Breast Cancer

Breast Surgeon in Pune – Dr. Amol Dumbre

Dr. Amol Dumbre is one of the leading Breast Cancer Specialist in Pune. He has been practicing in Pune as a surgical oncologist for the last ten years. He is the best Breast Cancer Specialist in Pune and works as a senior cancer specialist at Noble Hospital and Ruby Hall Clinic. Both Hospitals are very popular and trustable. He has trained and done his research fellowship from the Tata Memorial Hospital. During this period he was trained extensively in many aspects of cancer surgery. He was also involved in teaching programs. He is the best Breast Surgeon in Pune who is also a fellow in Minimal access surgery which is breast surgery. His main area of interest is breast cancer surgery.

Breast Cancer

Breast cancer is the most common of all cancers and is the leading cause of cancer deaths in women . Worldwide, accounting for >1.6% of deaths and case fatality rates are highest in low-resource countries. A recent study of breast cancer risk in India revealed that 1 in 28 women develop breast cancer during her lifetime. This is higher in urban areas being 1 in 22 in a lifetime compared to rural areas where this risk is relatively much lower being 1 in 60 women developing breast cancer in their lifetime. In India, the average age of the high-risk group in India is 43-46 years. In the west where women aged 53-57 years are more prone to breast cancer.

Breast Cancer Specialist in Pune | Breast Cancer Surgeon in Pune

What Are Symptoms And Signs Of Breast Cancer?

  • A lump felt by the patient or during routine physical examination or mammography.
  • Less commonly, the presenting symptom is thickening in the breast. Paget’s disease of the nipple presents with skin changes, including erythema, crusting, scaling, and discharges.
  • A few patients with breast cancer present with signs of metastatic disease (eg, pathologic fracture, pulmonary dysfunction).
    During a physical examination, a lump is felt distinctly different from the surrounding breast tissue. More advanced breast cancers are characterized by fixation of the lump to the chest wall or to overlying skin, by satellite nodules or ulcers in the skin. Matted or fixed axillary lymph nodes suggest tumor spread. Inflammatory breast cancer is characterized by diffuse inflammation and enlargement of the breast, often without a lump, and has a particularly aggressive course.

Risk Factors

The risk factors influencing breast cancer risk are broadly classified into two factors:

  1. Modifiable factors: The modifiable risk factors are BMI, age at first childbirth, number of children, duration of breastfeeding, alcohol, diet, and number of unsuccessful pregnancies ( abortions).
  2. Non – Modifiable factors: The non-modifiable risk factors are age, gender, number of first degree relatives suffering from breast cancer, menstrual history, age at menarche and age at menopause. 

Screening

Women with a higher than average risk of developing breast cancer may be offered screening and genetic testing for the condition. NHS Breast Screening Programme recommends that women between 50-70 years of age should be screened once every three years. Screening is especially recommended for women with risk factors, a significant one being a family history. Having a 1st-degree relative (mother, sister, and daughter) with breast cancer doubles or triples the risk of developing cancer. About 5% of women with breast cancer carry a mutation in one of the 2 known breast cancer genes, BRCA1 or BRCA2.

If relatives of such a woman also carry the gene, they have a 50 to 85% lifetime risk of developing breast cancer. Heightened awareness of breast cancer risk in the past decades has led to an increase in the number of women undergoing mammography for screening, leading to the detection of cancers in earlier stages and an improvement in survival rates. Approximately 20% of the cancers detected in a given year will be missed at the screening but will become clinically evident in the period before the next screen (interval cancers).


Pathology

The various abnormalities of the breast include nipple discharge, inflammations, ANDI, benign disorders, phyllodes/sarcomas, and carcinoma. Most breast cancers are epithelial tumors that develop from cells lining ducts or lobules; less common are nonepithelial cancers of the supporting stroma (eg, angiosarcoma, primary stromal sarcomas, phyllodes tumor). Cancers divided into two part  carcinomas in situ and invasive cancer. Paget’s disease of the nipple is a form of ductal carcinoma in situ that extends into the overlying skin of the nipple and areola, manifesting with an inflammatory skin lesion and may become invasive.

The pathological variations of breast cancer influence the prognosis. In situ cancers (DCIS/LCIS) are slow growing, indolent tumors. Autopsy studies have indicated that the incidence of DCIS in asymptomatic women ranges from 0.02% to 18.2% indicating that some DCIS does not become evident during a women’s lifetime. Invasive carcinoma is primarily adenocarcinoma. About 80% is the infiltrating ductal type.

Most of the remainder is infiltrating lobular. The pathological variants with favorable prognosis are tubular, cribriform, mucinous and adenoid cystic variants, while the intermediate prognosis is seen with medullary, secretory and invasive lobular cancers. The most unfavorable pathology is high grade metaplastic, micropapillary, signet ring cell morphology, inflammatory cancer.


Pathophysiology

Breast cancer invades locally and spreads initially through the regional lymph nodes, bloodstream, or both. Metastatic breast cancer may affect almost any organ in the body. Most commonly, lungs, liver, bone, brain, and skin.


Diagnosis

The triple assessment includes clinical examination, radiological investigation, and pathological correlation.

Radiology

Mammogram, ultrasound

Diagnostic mammography is a standard procedure done. as part of the triple test for diagnosing breast cancer. However, the efficacy of diagnostic mammography is anecdotal.

Often, the lump is not even visible on the mammogram or a lump is visible on a mammogram, but the appearance may be indeterminate. If the lesion is clinically suspicious and is not a cyst by ultrasonography or aspiration. then a biopsy is indicated despite the mammographic results. In this case, the mammogram adds little to the diagnosis. Its main use is for screening, the rest of the breast and the contralateral breast for unsuspected cancer.

The lump may have a classic appearance of a benign calcifying fibroadenoma, mixed radiographic density hamartoma, or fat lesions such as fat necrosis or a lipoma. The appearance of these lesions can be used to avoid a biopsy so that in these cases, the diagnostic mammogram is very helpful.

The lump may have a classic appearance of breast cancer and biopsy is clearly indicated. In this case, the mammographic findings could prevent a delay in diagnosis, by making it clear that a biopsy is needed.

Magnetic Resonance Imaging

MRI is useful to locate a suspicious mammographic lesion that cannot be located by CBE or ultrasonography. Especially useful in young women with dense breast, women with an implant in situ, previously operated breasts, recurrent lesions, wherein mammography may not be accurate.

Pathology

Needle Biopsy / FNAC

Confirmation of malignancy with cytology or histology is the minimum requirement for “indeterminate” or “high-risk” solid lesions.

Fine-needle aspiration / Tru cut/core biopsy / surgical excision/ Incision biopsy / percutaneous breast biopsy, for a non-palpable disease,  the various methods used to obtain tissue for pathological confirmation.

If a woman is being treated with neoadjuvant therapy. it is essential to perform a biopsy, to obtain the ER/PR status of the tissue.


Treatment

Breast cancer can be treated using

  • a multimodality approach of surgery
  • chemotherapy
  • radiotherapy 
  • targeted therapy 
  • hormonal therapy

The treatment options vary as per the stage of the tumor. Dr. Amol Dumbre is one of the leading Breast Cancer Specialist in Pune. He has been practicing in Pune as a Breast Cancer Specialist for the last ten years. He is the best Breast Cancer Specialist in Pune


Surgical options

  • Breast Conservation Surgery.
  • Modified Radical Mastectomy.
  • Mastectomy with Reconstruction.