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  • 1.  DR.ANANDA SELVAKUMAR. MD CONSULTANT RADIATION ONCOLOGIST MEENAKSHI MISSION HOSPITAL & RESEARCH CENTRE
  • 2.  Breast cancer became the commonest among urban scenario…becoming common in the rural areas too.(Lifestyle changes…?) According to ICMR statistics nearly one lakh breast cancers being diagnosed in india every year. More than 70% of them are diagnosed in advanced stage.
  • 3.  One out of every 22 Indian women is likely to get breast cancer during her lifetime. One Indian woman succumbs to breast cancer every ten minutes.
  • 4.  Breast cancer is becoming more common in younger women, with almost 50% of patients being women under 50. Younger women are showing an increased incidence of HER2+, a particularly aggressive form of breast cancer.
  • 5.  Being a women itself a high risk factor to get BREAST CANCER.
  • 6.  Don’t worry guys…..We are on top in LUNG CANCER.
  • 7.  Treatment of breast cancer has changed all over the world in all their aspects. ( surgery, radiation therapy, chemotherapy hormonal therapy & targeted therapy). Although the western countries are having higher incidence than ours…..we are on the top in mortality rates.
  • 8.  Any GOOD NEWS….????
  • 9.  Early detection is the only prevention.
  • 10.  Modifiable risk factorsa. Exercise.b. Low fat diet.c. Avoiding alcohol consumption.d. Avoiding hormonal replacement therapy.
  • 11.  Non modifiable risk factorsa. Sex and Increasing age.b. Genetic predisposition.c. Strong family history.d. Early menarche & Late menopause.e. Nulliparity.f. Age at first child birth.
  • 12.  Normal Risk :a. Age 20 to 40 years - Clinical breast examination (every 1-3 years) and breast awareness.b. >40 years - Annual Mammogram, annual clinical examination and breast awareness.
  • 13.  High risk : (Positive family history or Genetic predisposition…etc)a. Frequent clinical examination (every 6 – 12 months).b. Annual mammogram.c. Breast awareness.
  • 14.  Women should be familiar with their breasts and they should report to their physician , if they are getting any changes in it. Periodic breast self examination (BSE) should cover inspection and palpation of both breast, axillas and lower neck in various postures (erect, supine and bending forward).
  • 15.  Pre-menopausal women may find BSE more informative in immediate post menstrual period ( Breast will feel soft and non tender ).
  • 16.  Radiation therapy :A. Neo-adjuvant?..................Yes!B. Adjuvant? • Post mastectomy?..............Yes! • Post breast conservation?...........Yes!C. Metastatic?......................Yes!
  • 17.  YES………even I can do more here..!
  • 18.  Breast conservation is one of the mile stones in the management of breast cancer. Radiation therapy plays the pivotal role on it. We have a very solid evidence to promote breast conservation in early breast cancer (Lumpectomy with WBI ), and the results are equal with mastectomy.
  • 19.  Radiation therapy plays a vital role in most of the organ conserving protocols like cancers of breast, head & neck, anal, bladder, prostate, esophageal, lung, cervix, extremity sarcomas, and child hood tumors like RMS. The conformal techniques like 3D-CRT, IMRT,IGRT, & SBRT are more useful in delivering adequate dose to the tumor and lesser dose to the normal tissues.
  • 20.  Removing the tumor alone and sterilizing the remaining breast with radiation therapy is possible in all eligible early breast cancers.
  • 21.  In a highly selected low risk patients, in spite of treating their entire breast with radiation after lumpectomy , we can treat the lumpectomy cavity with 2 cm margins…! Bcz….most of the recurrence in this setup happens 1-2 cm in and around the lumpectomy cavity.
  • 22.  This technique is called accelerated partial breast irradiation. Small volume….higher dose…..and less treatment duration is possible here. It can be done with conformal EBRT, or HDR BRACHYTHERAPY.
  • 23.  Breast conservation not only maintains the appearance, it also maintains the confidence level, & relation ships in family and working environments. Even breast feeding is not contraindicated in a conserved breast.
  • 24. Even more powerful than mind andbody is the power of the spirit, thethird element for our survival.
  • 25.  Localized disease - 99% Loco regional disease -84% Metastatic disease – 23%
  • 26.  The 5-year relative survival rate is lower among women diagnosed with breast cancer before age 40 (84%) compared to women diagnosed at 40 years of age or older (90%). This may be due to tumours diagnosed at younger ages being more aggressive and/or less responsive to treatment
  • 27.  By avoiding four loco regional recurrences in 10 years, we can avoid one breast cancer death in subsequent 15 years .