Risk Factors of Breast Cancer Among Women – A Cross-Sectional Study in Selected Slums of Bhubaneswar City, India

Background: Breast carcinoma is the most commonly diagnosed cancer (27·7%) and the leading cause of death (23·5%) among women in India as per GLOBOCAN 2018. There is considerable evidence that breast cancer risk is related to certain modifiable and nonmodifiable lifestyle factors. Thus, this study was conducted to estimate the prevalence of risk factors of breast cancer in women of age group 18-70 years in selected urban slums.Methodology: This community based cross sectional study was conducted in selected 13 urban slums of Bhubaneswar which comes under the field practice area of Department of Community Medicine, Bhuba-neswar, IMS and SUM Hospital Bhubaneswar, Odisha from September 2018 to October 2020. Data were entered to an excel sheet and SPSS software version 20 was used for analysis. Results: Among the total population of 300, the mean age of the study subjects was 42 + 12 years rang-ing from 20 to 69 years. Married women in the study were 95.3%. Including both modifiable and non-modifiable risk factors, 57% of the participants were having risk factors of breast cancer. Conclusion: Women need to be aware of both modifiable and non-modifiable risk factors for breast can-cer to adopt appropriate practices for prevention of Breast cancer.

Correlation of coagulation markers with axillary lymph node metastasis in breast malignancy: a tertiary care centre study in North India

Background: Breast cancer is the most common female cancer worldwide representing nearly a quarter (25%) of all cancers. Search for a marker which can predict lymph node metastasis in clinically negative axilla has been a matter of research for long. The present study is an attempt to evaluate role of coagulation makers with special reference to D-dimer and factor 7 and 8 in patients of carcinoma breast in predicting lymph node metastasis in carcinoma patients.Methods: The study was a prospective study conducted in 50 diagnosed patients of carcinoma breast in whom D dimer levels and factor 7 and 8 levels were measured at the time of commencement of the treatment and at six weeks after surgery.Results: Most of the patients in the study group were in the age group 41-70 (80%) years. 22% patients were of early Breast cancer. The reduction in D-dimer, factor VII and factor VIII value after 6 weeks of surgery were significant (p value 0.0001 for all three).Conclusions: D-dimer and factor VII were found to be an independent predictive factor for lymph node metastatsis, thus providing as a safe, easy, objective and convenient supplement to sentinel node biopsy in assessing metastatic disease in axilla. Combined- with other biomarkers, it may prove to be an alternative to sentinel node biopsy in assessing metastatic disease in axilla. Significant postoperative decrease in D-dimer, factor VII and factor VIII may provide objective criteria to assess completion of surgery.

Apocrine carcinoma of breast: a rare case report.

Apocrine carcinoma of breast is a very rare form of breast malignancy represent about 0.4% of all invasive ductal carcinoma (IDC). Though clinical presentation and gross appearance are indistinguishable from classic IDC, they have distinct cytological, histopathlogical and immunohistochemical features. Tumor cells are characterized by typical apocrine features large cells with abundant eosinophilic granular cytoplasm and large pleomorphic vesicular nuclei and prominent nucleoli. It tends to show estrogen, progesterone receptors and her2/neu negativity and show positivity for Gross Cystic Disease Protein Fluid -15 (GCDPF-15). We report a case of 65 year old female presenting clinically as lump in right breast in upper inner quadrant since four months and having similar cytological, histopathological and immunohistochemical features.

Preoperative Prediction of Ductal Carcinoma in situ Underestimation of the Breast using Dynamic Contrast Enhanced and Diffusion-weighted Imaging

OBJECTIVE: To investigate roles of dynamic contrast enhanced magnetic resonance (DCE MR) and diffusion-weighted (DW) imaging in preoperative prediction of underestimation of ductal carcinoma in situ (DCIS)> or =2cm on US guided core needle biopsy. MATERIALS AND METHODS: Twenty two patients with DCIS on US-guided 14 gauge core needle biopsy were included. Patients were divided into a group with and without DCIS underestimation based on histopathology. MR images including DCE and DW imaging were obtained with a 3.0-T MR. The lesion type (mass or non-mass), enhancement pattern, peak enhancement, and apparent diffusion coefficient (ADC) values of proven malignant masses were generated using software of CADstream and compared between two groups using Fisher's exact test and Mann Whitney test. RESULTS: Eight patients were in the group with underestimation and 14 patients were in the group without underestimation. The lesion type and enhancement pattern were not different between two groups (P values = 1.000 and 0.613, respectively). The median peak enhancement of lesions with underestimation was 159.5%, higher than 133.5% of those without underestimation, but not significant (P value = 0.413). The median ADC value of lesions with underestimation was 1.26x10(-3) mm2/sec, substantially lower than 1.35x10(-3) mm2/sec of those without underestimation (P value = 0.094). CONCLUSION: ADC values had the potential to preoperatively predict DCIS underestimation on US-guided core needle biopsy, although a large prospective series study should be conducted to confirm these results.

Importancia del programa de detección del cáncer de mama para estudiantes de medicina / Importance of the breast cancer detection program for medical students

La detección precoz del cáncer de mama es de gran importancia, por continuar siendo éste la segunda causa de muerte en la mujer cubana. Entre los programas del Sistema Nacional de Salud, el Programa Nacional de Estética, categoría dentro del concepto de lo bello, que según Aristóteles descansa en la armonía, la proporción y la medida, queda trunco en la mujer portadora de una cirugía radical (mastectomía). La mujer portadora de un cáncer de mama cuyo diagnóstico se ha realizado tardíamente, precisa de un tratamiento quirúrgico mutilante en su glándula mamaria y, por ende, afectando su esfera espiritual -psicológica, al provocar una influencia contraproducente en sus relaciones sociales. La práctica médica en la prevención de esta enfermedad es la utilización del programa de pesquisaje en la población femenina como única forma para el diagnóstico precoz de las masas ocultas de las glándulas mamarias por medio de la mamografía en toda mujer entre 50 y 64 años o con factores de riesgo conocidos. En nuestra práctica diaria durante 16 años, el autoexamen de las glándulas mamarias, así como la lucha por modificar los factores de riesgo como el hábito de fumar y la no lactancia materna son medios en los cuales nos basamos para el desarrollo de la cultura general de la comunidad, tarea importante en los estudiantes de Medicina.

The early detection of breast cancer is very important because it continues to be the second cause of death in Cuban women. Among the National Health Systems, the National Program on cosmetics with a category within the concept of beauty , which according to Aristoteles lies on harmony , proportion and measurement disappears in a woman who has undergone a radical surgery (mastectomy). A woman with a late breast cancer diagnosis needs a mutilating surgical procedure of the breast gland, and it damages her spiritual sphere with a contrary influence on the social relationships. The medical practice to prevent this condition is the use of a screening program in female population as the only way for the early diagnosis of the hidden masses of the breast glands by means of mammography in every 50 and 64 year old women or those with known risk factors. In our daily practice during 16 years the self examination of the breasts, as well as the attempts to change risk factors such as the smoking habit and the non breast feeding are means for basing the development of the community general culture, which is considered an important task in the medical students.

Clinical Evaluation of Nipple Discharge

PURPOSE: Nipple discharge is a disturbing symptom due to the fear of breast cancer, although approximately 95% of incidents of nipple discharge arise from benign causes. This study was designed to determine a proper approach for referrals with nipple discharge. METHODS: One hundred and ten patients who underwent surgery due to nipple discharge were included in the study. Clinical parameters, including age, characteristics of nipple discharge, clinical breast examination findings, mammographic findings and ultrasonographic findings were analyzed in association with the pathologic diagnosis of malignancy. A chi-square test and logistic regression test were used to assess the statistical significance of the results. RESULTS: The mean age of the patients was 44.8 year-old (range: 19-84). The most common cause diagnosed was intraductal papilloma of 58 (52.7%), followed by 18 fibrocystic changes (16.4%), 17 infiltrating ducal carcinomas (15.5%), 14 intraductal carcinomas (12.7%) and 3 duct ectasias (2.7%). The number of incidences of malignancy was 31 (28.2%). Bloody nipple discharge, nipple discharge with accompanying mass, abnormal mammographic finding and abnormal ultrasound finding were associated with malignancy in 43.2%, 55.6%, 50% and 66.7%, respectively, as compared with 11.5% in serous discharge, 22.6% in discharge without accompanying mass, 21.9% in normal mammographic finding and 52.9% in normal ultrasonographic finding, respectively. In a multivariate analysis of factors predicting malignancy, nipple discharge with accompanying mass and bloody nipple discharge were the independent risk factors. CONCLUSION: Triple examinations including physical examination, mammogram and ultramammography would be necessary for the complete evaluation of nipple discharge and surgical excision is mandatory in cases with suspicion of cancer.