Breast Health Programme at S.G.P.G.I.
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1 Breast Health Programme at S.G.P.G.I. The first decade Department of Endocrine Surgery
2 Br.H.P.: Components Breast Clinic Surgery Resident training Research Community Education/ Awareness
3 Br.H.P.: Clinical Activities Breast clinic: 5 days a week Breast cancer Benign breast diseases Breast cancer screening: high risk groups Operative work load: 20% of all operative work of the dept. Highlights: breast conservation, reconstruction 80% of all minor surgical procedures
4 Research Experimental BrCa model in rat Iodine and breast diseases Lipid aberrations and BBD Prognostic markers in BrCa predictors of skeletal mets. Clinical research in BrCa: epidemiology prognostic markers. Participation in international clinical trials: ATLAS
5 Publications & Presentations 3 publications in international and 4 in Indian journals Lipid metabolism and BBD Dietary fat restriction for Tt of BBD Reports of unusual benign and malignant breast conditions 2 presentations in international and 6 in national conferences.
6 Community Breast Health Motto: SAVING LIVES AND BREASTS Awareness campaigns, public lectures Collaborations: NGO s, women organizations, public health planners Mobilizing support groups Information and counseling: Mass contact through print and electronic media Interactive education/ counseling: web-site, e.mail, IVRS
7 Community Breast Health Addressing social issues: ignorance, mis-information hesitation in seeking medical advise: Lajja alternative medicine/ quackery Lack of facilities, funds Re-habilitation ABC: message Not all breast diseases are BrCa BrCa is curable Screening, Early detection
8 Br.H.P.: Future Patient care: Aesthetic breast surgery, endoscopic Sx Digital mammography Image guided <stereotactic> biopsy Sentinel LN mapping & biopsy, lymphoscintigraphy, RIGS Intra-ductal endoscopy Tumor marker lab.
9 Br.H.P.: Future Teaching & Training: Specialist training,? diploma course Research: oncogenesis, newer therapeutic options iodine and breast diseases tumor angiogenesis, PCD & apoptosis molecular markers of prognosis : clinical application
10 Breast Clinic: Preliminary evaluation History and Physical FNAC? Lipid profile? Mammography? USG Guided FNAC Education-Breast Self Examination Follow up
11 BrCa: Multi Disciplinary Approach Surgeon Radiologist/ Nuclear Medicine Radio-therapist Pathologist
12 35 Carcinoma Breast n= Primary Recurrent * *upto June
13 BrCa: Demography n=232 ( ) Range: yrs Age No Pre-menopausal- 141 (60.7%) Post-menopausal- 91 (39.2%) Female 224 (96.5%) > Male 8 (3.4%)
14 Tumor Characteristics n=232 ( ) Right 107(46.12%) B/L 5 (2.1% ) Left 120( 51.7%) UIQ 23 ( 9.9%) Central 40 (17.2%) LOQ 42 (18.10%) LIQ 38 (16.3%)
15 Tumor Characteristics n=232 ( ) <2 cm- 13 (5.6%) 2-5 cm 68 (29.3%) >5 cm 115 (49.5%) Skin/Chest wall 51 (21.9%) Involvement Tx 36 (15.5%)
16 Lymphadenopathy n-232 ( ) Clinical Lymphadenopathy Positive 180 (77.5%) Negative 52 (22.4%) Histological Lymphadenopathy Positive 176 (75.8%) Negative 56 (24.13%)
17 CaBr: Staging (TNM/AJCC) n-232 ( ) Stage I T1No 9 (3.8%) Stage IIa T1N1, T2N0 23 (9.9%) Stage IIb T2N1, T3N0 47 (20.2%) Stage IIIa T0N2,T1N2 44 (18.9%) T2N2, T3 N1 Stage IIIb T4any N, Any TN3 53 (22.8%) Stage IV Distant Metastasis 25 (10.7%) Tx NxMx 31 (13.3%)
18 Distant Metastasis n-25 Metastatic work-up 99m Tc MDP Bone scan 99m Tc Sulfur colloid Liver scan s-alp, Abdominal USG Metastatic disease: Skeletal - 16 Visceral - 4 Distant LN - 5
19 CaBr: Hormone Receptors Status 33 patients over 18 mo ER-, PR- 19 (57.5%) ER+, PR+ 9 (27.27%) ER+, PR- 1 ER-, PR+ 4
20 CaBr: Operative Procedures Modified Radical Mastectomy 167 Radical Mastectomy 5 Toilet Mastectomy 12 Excision Of Recurrent Nodule 11 Axillary Clearance 11 Others 7
21 CaBr: Oopherectomy Indication Metastatic Disease in Premenopausal Total No- 30 Laparoscopic ( Mid 1998 ) Total No -4
22 Post-mastectomy Reconstruction n-9 (3.8%) Functional reconstruction for: Large surgical defect Post- radiation sinus Latissimus dorsi Flap- 8 No tumor recurrence No radiation necrosis Sub-optimal cosmesis TRAM Flap 1
23 Ca Br: Histopathology Infiltrating Duct Carcinoma 195 (84%) Medullary Carcinoma 7 (3%) Invasive Lobular Carcinoma 5 (2.15%) Papillary Carcinoma 1 Paget s Disease with IDC 2 Paget s Disease 2 Mucinous Carcinoma 2 Tubular Carcinoma 2
24 CaBr: Rare Pathological Types Male Breast Carcinoma 8 (3.4%) Malignant Cystosarcoma 4 (1.7%) Squamous Cell Carcinoma 2 (0.86%) Occult Carcinoma Breast 4 (1.7%) Fibro Sarcoma 1 Lymphoma 1
25 CaBr.: Conservative Surgery n-14 Wide local excision 8 and Axillary clearance Quaderentectomy and 6 Axillary clearance Indications Tumor size <5cm N0, N1 Non-multicentric Patient s desire
26 Ca Male Breast n=8 (3.4%) Mean age (range 50-70) Commonest presentation: Lump Stage III 6 TxN1 2 Histopathology IDC 7 Carcinoma in situ 1
27 Cysto-sarcoma Phylloides n=08 Benign 4 Malignant 4 Recurrence 5 MRM+SSG 5 MRM+LD flap 3
28 BBD (n= 542) New FUC
29 BBD: Symptoms Well defined lump 203 (37%) Mastalgia & Nodularity 237 (43% ) Pain 91 (16.7%) Nipple discharge 65 (11.9%) Galactorrhea 10 (1.8%)
30 BBD: Conservative Management (n - 414) Fat restriction with adequate calorific diet Breast Support Analgesic Breast Self examination Follow up Six monthly Partial Or Complete Response- 334 (80.6%)
31 BBD: Fine Needle Aspiration Cytology Total No of Patients 480 Fibroadenosis 288 (60%) Fibroadenoma 99 (20%) Atypical Epitheliosis 40 (8.3%) Fibrocystic Disease 26 (5.4%) Duct Papilloma 27 (5.6%)
32 BBD: Demography n- 128 Age range yrs. Age No (11.7%) (37.5%) (32%) (13%) >50 7 (5.4%)
33 BBD: Surgical Treatment n=128 ( ) Excision of Lump 92 (73.6%) Reduction Mammoplasty 15 (11.7%) Micro-dochectomy 13 (10.4%) Others 8 (6.4%)
34 BBD: Histopathology n-128 Fibroadenoma 35 (28%) Fibroadenosis 48 (38.4%) Gynecomastia 15 (12%) Duct Papilloma 14 (11.2%) Duct-ectasia 6 (4.8%) Inflammatory 10 (8%)
35 CaBr: Mammo Scintigraphy 99m Tc Sestamibi Total No -10, Recurrent -2, Pre-chemo. 8 99m Tc MDP Total No-30, Malignant 28, Benign - 2 Experience Limited Characterization of Suspicious mass Response to Neo-adjuvant Treatment
36 Mammography Classical signs: Clustered micro-calcification Stellate mass Indirect signs: Area of asymmetry Architectural distortion Dilated Duct Nipple and Skin changes
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