Breast Surgeon in Pune | Dr.Vinod Gore

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Looking for Breast Surgeon in Pune ? Get proper diagnosis and treatment on breast Cancer by highly experienced Breast Surgeon in Pune Dr.Vinod Gore

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Breast cancer : An emerging epidemic and screening for the Indian subcontinent - DR. VINOD GORE SURGICAL ONCOLOGIST

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Breast Cancer The most common form of cancer among women The second most common cause of cancer related mortality One third of women with breast cancer die from breast cancer Asia–Pacific region, including India, has experienced a more rapid rise in the annual incidence , and mortality

The Numbers Don’t Lie:

The Numbers Don’t Lie Breast cancer impacts over 240,000 new patients a year in the United States alone. Approximately every 3 minutes a woman is diagnosed with breast cancer and approximately every 12 minutes breast cancer claims another life. 70% of breast cancer cases occur in women who have no identifiable risk factors.    

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Age shift: Breast cancer now more common in 30's and 40's

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Breast Cancer Survival rates Five-year localized survival rate 97% Five-year regional survival rate 78% Five-year distant survival rate 21%

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Warning signs and symptoms Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle Change in the size, shape, or contour of the breast Blood-stained or clear fluid discharge from the nipple Change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly, or inflamed) Redness of the skin on the breast or nipple Early breast cancer may not have symptoms.

Factors that increase risk:

Factors that increase risk Family History Lifestyle Personal History

Lifestyle:

Lifestyle Several studies found a lower incidence of breast cancer among women who exercise regularly Higher proportion of breast cancer among obese women. There is increased risk of breast cancer with increased alcohol use (i.e., 3 or more drinks per week); perhaps due to the fact that alcohol increases blood estrogen levels.

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Risk Factors for Breast Cancer Female (1% male) Aging Relative (mother or sister) Menstrual history early on set late menopause Child birth After the age of 30

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Exogenous Estrogen Hormonal replacement therapy(HRT) 30% increased risk with long term use Oral Contraceptives(OC) risk slight risk returns to normal once the use of OC’s has been discontinued

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Breast cancer screening tests Breast self examination (BSE) Clinical breast examination (CBE) Mammography

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Clinical Breast Examination Performed by doctor or trained nurse practitioner Annually for women over 40 At least every 3 years for women between 20 and 40 More frequent examination for high risk patients

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The Procedure Explain what you will be doing Ask if she does breast self exam Warm your hands Assure privacy Would someone else in the room be helpful? Assist patient to supine position

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Palpation Variables important in palpating the breast correctly are patient position breast boundaries examination pattern finger position, movement, and pressure duration of the examination

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Patient Position Clinical breast examination requires flattening breast tissue against the patient's chest Patient is supine during the examination

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Breast Boundaries Breast tissue extends laterally toward the axilla and superiorly toward the clavicle Cover a rectangular area bordered by the clavicle superiorly, the midsternum medially, the midaxillary line laterally, and line passing through xiphisternum inferiorly

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Examination Pattern Palpation begins in the axilla and extends in a straight line down the midaxillary line to the inferior axis line The fingers move medially, and palpation continues up the chest in a straight line to the clavicle Rows should be overlapping

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Technique The 3 middle fingers are held together, with the metacarpal-phalangeal joint slightly flexed Pads of the fingers are the examining surface Each area is palpated by making small circles using 3 different pressures—light, medium, and deep

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Duration 3 minutes recommended for each breast Average actual time spent is 1.8 minutes Discuss with patients the time needed to do a complete examination and discuss the procedure during the examination

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Screening by Clinical Breast Examination Statement of benefits: Based on fair evidence, screening by clinical breast examination reduces breast cancer mortality http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional

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Breast Self Examination Opportunity for woman to become familiar with her breasts Monthly exam of the breasts and underarm area May discover any changes early Begin at age 20, continue monthly

Breast Self Exam Information:

It is easy to do and the more you do it, the better you will get at it. When you get to know how your breasts normally feel, you will quickly be able to feel any change, and early detection is the key to successful treatment. A breast self-exam could save your breast - and your life. Most breast lumps are found by women themselves, but in fact, most lumps in the breast are not cancer. Breast Self Exam Information

When to do a Breast Self-Exam:

When to do a Breast Self-Exam The best time to do breast self-exam is right after your period, when breasts are not tender or swollen. If you do not have regular periods or sometimes skip a month, do it on the same day every month.

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Breast Self Examination There are two parts to the BSE Looking Feeling

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Looking in the mirror

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Lump Any new lump or hard knot found in the breast or armpit Any new lump or thickening that does not shrink or lessen after your next period

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Change in Skin Color, Size or Texture Any change in size, shape or symmetry of your breast Any thickening or swelling of the breast

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Skin Dimpling Any dimpling, puckering or indention in the breast Dimpling, skin irritation or other change in the breast skin or nipple

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Changes in Nipple Redness or scaliness of the nipple or breast skin Nipple tenderness or pain Nipple retraction; turning or drawing inward or pointing in a new direction

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Nipple Discharge Any fluid coming from your nipples other than breast milk, particularly if the discharge is bloody, clear and sticky, dark or occurs without squeezing your nipple

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Feeling Examine each breast separately Use pads of fingers not the tips Examine the armpits

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Feeling Finger Use Use the pads of your middle three fingers to feel the texture of your breast Your finger pads are the top third of each finger, not the tips

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Feeling

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Patterns

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When using any of the 3 patterns, you should always be using a circular rubbing motion (in dime-sized circles) without lifting up your fingers.

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Screening by Breast Self-Examination Statement of benefit Based on fair evidence, teaching breast self-examination does not reduce breast cancer mortality http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional

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Mammography Sensitivity From 53% to 92% in western countries* Low in pre-menopausal women (from 44% to 76 % in women <50*) Specificity From 82% to 98% in western countries* Mammography requires quality control Continuous Training and Monitoring, Double reading *IARC handbook of cancer prevention

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WHY IMAGING ? Size of lump detected with routine mammogram (1.1cm) Average-size lump found by breast self-exam (2.1 cm) Average-size lump found accidentally (3.6 cm)

Indications and potential role of mammography :

As a screening tool A screening mammogram is an x-ray examination of the breast in a woman who has no symptoms. The goal of a screening mammogram is to find cancer when it is still too small to be felt by a woman or her doctor. Effective in women above age of 50 yrs. Indications and potential role of mammography

EVIDANCE:

EVIDANCE 23% benefit above 40 yr age –statistically significant. 14% benefit for all ages –not sta.significant Cancer 1995:75:1619-26 24% reduction in cancer related mortality Swidish trial-LANCET 1993, 341:973-978

Initial Study Results:

Initial Study Results Controls Screening N 31,000 20,000 Cancers 284 223 Node negative 46% 63% Mortality 30% reduction Strax, Venet and Shapiro, Value of mammography in reduction of mortality from breast cancer in mass screening, AJR. 117:686(1973)

Additional Studies:

Additional Studies HIP 1963 Malmo 1976 Swedish Two County 1977 Edinburgh 1978 CNBSS-1 1980 CNBSS-2 1980 Stockholm 1981 Gothenburg 1982

Mortality Reduction:

Mortality Reduction 50-69 y.o.: mortality reduction 16-35% 40-49 y.o.: mortality reduction 15-20% Lower incidence Rapidly growing tumors Dense breasts

Mortality Reduction:

Mortality Reduction Due to detection of cancers at smaller size/earlier stage Mammographically visible 3-5 years before palpable Increased detection of DCIS Not just “lead time bias” Early stage disease is curable

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STANDARD VIEWS

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Ill defined margins

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The margins of the solitary Mass is lobulated , undulation is better appreciated on magnification

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Round lesion, ill defined margins

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Focal architectural distortion resembling mass

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Multicentric Carcinoma

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Irregular & polymorphic, branching and heterogeneous in size and morphology Pleomorphic/Heterogenous Reticular

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Invasive ductal carcinoma

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Mammographic Abnormalities 1. Mass 2. Microcalcifications 3. Asymmetric Density

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Screening by Mammography Statement of Benefit: Based on fair evidence, screening mammography in women aged 40 to 70 years decreases breast cancer mortality The benefit is higher for older women, in part because their breast cancer risk is higher http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional

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Mammography American Cancer Society recommends: Women (asymptomatic) 40 years of age and older should have a mammogram every year .

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Symptoms of Breast Cancer

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Abnormal signs and symptoms Puckering Dimpling Retraction Nipple discharge Thickening of skin or lump or “knot” Retracted nipple

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Abnormal signs and symptoms Change in breast size Pain or tenderness Redness Change in nipple position Scaling around nipples Sore on breast that does not heal

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Thank You

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