10-20% of cancers.

If discharge is bloody or clear watery, it may be a sign or a growth in the ducts thats bleeding or secreting fluid. Such discahrge usually affects onebreast or only one particular duct opening. If you notice that without any stimulation, your bra on one side is wet, or shows blood spots, that imay be cause for concern. If you are not pregnant or breast feeding, but have milky discahrge, this is abnormal as well.

Simple measures you can take include

Reduce consumption of caffeine in tea coffee and sodas.

Wear a comfortable, support bra.

Apply warm or cool compresses when the breasts are painful.

Try vitamin E, evening primrose oil or GLA

See a breast specialist for guidance if you have significant pain.

If you find a breast lump, do not panic as most breast lumps are not cancerous.However do not try to diagnose yourself at home. See a breast specialist who can examine you and advise any additional investigations that may be needed for an accurate diagnosis.

There are different types of breast cysts. "Simple cysts" can often be safely observed. They do not convert to cancer nor do they increase risk of breast cancer . "Complex cysts" may need a needle aspiration and occasionaly a biopsy of the wall.

A cyst may occasionally grow to a large size, be felt by hand and cause discomfort. A needle aspiration can be performed to remove fluid and alleviate the discomfort. Much like a water balloon, a cyst collapses after removal of fluid. Cyst fluid may be sent for testing if needed. A breast specialist can help decide what if anything needs to be done about these cysts. Rarely does a cyst need surgery.

FNAC only samples a few cells from a breast lesion. Often sampling is inadequate or yields only blood cells or fat. Reports may describe abnormal cells (atypia) which may ot may not represent cancer. FNACs can also cause higher number of 'false negative' reports which can cause delay in diagnosis and treatment. A core needle biopsy which samples pieces of tissue instead of cells, gives a higher accuracy of diagnosis. The procedure is done under local anesthesia in the clinic without necessitating surgery for diagnosis. We hence prefer core biopsy over FNAC.

Simple measures you can take include

Reduce consumption of caffeine in tea coffee and sodas.

Wear a comfortable, support bra.

Apply warm or cool compresses when the breasts are painful.

Try vitamin E, evening primrose oil or GLA

See a breast specialist for guidance if you have significant pain.

If you find a breast lump, do not panic as most breast lumps are not cancerous.However do not try to diagnose yourself at home. See a breast specialist who can examine you and advise any additional investigations that may be needed for an accurate diagnosis.

Some fibroadenomas and cysts will shrink and resolve on their own especially in women nearing menopause. In young women they may increase in size during puberty, pregnancy and breastfeeding, under influence of norma femalel hormones. As there is no 'imbalance' or hormones to be corrected, no medical treatements are usually advised for these conditions.

'Inflammatory breast cancer' is a specially aggressive type of breast cancer. Tumor cells block lymphatic channels of the breast skin causes redness and thickening of the skin of the breast, resembling inflammation. The diagnosis is often confused with mastitis and treated with multiple courses of antiobiotics causing delay in diagnosis. If inflammation of the breast does not respond to antibiotics, you should see a breast specailist. A tissue biopsy is important for a diagnosis in such cases.

80-90% of hereditary breast cancer is caused by mutations in BRCA1 or BRCA2 gene. TP53, PTEN,CDH1, ATM, CHEK2 and PALB2 are other genes responsible for familial cancers.

No, it is a common myth that a needle may disturb tumor cells and cause them to spread. This myth has been dispelled by several studies. If cancer cells get displaced into the surrounding environment they do not remain viable to implant. In fact patients who have cancer diagnosed on needle biopsy have better survival outcomes than women who directly undergo surgery.

Menstrual cycles may become irregular around menopause. Ovulation may not occur. The cyclial painful changes that occur in the breast can become exaggerated. Often these painful symptoms subside when menopause is complete. Women are advised to continue annual screening mammography after 40 years and discuss any unusual breast symptos with a breast surgeon.

Menstrual cycles may become irregular around menopause. Ovulation may not occur. The cyclial painful changes that occur in the breast can become exaggerated. Often these painful symptoms subside when menopause is complete. Women are advised to continue annual screening mammography after 40 years and discuss any unusual breast symptos with a breast surgeon.

Yes ,risk of breast cancer risk can be inherited with equal probability from the mother or father. Paternal uncles, aunts, cousins and grandparents also contribute to your family hisotry.

We usually advise women to come in for a baseline screening mammogram at age 40 years. After a review of your risk factors and a clinical exam, a personalized screening strategy is prepared for you. Women over the age of 40 years women are usually advised mammography every 1-2 years. After the age of 50 years, the test is advised annually. If you have a strong family history or known genetic risk, you may need to start screening earlier and use other tools besides mammography. Consult a breast specialist who can guide you appropriately.

No, it is a common myth that a needle may disturb tumor cells and cause them to spread. This myth has been dispelled by several studies. If cancer cells get displaced into the surrounding environment they do not remain viable to implant. In fact patients who have cancer diagnosed on needle biopsy have better survival outcomes than women who directly undergo surgery.

Most fibroadenomas can be and should be removed through hidden scars around the pigmented area of the areola. Scars in the armpit or in the crease where the breast attaches to the chest wall also hide well. As these are "pushing growths" that do grow into surrounding normal tissue, removal does not cause volume loss. The surrounding tissue that has been pushed away, falls into the space created on removal. Use of absorbable sutures instead or remoable sutures or staples, also minimises scars.

Whenever we suspect IGM, we try to avoid surgery and diagnose the condition on core needle biopsy. We use a protocol that involves medical management with steroids and abscess aspirations whenever needed to minimize pain, scarring and deformity. Treatment may often need several months and close supervision for prevention of complications from steroid use. Patients need counselling and emotional support during treatment. T

Need for radiation is determined by the type of surgery you have, the size of the tumor and whether it has spread to the lymph nodes.

1) Radiation is advised in nearly all cases if the type of surgery is a "lumpectomy for breast cancer" or "breast conservation surgery".

2) Radition is also used in locally advanced cancers which are large in size and those that have spread to the lymph nodes

3)Radiation may be omitted in certain small tumors of favorible biology in elderly patients.

To know if your case benefits from radiation, contact us for an opinion.

Avoidi harsh soaps that cause drying of the nipples. Y

ou can use purified lanolin creams between feeds.

Apply few drops of milk to the nipple and air dryi the nipples.

You can also use nipple shields are measures that can be used to prevent cracked nipples.

Avoidi harsh soaps that cause drying of the nipples. Y

ou can use purified lanolin creams between feeds.

Apply few drops of milk to the nipple and air dryi the nipples.

You can also use nipple shields are measures that can be used to prevent cracked nipples.

Patients often believe that the cancer can come back in the remaining breast after lumpectomy, but cannot recur after mastectomy. Truth is although most patients will never develop a recurrence, a cancer can recur in the chest wall or skin flap after a mastectomy or in the remaining breast after a lumpectomy. Regardless of which surgical approach is taken, routine follow-up with your breast surgeon or oncologist is a must.

After a breast surgeon has evaluated you for breast cancer, you may be a offered a the choice between lumpectomy+ radiation and a mastectomy.

The choice is only offered if the cancer lends itself safely to be treated by either options. This means that you will not be offered a lumpectomy if the tumor were not suitable for that treatment eg. if the tumor involved multiple areas of the breast. However when the choice is offered to you, your survival will not be affected by the surgical treatment you choose, as long as you complete all treatments advised. Not completing radiation after lumpectomy has high risk of recurrence.

When making the decision between lumpectomy and mastectomy discuss the following with your breast surgeon.

1) Need for radiation: Radiation is almost always given after a lumpectomy, whereas it can be av

oided in certain cases after a mastectomy.

2) Options for reconstruction after mastectomy: A mastectomy may not be a mutilating surgery, often the skin and nipple areolar complex can be preserved at the time of surgery and the breast is removed and replaced with an implant or a flap.

3) Plan for surveillance / follow-up after surgery: Routine mammography for the treated side is necessary after a lumpectomy. If you undergo a mastectomy, mammography is needed for the opposite side. The side of the cancer is followed with clinical exam alone

4) Possibility of genetic/ hereditary breast cancer: In cases of known BRCA mutations, a bilateral mastectomy may be offered over the choice of lumpectomy and radiation. If you opt for a lumpectomy in this situation, annual MRI is also advised for surveillance given the higher risk of recurrence.

5) Expected cosmetic outcomes of either approach: Aesthetic outcomes of both approaches may be satisfactory. Sometimes patients opt for a bilateral mastectomy with reconstruction for symmetry. In cases of a lumpectomy, a symmetrization procedure may be offered for the opposite side. Radiation also affects long-term appearance of the breast.

It is important for the woman to be comfortable with the decision she makes. It is also important for family members to help the patient make her own decision and notjudge them for the choices they make.

Menstrual cycles may become irregular around menopause. Ovulation may not occur. The cyclial painful changes that occur in the breast can become exaggerated. Often these painful symptoms subside when menopause is complete. Women are advised to continue annual screening mammography after 40 years and discuss any unusual breast symptos with a breast surgeon.

We usually advise women to come in for a baseline screening mammogram at age 40 years. After a review of your risk factors and a clinical exam, a personalized screening strategy is prepared for you. Women over the age of 40 years women are usually advised mammography every 1-2 years. After the age of 50 years, the test is advised annually. If you have a strong family history or known genetic risk, you may need to start screening earlier and use other tools besides mammography. Consult a breast specialist who can guide you appropriately.

Certain medications that increase prolactin levels can cause galactorrhea. These include some antacids, antidepressants, antipsychotics, anti-hypertensive and estrogen containing drugs. Abnormalities in thyroid and other hormones can also cause galactorrhea. Rarely galactorrhea may be caused by a tumor in the pituitary gland. A breast surgeon can do a hormonal workup and advise you to see an endocrine specialist if needed.

Certain conditions like intraductal papillomas and ductal carcinoma in-situ are microscopic, cell level changes in the duct lining. They often do not cause a mass or calcifications, so mammograms and ultrasounds may be normal. If you have abnormal discharge you should see a breast surgeon even if your imaging is normal.

If you are healthy premenopausal and undergoing a regular screening mammogram, try to schedule your test in the week after your menstrual period when the breasts are less tender. Do not apply deodorants, talcum powders and antiperspirants around the breast or armpits before your exam, as the salts contained in these may cause “specks” to appear on the mammogram. You do not need to fast for the exam and no IV or contrast is needed for the test. Remember to gather your previous mammography and ultrasound reports as well as images on films or CDs. Decisions in reporting involve comparison with images from prior years and noting changes over time. Any prior breast biopsy or surgery reports should also be made available to the radiologist reading your mammogram. If you’re anxious, take a friend or family member to accompany you.

“Excisional Biopsy” i.e. removal of a breast lesion as a first step in diagnosis is a very common but wrongful practice. Diagnosis of most breast problems can be made with a high level of confidence by performing a core-needle biopsy under local anesthesia in the OPD. 1)Several breast problems may not need surgery at all, and a needle biopsy can avoid unnecessary surgery.

2)If you have cancer that is picked up on excisional biopsy, you’ve undergone incomplete surgery. This is because a cancer operation involves more than just removal of a lump. Repeat surgery is needed to obtain clean margins and for lymph node staging.

3)If your tumour would have benefitted from chemotherapy to shrinking it prior to surgery, this opportunity is lost.

4)Scars from the excisional biopsy may not allow skin-preservation and optimal aesthetic outcomes at the subsequent cancer operation.

For all these reasons, a needle biopsy should be done first. Surgery should be performed only if it is actually required at all; and the right operation should be performed knowing what the diagnosis we intend to treat.

Most patients to receive breast cancer chemotherapy have no pain or discomfort during the IV infusion. Pain and irritation at the IV site can be minimised by using a chemotherapy port. To know more about chemo-ports click here

“Excisional Biopsy” i.e. removal of a breast lesion as a first step in diagnosis is a very common but wrongful practice. Diagnosis of most breast problems can be made with a high level of confidence by performing a core-needle biopsy under local anesthesia in the OPD. 1)Several breast problems may not need surgery at all, and a needle biopsy can avoid unnecessary surgery.

2)If you have cancer that is picked up on excisional biopsy, you’ve undergone incomplete surgery. This is because a cancer operation involves more than just removal of a lump. Repeat surgery is needed to obtain clean margins and for lymph node staging.

3)If your tumour would have benefitted from chemotherapy to shrinking it prior to surgery, this opportunity is lost.

4)Scars from the excisional biopsy may not allow skin-preservation and optimal aesthetic outcomes at the subsequent cancer operation.

For all these reasons, a needle biopsy should be done first. Surgery should be performed only if it is actually required at all; and the right operation should be performed knowing what the diagnosis we intend to treat.

First and Second Degree relatives are considered close blood relatives from standpoint of assessing familial risk. First degree relatives include mother, father sister, brother, son and daughter. Second degree relatives include aunts, uncles, grandparents, grandchildren, nieces, nephews, half brothers or half sisters.

Risk of breast cancer can be inherited from the maternal and paternal side and cancer hisotry of all of these relatives may be important

If you are a healthy woman, going for regular screening mammography, plan your mammogram in the week after your period. The breast tissue is less tender and lumpy during this time. You can also taken an anti-inflammatory medicine half an hour before your test. Schedule your mammogram at a center that does a good number of mammograms, has experienced personnel and advanced diagnostic tehnology such as tomosynthesis to minimise need for repeated tests. Ask if they provide padding technology.

If you are a healthy woman, going for regular screening mammography, plan your mammogram in the week after your period. The breast tissue is less tender and lumpy during this time. You can also taken an anti-inflammatory medicine half an hour before your test. Schedule your mammogram at a center that does a good number of mammograms, has experienced personnel and advanced diagnostic tehnology such as tomosynthesis to minimise need for repeated tests. Ask if they provide padding technology.

If you are a healthy woman, going for regular screening mammography, plan your mammogram in the week after your period. The breast tissue is less tender and lumpy during this time. You can also taken an anti-inflammatory medicine half an hour before your test. Schedule your mammogram at a center that does a good number of mammograms, has experienced personnel and advanced diagnostic tehnology such as tomosynthesis to minimise need for repeated tests. Ask if they provide padding technology.

If you are healthy premenopausal and undergoing a regular screening mammogram, try to schedule your test in the week after your menstrual period when the breasts are less tender. Do not apply deodorants, talcum powders and antiperspirants around the breast or armpits before your exam, as the salts contained in these may cause “specks” to appear on the mammogram. You do not need to fast for the exam and no IV or contrast is needed for the test. Remember to gather your previous mammography and ultrasound reports as well as images on films or CDs. Decisions in reporting involve comparison with images from prior years and noting changes over time. Any prior breast biopsy or surgery reports should also be made available to the radiologist reading your mammogram. If you’re anxious, take a friend or family member to accompany you.

Yes. Pregancy associated breast cancer is a special type of cancer that can occur during pregnancy and in the first 2 years after pregnancy. Signs are often confused with expected changes associated with pregnancy, leading to late diagnosis. Breast Cancer during pregnancy should be managed in a cancer center with a breast surgeon, medical oncologist and obstetrician working in close co-ordination.

Yes. Pregancy associated breast cancer is a special type of cancer that can occur during pregnancy and in the first 2 years after pregnancy. Signs are often confused with expected changes associated with pregnancy, leading to late diagnosis. Breast Cancer during pregnancy should be managed in a cancer center with a breast surgeon, medical oncologist and obstetrician working in close co-ordination.

Most of the time, a simple cyst can be left alone. If the cyst is large or its appearance sugests a complex cyst, we perform an ultrasound guided aspiration for the cyst. This is a quick 5 min outpatient procedure, in which fluid contained in the cyst is removed. Ultrasound ensures that the cyst collapses completely after fluid removal.If the cyst appears bloody it may be sent for cytology studies. If the cytology shows any abnormality, or if the cyst fills up repeatedly causing symptoms, then surgery may be needed.

Abscesses are pockets of pus and during surgery these pockets are unroofed to clean out unhealthy tissue and pus. If wounds are sutured, they get infected, pus reaccumulates in the pocket and the stitches open up. Abcess wounds are hence left open, to allow healing from the inside out. Just like a pot of earth gets filled from the base, healhty tissue grows in and fills up the pocket created for definitive healing. Daily dressings are usually needed in this process that may last few days to weeks.

Every pathology report should be compared with your physical exam as well as radiological reports. This step called establishing radio-pathological concordance, should be done by an experienced breast specialist. In cases where pathology reports are consistent with radiological findings, a second opinion is usually not required. If the findings are discordant eg if the radiological picture is suspicious, but the biopsy report does not show malignancy you may be advised a review of the biopsy blocks by a different pathologist or a re-biopsy.

Some women have breastst that are disproportionately large compared to their body frame. This condition is called macromastia. Due the weight of the large breasts, women often complain of upper back, neck and shoulder pain caused. This type of pain can be signifcantly improved by breast reduction surgery. You should consult a breast surgeon for these concerns.

No. Breast tissue in young women is too dense to allow X-ray penetration and obtain any useful information. Incidence of breast cancer in young women is low and hence it is not advisable for all healthy young women to undergo screening. When a young woman has a breast complaint, we usually perform an ultrasound examination of the breast.

As we are testing for inherited gene mutations that are present in all cells of the body, a blood sample or saliva swab can be used for the test. We usually collect 3ml of blood and send it to the genetics lab for testing.

There are several things you can do in the time from diagnosis to surgery, to help with your recovery from surgery.

1) Increase your protein intake in diet

2) If you smoke or use tobacco products, ask your doctor about help with quitting

3) Continue to follow your exercise regimen and go for walks.

4) Ask your doctor about holding your aspirin or other blood thinners if you take them

For a more details on preparing for breast cancer surgery, read more here

Once a pus collection develops in the breast, it usually will not respond to antibioitics along, and needs a draining procedure. This can be done one of two ways.

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A)Percutaneous Abscess Aspiration:

Using ultrasound guidance, we can aspirate the abscess with a needle to remove the pus. This sample is also sent for culture to guide further antibiotic therapy. Multiple such aspirations may be required in some cases.

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B) Surgical Incision and Drainage:

This procedure is usually done in the operating room under short general anaesthesia. Usually the incision is placed in a way that can allow the mother to continue breast-feeding after the surgery. Daily dressing changes may be needed after this procedure to allow complete wound healing.

Sometimes a papilloma is associated with atypia or DCIS (ductal carcinoma insitu) and hence a complete removal of the papilloma and involved duct is advised. The surgery can usually be done as a short-stay or day-care procedure and the scar around the areola usually becomes invisible in a few months.

Every pathology report should be compared with your physical exam as well as radiological reports. This step called establishing radio-pathological concordance, should be done by an experienced breast specialist. In cases where pathology reports are consistent with radiological findings, a second opinion is usually not required. If the findings are discordant eg if the radiological picture is suspicious, but the biopsy report does not show malignancy you may be advised a review of the biopsy blocks by a different pathologist or a re-biopsy.

I will often prefer an ultrasound guided core needle biopsy over conventional FNAC or excision of the breast mass or lesion. The core biopsy is done under local anesthesia in the ultrasound room with minimal discomfort and takes 10 -

15 minutes. You do not have to be fasting for it. Ultrasound guidance allows accurate sampling of the tissue and less chance of missed diagnosis. Histopathological diagnosis obtained with core biopsy has lower error rate than FNAC and avoids unnecessary surgery for diagnosis. If the condition is benign or amenable to medical management, surgery can be avoided. If the condition is cancerous, information about the exact type of tumor can be obtained from this biopsy and the right surgery can be planned for treatment, avoided need for re-operations. Know more about breast biopsy here

No. Breast tissue in young women is too dense to allow X-ray penetration and obtain any useful information. Incidence of breast cancer in young women is low and hence it is not advisable for all healthy young women to undergo screening. When a young woman has a breast complaint, we usually perform an ultrasound examination of the breast.

There is no specific age at which you should stop mammography as risk of cancer increases with age. As long as you are healthy enough to undergo treatments, it is ok to continue annual mammography. Early detection of breast cancer also improves outcomes in the elderly.

A Breast MRI is helpful in some cases of breast cancer. In young women with dense breasts, mammography may not describe the complete extent of disease. We often use MRI when planning breast cancer surgery for women less than 40 years of age. MRI is also helpful in occult cancers i.e. when tumor is seen in the lymph nodes but not in the breast. Paget's disease which is special type of cancer of the nipple, is another area where we use breast MRI. We also use Breast MRI for women with genetic predisposition to breast cancer eg BRCA positive cases.

Puerperal breast abscesses are common in women during lactation. Bacteria from the baby's mouth travel into collections of milk causing infections and abscesses. These can often be treated with a combination of needle aspiration (removal of the pus collection with a needle) and antibioitics. Sometimes they need open incision and drainage with surgery.

When an abscess occurs outside of the context of breast feeding and pregnancy and especially if they occur repeatedly, a specialist consultation is advisabe. Causes can include

Diabetes: Poorly controlled blood glucose makes diabetics prone to infections

Smoking/ tobacco: Smoking can cause ongoing inflammation and recurring infections around the nipple and areolar region.

Tuberculosis: TB does not respond to standard antibiotics and can cause long standing breast infections, abscesses, sinuses and fistule.It responds well to anti-TB treatments.

Idiopathic Granulomatous Mastitis: This condition causes recurring inflammation, abscess formation, sinuses and fistulae in the breast. It is a difficult to treat, autoimmune, chronic condition but responds to medical therapies that may include steroids and immunosuppression.

As treatments for each of these conditions differ, a correct diagnosis and treatment is critical to avoid repeated surgery and defomitiy of the breast.

A Breast MRI is helpful in some cases of breast cancer. In young women with dense breasts, mammography may not describe the complete extent of disease. We often use MRI when planning breast cancer surgery for women less than 40 years of age. MRI is also helpful in occult cancers i.e. when tumor is seen in the lymph nodes but not in the breast. Paget's disease which is special type of cancer of the nipple, is another area where we use breast MRI. We also use Breast MRI for women with genetic predisposition to breast cancer eg BRCA positive cases.

In correctly selected patients, the long term outcomes of a lumpectomy with radiation are equivalent to a mastectomy. We only offer you a choice when both outcomes are safe for your cancer. The decision should be taken jointly by the patient and the breast surgeon and may depend on the following points

1) Size and location of the tumor, number of tumors and extent of pre-cancerous tissue in the breast.

2) Need for radiation if a mastectomy is performed

3) Plan for surveillance / followup after surgery

4) Possibility of genetic/ hereditary breast cancer

5) Expected cosmetic outcomes of either approach

It is important for the woman to be comfortable with the decision she makes. It is also important for family members to help the patient make her own decision and notjudge them for the choices they make.

There is no specific age at which you should stop mammography as risk of cancer increases with age. As long as you are healthy enough to undergo treatments, it is ok to continue annual mammography. Early detection of breast cancer also improves outcomes in the elderly.

The genetics lab isolates DNA from the blood, then processes the DNA in several complex steps using specialized gene sequencing equipment. A large amount of data is generated in the process which needs detailed analysis, referencing and then interpretation. A genetic test report is generated, which describes any gene mutations which may be found. The entire process can take 4-8 weeks of time.

A team of technicians and radiologists that is experienced and competent in breast imaging should perform mammography. Several centers in India now have “Full field Digital Mammography with tomosynthesis” a more advanced technique that is particularly helpful in women with dense breasts. It allows smaller cancers to be picked up earlier and also avoids “false positives” from tissue overlap. If possible, have all your exams performed at one place that keeps your old records and has them available for comparison. We can advise you on mammography when you come for your clinical breast exam.

A team of technicians and radiologists that is experienced and competent in breast imaging should perform mammography. Several centers in India now have “Full field Digital Mammography with tomosynthesis” a more advanced technique that is particularly helpful in women with dense breasts. It allows smaller cancers to be picked up earlier and also avoids “false positives” from tissue overlap. If possible, have all your exams performed at one place that keeps your old records and has them available for comparison. We can advise you on mammography when you come for your clinical breast exam.

Genomic risk assays can be performed on certain types of breast cancer. If a tumor is small, has not spread to the lymph nodes and is ER+PR+ HER2 negative subtype, these tests can be used to classify a tumor as high risk or low risk for recurrence. In low risk groups, hormone therapy alone for 5-10 years may be sufficient and chemotherapy may not add any benefit.

A patient with a harmful mutation in BRCA may have a 60-80% lifetime risk of developing breast and 40-60 % risk of developing ovarian or fallopian tube cancer. In a patient who has already developed breast cancer, the lifetime risk of developing a breast cancer in the opposite breast may be 40%-60%. These are rough estimates and individial risk may vary with the mutation and the pattern of family history.

Genomic risk assays can be performed on certain types of breast cancer. If a tumor is small, has not spread to the lymph nodes and is ER+PR+ HER2 negative subtype, these tests can be used to classify a tumor as high risk or low risk for recurrence. In low risk groups, hormone therapy alone for 5-10 years may be sufficient and chemotherapy may not add any benefit.

Most breast cancers are sporadic ie, most patients with breast cancers occur in women who have no significant family history. 5-10% of breast cancers are clearly linked to genetic mutations that can be inherited from parents and passed down to children. BRCA 1 and BRCA 2 mutations are the commonest genetic defects found in families with breast and ovarian cancers, however other genes may be responsible. If you have a family history of breast cancers or multiple other cancers, genetic counselling prior to genetic testing is advised.

Men who are BRCA mutation carriers have increased risk of breast cancer and prostate cancer. They are instructed on self breast exams and advised annual breast exams after the age of 35 year and annual prostate cancer screening after age 40 years. Men can pass on the mutation to their biological children- both their sons and daughters.

Yes, genes responsible for breast cancer can be inherited from maternal or paternal side of the family. Men with BRCA mutations are prone to breast cancer and prostate cancer. A father may carry the breast cancer gene and pass them down to his children without facing cancer himself. If you father's mother, sisters, aunts have a history of breast cancer, you need to discuss this history with your genetic counsellor of breast specialist.

A mammogram delivers very low dose of radiation. There is constant background radiation in the environment that we are constantly exposed to. The radiation dose from a mammogram is estimated to equal to about two months of background radiation for the average woman. This is much lower than radiation from other investigations such as CT scan of the chest. Most experts advise that the benefits of early detection far outweigh any possible harm from radiation.

You should undergo genetic counselling to see if you may benefit from genetic testing. A diagnosis of a harmful mutation (eg BRCA positivity) might impact how we treat your cancer. It could a make a difference in the type of surgery as well as chemotherapy that is used in your treatment. Read more about genetic testing here

A mammogram delivers very low dose of radiation. There is constant background radiation in the environment that we are constantly exposed to. The radiation dose from a mammogram is estimated to equal to about two months of background radiation for the average woman. This is much lower than radiation from other investigations such as CT scan of the chest. Most experts advise that the benefits of early detection far outweigh any possible harm from radiation.

You should undergo genetic counselling to see if you may benefit from genetic testing. A diagnosis of a harmful mutation (eg BRCA positivity) might impact how we treat your cancer. It could a make a difference in the type of surgery as well as chemotherapy that is used in your treatment. Read more about genetic testing here

Mammograms are not 100% accurate in detecting breast cancer. If you feel a problem but your mammogram doesn’t show it, do not hesitate to come in for a specialist opinion.

A normal mammogram when you have cancer is called a “false negative”. Your possibility of having a false negative report is increased if you have “dense breasts” that do not allow optimal X-ray penetration. You may be advised supplemental tests such as ultrasound or breast MRI depending on your risk.

If you have a known harmful gene mutation, the surgical plan for your breast cancer treatment may change. We may give you the option to consider removal and reconstruction of both breasts instead of undergoing a lumpectomy. The reason for this is that even after successful treatment of your known cancer, you may have a significant risk of developing a new cancer in the remaining breast tissue on the same side, or a new tumor on the opposite side in future.

We may suggest you undergo a removal of your tubes and ovaries to minimize risk of ovarian and fallopian tube cancer. In some cases this may help with treatment of your breast cancer as well. Your medical oncologist may incorporate drugs such as platinum agents and PARP inhibitors in your chemotherapy, which are known to be effective when a patient has a BRCA gene mutation.

Mammograms are not 100% accurate in detecting breast cancer. If you feel a problem but your mammogram doesn’t show it, do not hesitate to come in for a specialist opinion.

A normal mammogram when you have cancer is called a “false negative”. Your possibility of having a false negative report is increased if you have “dense breasts” that do not allow optimal X-ray penetration. You may be advised supplemental tests such as ultrasound or breast MRI depending on your risk.

Never try to diagnose yourself at home. Consult a breast specialist for a physical breast exam and get a mammography and /or ultrasound as advised. If needed, you may be advised to undergo a needle biopsy for complete diagnosis. Always seek attention prompty and undergo athorough diagnostic evaluation for a breast mass.

A PET-CT evalautes distant spread of breast cancer. It is usually advised in larger tumors, aggressive tumor types or tumors that have spread to the lymph nodes.It is helpful to study extent of disease in metastatic stage 4 disesae as well. In early breast cancer, the possibility of finding distant spread is very low. The risk of PET-CT scans is that they may show 'false positive' findings ie areas that appear suspicious on scans but do not represent cancer. This may lead to unnecessary biopsies and delay in treatments.

A PET-CT evalautes distant spread of breast cancer. It is usually advised in larger tumors, aggressive tumor types or tumors that have spread to the lymph nodes.It is helpful to study extent of disease in metastatic stage 4 disesae as well. In early breast cancer, the possibility of finding distant spread is very low. The risk of PET-CT scans is that they may show 'false positive' findings ie areas that appear suspicious on scans but do not represent cancer. This may lead to unnecessary biopsies and delay in treatments.

Doing a self breast exam doesn't mean you're expected to make a diagnosis at home. If you perform regular monthly breast exams, you get used to feeling what your normal breast feels and look like. The easiest way to do this is when you're soaping up in the shower, pay attention to what your breast feels like. If you notice something unusual or something different from your last self-exams, you simply need to schedue a consultation with a breast specialist.

No. Certain subtypes of breast cancer may do very well with hormone therapy alone. The decision about chemotherapy should be made in consultation with an oncologist that has expertise in breast cancer

Once a diagnosis is made, patients believe there is a need to rush to surgery. However it is important to gather adequate information on the tumor to make a proper treatment plan. Obtaining molecular details on the tumor, information on disease stage, as well as optimising the patients fitness for surgery may take a few weeks. Several studies have shown that waiting 4-6 weeks to schedule surgery does not advance the stage of most breast cancers. However we usually advise to not delay surgery once the information gathering and surgical planning is complete.

Once a diagnosis is made, patients believe there is a need to rush to surgery. However it is important to gather adequate information on the tumor to make a proper treatment plan. Obtaining molecular details on the tumor, information on disease stage, as well as optimising the patients fitness for surgery may take a few weeks. Several studies have shown that waiting 4-6 weeks to schedule surgery does not advance the stage of most breast cancers. However we usually advise to not delay surgery once the information gathering and surgical planning is complete.

If you have a significant family history and have seen other family members struggle with cancers, it is natural to be apprehensive of your own risk. Knowledge of this risk however should be used as a tool to make positive health decisions.

Consider this scenario: You are healthy but have a strong family history. You have always been worried about your risk and your children’s risk. A genetic mutation is found in the family by testing one of your close blood relatives. You undergo the test and find out that fortunately you have not inherited this gene. Such a report may largely relieve your anxiety about your risk and you may be advised routine screening

Consider a second scenario: You have a strong family history and are worried about developing cancer. You undergo testing and a BRCA mutation is found. Now you have carried this genetic abnormality since your birth and the report puts this information in your hands to be used as a tool to lower your risk. You will be given multiple choices and you will be making shared decisions with your doctors about your options. Most patients in this scenario develop a sense of regaining control over what was once assumed a predestined outcome.

A cost of a mammogram can vary anywhere in the range of Rs 800-3000. Keep in mind that a lot of smaller centers and clinics have older analogue or film mammography equipment. Dedicated Breast imaging centers and departments have what we call "Full Field Digital Mammography" with 3 D imaging called 'tomosynthesis" This test may seem to be more expensive however it is able to pick up smaller breast cancer earlier especially in women who have 'dense breasts'. It has lesser number of 'false positives'. If you are going to a do screening mammography, we generally advise women to invest in a good quality digital mammogram.

A chemo port helps a patient avoid repeated needle sticks for blood draws and intravenous (IV) cannula placements. Chemotherapy drugs are often irritant and cause the veins of the forearms to get clotted off and scarred. Finding veins for IVs becomes difficult with successive chemo cycles. In breast cancer patients, we protect the arm on the side of the cancer if the lymph nodes have been removed. This limits IV placement options to the opposite side. In this scenario, a port is helpful as it allows blood draws and drug adminstration without repeated IV placements.

Before choosing to undergo a port placement, discuss risks and benefits risks of port placement with your cancer surgeon.

If you carry the gene, a biological child has a 50% probability of inheriting the genetic mutation. Genetic testing for BRCA and similar mutations is only done after the child is18 years of age when he or she can understand the testing process, its implications, and give consent for testing. The children who do not inherit the gene have the same cancer risk as the average population, which can be a source of great relief in the background of strong family history. If they do test positive they will be offered options similar to those mentioned before.

With use of Next Generation Sequencing, and availablity of the test locally, the cost of testing has decreased considerably, compared to what it was a few years ago. The initial cost can vary based on whether we are testing for specific gene mutations or a comprehensive panel. Once a familial mutation is known, other family members can be tested at much lower cost. Discuss what test that is right for you, with your breast specailist or genetic counsellor.

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There is no Magic Diet Plan that is proven to cure cancer or stop its growth.

*A Healthy Balanced Diet rich in protein & vitamins will help meet additional demands of treatments.

*Avoid Fad Diets that make sudden large changes, as they may be harmful.

*Do not attempt rapid weight loss if you are overweight.

• After general anesthesia, your appetite may be low for a day or two, and you may experience some nausea. Do not force- feed yourself. In the hospital, you will be started on liquids and slowly given solid food.

• Once home, drink plenty of fluids. Try soft, non-spicy foods as your medications may make you prone to gastritis and heartburn.

• Proteins, vitamins and minerals are important for wound healing.

• Diabetic patients should pay special attention to their diet as blood sugar levels may fluctuate during this time.

*Radiation for breast cancer should not affect your ability to eat. You can take a normal balanced diet.

*Eat a light diet before going to the radiation center. Keep a snack with you if you anticipate a wait.

*If you have gained weight during other treatments, restrict high calorie, fatty food.

*Do not take antioxidants/ vitamin supplements without consulting your oncologist.

On the day of planned chemotherapy, eat a light meal before coming to the hospital/ chemo center.

Lower Infection risk during chemotherapy by following safe food –practices as below

• Water should be filtered or boiled.

• Milk should be pasteurized.

• Leaves of vegetables be washed thoroughly

• Fruits should be cleaned and peeled & eaten.

• Avoid raw meat, raw eggs.

• Sprouts should be well cooked

• Home food is general y safer than eating out.

• Avoid thawing food: Perishables should be cooked or consumed immediately after removing from the fridge

• Clean surfaces, knives and utensils should be used to prepare food.

If you experience nausea/ vomiting:

Do not force-feed yourself.

Try to eat small portions of light food several times a day.

Ginger may help with nausea.

Avoid hot, fatty, spicy food.

Try cold liquids, cleaned and peeled fruits.

Light exercise may help improve appetite.

If you cannot maintain enought intake, you may need to be admitted to the hospital for hydration.

If you have diarrhea/loose stools: Keep sipping water and clear fluids. Try soups, juices, bananas to maintain hydration and electrolytes. If diarrhea persists, you may need to be admitted to the hospital for hydration.

FLUIDS: Water, Fruit juice, lime juice, coconut water, broth, buttermilk, lassi.

ELECTROLYTES: Bananas, fresh fruits

If you get Mouth Sores during chemotherapy:Try soft cold foods. Avoid nuts, seeds and others foods that have sharp edges. Ask your oncologist about medicated mouthwashes.

If you're experiencing constipation: Increase fluid intake up to 3liters a day. Ask your doctor to suggest medicines.

If you're gaining weight: Patients may gain weight from medications given during chemotherapy. Try avoiding rich fatty foods as this may exacerbate the weight gain. Continue walking and light exercise.

DO NOT take wheat grass juice or herbal supplements without consultation with your oncologist

Diagnosis of a Breast lump usualy needs a complete triple test. This includes

1) Clinical breast exam ie. Physical exam by a doctor

2) Age appropriate imaging: Mammography and or ultrasound

3) Needle biopsy for a definite pathological diagnosis

Breast cancer is often a painless lump. That being said, benign lumps like fibroadenomas and cysts can also be painless. Pain or lack therof is not a reason to ignore a breast lump. Any lump in the breast should be thoroughly investigated.

Mammography screening (Fig. A) often detects tumors that neither you nor the surgeon can feel by hand. It is imperative that image guidance is used in planning surgery for removal of such tumors. Use of ultrasound (Fig. B & C) in the operating room or wire-localisation technique enables surgeons to remove the exact area that bears the tumor

A fibroadenoma is a benign non-cancerous condition and does not convert to cancer. It is important to ascertain that a breast lump is a benign fibroadenoma with a combination of imaging and needle biopsy as needed.

Fibroadenomas that are small and not causing discomfort do not need treatment. Some fibroadenomas continue to grow while others regress or shrink on their own. If a fibroadenoma is growing, causing pain or other symptoms it can be surgically removed.

The gene defect responsible for hereditary cancer syndromes, if present is found in all cells of the body. A patient can hence provide blood , saliva or a cheek swab for testing.