By: Dr. Jyoti Arora
Every four minutes, a woman is diagnosed with breast cancer in India (Cancer India Statistics report). Additionally, one in every 28 Indian women is likely to develop breast cancer during her lifetime. Specifically, in the Indian context, breast cancer is the reason behind the highest number of cancer mortalities— 14% of all cancers in women.
At such high incidence rates of breast cancer, another startling report by the All India Institute of Medical Sciences highlights the early onset of breast cancer in women. The report states, “almost 35% of patients diagnosed with HR+ breast cancer and HER2-negative disease are under the age of 40.” Unfortunately, in Indian population, cancer is picked up late when the treatments are not very effective. Hence, the time is now to accelerate measures to detect and treat breast cancer in the initial stage itself.
Conventional procedures to detect malignancies (abnormal growth of breast cells) involved undergoing an open surgical excision of the suspected lesion. If the cancer is confirmed, then a second surgery is needed. However, over the course of time, science has ushered a new ray of hope with minimally invasive procedures, reducing the risk of associated morbidities with an open excision. Before starting the management of perceived breast cancer, it is important to confirm the diagnosis by tissue sampling, which can be done by placing a small needle through the skin into the lump and removing a tiny bit of the lump to know its exact nature.
First response: Understanding the symptoms of breast cancer better
Traditionally believed to hit women in post-menopausal stage, breast cancer is equally a threat in the pre-menopausal stage. “Younger patients have been of particular concern because breast cancer is known to be more aggressive and to be associated with poorer prognosis in younger women than in older women,” claims The New England Journal of Medicine.
It is therefore imperative to understand the medical condition completely in order to address it with reliable diagnostic solutions. From lumps, change in the size, shape or appearance of a breast to nipple discharge and flaking of the pigmented area surrounding the nipple (areola), the early symptoms of breast cancer can vary from one patient to another. Throughout the medical fraternity, oncologists stress on the need for early screening of malignancies to begin treatment and manage the persistent outgrowth of cells.
What we must understand is that ill effects of breast cancer are highly preventable by early detection of cancerous cells helping in minimising mortality risks. At the initial observation stage, a patient is recommended mammogram to screen for abnormalities that are too small to be seen or felt. However, a mammogram is not capable of detecting all kinds of breast cancers, which is why we need advanced screening procedures to root out any leftover malignancies. Take, for instance, when women with dense breasts (presence of more fibrous and glandular tissue) undergo a mammogram, the glands appear white and can obscure the appearance of tumours, which also appear white. On the contrary, non-dense breast tissue shows up as dark areas and it is easy to detect white tumours on the dark background.
Hence, along with educating women about the medical condition, it’s also necessary to elevate public perception of the need for opting early detection measures. By promoting an environment that advocates for early screening for malignancies, we can significantly reduce the disease burden.
Addressing breast cancer with smarter innovations: Vacuum Assisted Breast Biopsy (VABB)
One of the reasons why a lot of women are diagnosed only in the later stages of breast cancer can be because of the highly complex and heterogeneous disease profile. Since initial signs are almost invisible to the naked eye, it makes it even more necessary to voluntarily opt for regular screening procedures.
The advancements in the field of oncology have now made it easier to target various subsets of breast cancer with specific therapeutic procedures. Take, for instance, the Vacuum Assisted Breast Biopsy (VABB). Not just an accurate diagnosis, VABB prevents the chances of missing small cancer, which is a problematic area with routine biopsy technique. Let’s understand how technology like VABB can benefit patients at risk of progressing to later stages of breast cancer. A breakthrough in breast cancer diagnosis, VABB requires a single insertion into the breast to collect enough specimen to provide an accurate visualisation of the lesion, howsoever small it may be.
While still at a nascent stage in India, VABB is regarded as the cornerstone of innovative breast lump sampling techniques across developed countries. An alternative to painful and risky surgical procedure, VABB is a minimally invasive procedure with proven clinical results. It can be used under sonographic, mammographic, and magnetic resonance imaging guidance, allowing a doctor to have access to even the tiniest of abnormalities in the breast tissue. Performed under local anaesthesia, the procedure is extremely safe and risk-free.
As no two patients represent identical lesions, the technique can be useful for the detection of benign as well as malignant breast lesions. Using a single tiny incision, VABB ensures minimum scarring on the skin/breast. Infect, the benign lesion can be completely removed using this technique waving off the need to perform open surgery under general anaesthesia. This can be done as an OPD based procedure and the patient can continue with their routine work.
With the development in vacuum-based techniques to detect the presence of small lumps in the breasts, management of breast cancer has been revolutionised.
Minimally invasive and safe techniques such as VABB have shortened the time lapse between detection and diagnosis of breast cancer. As things stand, the future of breast cancer management rests on smart technologies that aid in the safe and accurate diagnosis of lesions and help reduce the disease burden. Hence, it’s time to address one of the most highly preventable forms of cancer deaths with innovations which promise results.
About the author
Dr. Jyoti Arora is the Associate Director-Radiology at Medanta, The Medicity Hospital, Gurgaon. She is a CCST (UK), FRCR (London) with MD and DMRE Radiodiagnosis. She has sub-specialty training in Breast Imaging and Radionuclide Radiology