Dr. Shikha Panwar is a Leading Radiologist based in New Delhi
Breast cancer diagnosis and treatment have evolved tremendously over the last two decades. 3D- mammography or digital breast tomosynthesis (DBT) is the latest imaging technology for the breast cancer diagnosis, which has significantly improved the diagnostic accuracy of breast cancer detection even in women with dense breasts.
In this technology, multiple thin slice images of each breast are obtained and reconstructed into standard mammographic views, which help in the detection of small hidden cancer in the breast by reducing the superimposition of normal breast tissue.
The Amulet Innovality from Fujifilm is one such technology, which has the ability to detect breast cancer in early stages and the cancer detection rate is 30-41% higher than the conventional 2D-mammography.
Many of the patients complain that mammography is a painful examination because of breast compression. With the recent advancements in mammography technology, 3D-digital mammography images can be acquired with relatively less compression force (approx. 40-50% of the standard) with no negative effects and higher diagnostic accuracy compared to the conventional mammography, and thus is not a painful examination anymore.
Early detection is the key. Some causes of concern are lack of screening programs, awareness deficits, familial and social stigma, lack of priority given to a woman’s health and family support, financial constraints, poor access to healthcare facilities and late presentation at the breast clinic due to various reasons or myths. Very low awareness about breast self-examination (BSE) also leads to late presentation of patients with breast cancer and in advanced stages.
One of the main reasons for the abysmal outcome amongst Indian women is the advanced stage of breast cancer at presentation. In India, more than 50% women present with stage 3 or locally advanced breast cancer (LABC) at diagnosis. Delayed diagnosis, increases cost of treatment by 1.5 to 2 times and reduces survival rate 3-17 times.
Common presenting signs of breast cancer are painless palpable breast lump, skin thickening, crusting or scaling of the skin around the nipple areola complex, new onset nipple inversion & spontaneous bloody or watery unilateral nipple discharge. The symptoms may vary from patient to patient, but before the signs or symptoms develop, the cancer would have already been present for two to five years. This makes timely mammography screening at regular intervals a health priority.
Breast self examination every month and clinical breast examination by healthcare worker/specialist every year is recommended. Women aged 40 years or more should consult an oncologist or breast surgeon and after evaluation of their personal and family history as well as clinical examination, a plan for breast cancer screening should be formulated. Most of the standard guidelines recommend screening mammography for women aged 40 to 74 years, to be done once every 1 or 2 years.
In India, 60-70% of patients present in advanced stages due to various reasons. In the West, the numbers are at 20-30%. Breast cancer is a potentially curable disease and after completion of appropriate standardised treatment, a patient’s life is almost like normal healthy individuals. Early detection does not only improve the outcomes, but also drastically reduces the cost and duration of treatment. Earlier the detection of breast cancer, higher are the chances of cure.
