 While 99% of breast cancer is diagnosed in women, one person can also occur in men and being a woman and getting older is the most important unmodifiable risk factor for breast cancer and that's going to happen to all of us, whatever we may do so. So the incidence of breast cancer will also increase as the population increases. Now as I said, potentially every lady is at risk of development of breast cancer but then there are some modifiable risk factors and some unmodifiable risk factors. The unmodifiable risk factors are gender, age, family history, age of menstruation, age of menopause which we can't do anything about and there are some modifiable risk factors. These modifiable risk factors are obesity, diet, lack of physical activity, tobacco and alcohol consumption and usage of some types of hormones. The most common symptom of breast cancer is a painless lump in the breast or underarm region. This may be or may not be associated with changes in the skin of the breast, there may be associated retraction of the nipple, there may be dimpling of the skin, there may be a blood stain spontaneous discharge from the nipple, sometimes there's a rash-like appearance of the skin of the breast. Any of these changes if you see please visit your doctor. Once a diagnosis of a breast cancer is made we have to know as to what stage the disease is so for that to happen we do something called as initially we do a mammogram to make sure we don't miss out on any other lumps in the same breast or on the opposite breast and for doing a proper staging we do something called as a pet CT to look for disease elsewhere in the body and once this is done based on the size of the tumor the location and the patient preference we give the patient options of surgery like a lumpectomy where in a breast is conserved the entire breast is not removed this is also called as a breast conserving surgery versus total mastectomy. So these are the precautions and once the surgery is done then we tell what next to be done. What do we mean by reconstruction? We take out one part of the breast either it is a lumpectomy where in a specific part of the breast that is lump along with margins is taken out so we need to rearrange the breast to get the best possible functional and cosmetic outcomes. This is called as oncoplasty if it is done it can be done by two methods one is called as local oncoplasty where we use the native breast tissue and rearrange it in such a way that the breast contour is reached again the second method is called as a volume replacement surgery wherein we use tissues from other parts of the body which can be from the surrounding areas like the back or from the abdominal wall that is specifically tram flap and df flap or implants also can be used yeah it depends on the patient's preference if the patient wants it to be done at the same setting we can do it then and there which is preferred if the patient decides to get it done later we can you know schedule it later at the end of the complete treatment. Well breast cancer is the commonest cancer in India both males and females combined as per the globe book and 2020 data so around one in eight women have a lifetime risk of developing breast cancer so that is an appalling figure the incidence of cancer in India overall is 100 for one lakh population and breast cancer it is 30 to 35 per one lakh population and most of it is in sixth or seventh decade post-menopausal women however younger women can also get breast cancer and in men also out of for every hundred females one male can get breast cancer. Around five to ten percent of breast cancers are hereditary and some features indicating hereditary breast cancer are aged less than 45 years multiple cancers on the same side of the pedigree in the family multiple cancer is in the same individual like breast and ovulation cancer in the same individual certain ethnicity like Ashkenazi Jewish population they have a higher incidence of mutations some specific types of breast cancer like triple negative breast cancer an unusual presentation of breast cancer like breast cancer in a male or bilateral breast cancer in a female these indicate hereditary breast cancer and there are very simple blood tests available nowadays which cost only a few thousand rupees which can determine whether it is a hereditary breast cancer and gene targeted therapy is also available nowadays well yes definitely the survival the quantity and quality of life both can be significantly increased even in stage for even though cure is not possible with newer treatment options such as targeted therapy hormonal therapy immunotherapy biological therapy so every patient deserves treatment not every patient require radiation after breast cancer surgery however all those patients who undergo breast conservative surgery would require radiation those patients who undergo mastectomy either as a choice or because of their disease pattern some of these patients may not require radiation those patients who have spread to the lymph nodes after mastectomy or those who have risk factors those would require radiation treatment even after mastectomy usually radiation does not cause much of side effects when we treat the chest wall or the breast region generally they have either heaviness of that breast or the tenderness in that region and they would be some skin darkening and pigmentation and patients typically they take radiation for 15 minutes and then they go back to work after completion of radiation even if they have some pigmentation of the skin it takes around a month for the side effects to subside by itself generally breast cancer treatment is a multi-modality treatment involving surgery radiation and chemotherapy so we generally advise these patients to wait at least for two years before they consider having a family the mastectomy is removal of the entire breast tissue so there are specific indications in breast cancer when the entire breast has to be removed for example when the breast cancer involves the entire skin or which we call as beauty orange or an ulcer is formed because of the tumor on the skin another indication would be if there are multiple sites of breast cancer in the same breast multiple cent multifocal disease as we call it breast has to be entire breast has to be removed another specific indication is known as inflammatory breast cancer where breast entire breast has to be removed after chemotherapy so these are the few situations where mastectomy is definitely indicated in breast cancer so recurrence rate means what are the chances of breast cancer coming back in spite of being treated in spite of undergoing complete treatment so the recurrence rate depends on the stage at which breast cancer is diagnosed so for stage one the cure rates is almost about 95 percent which means the recurrence rates are only about three to four percent so stage two in which the breast cancer could have spread to the glands lymph glands in the armpit or in the axilla as we call it the cure rates are almost about 85 80 to 85 percent which means the chance of it coming back is about 15 10 to 15 percent stage three in which the size of the tumor in the breast is more or it has already spread to the lymph glands so this the cure rates would come down to about 50 to 60 percent which means the chances of it coming back is about 40 to 50 percent the answer is a big yes we have a lot of success stories of women in their 30s and early 40s which is seems to be the age at which breast cancer is diagnosed nowadays who have completed successfully completed treatment and conceived so when they express their desire at the start of treatment to conceive in spite of having breast cancer they undergo a procedure known as ovum banking or embryo banking which will be used following the treatment the same ovum or embryo is used for them to conceive and generally the offsprings will not have any you know complications because the treatment which the mother has undergone due to breast cancer in the past the most common surgery for breast cancer used to be a mastectomy nowadays more and more women with breast cancer are being diagnosed at an early stage and the majority of them are able to undergo a lumpectomy a lumpectomy is also called breast conserving surgery or organ conserving surgery this is because the cure rates in early breast cancer are the same irrespective of whether a woman chooses to undergo a lumpectomy or a mastectomy a lumpectomy is the surgical removal of the cancerous lump in the breast along with a small margin of prestige it was also called breast conserving surgery or organ conserving surgery in mastectomy the entire breast along with the cancer is removed apart from a few exceptions most women with early breast cancer can undergo a lumpectomy rather than a mastectomy you know in addition to the obvious advantage of preserving the breast and therefore having a superior cosmetic and psychological outcome a lumpectomy or breast conserving surgery is also a smaller operation with a quicker recovery does recovery take after a breast cancer surgery the breast is a subcutaneous organ that means it lies just under the skin therefore surgical access is technically easy it does not require any painful or difficult incisions so recovery after breast cancer surgery is quite quick in fact most patients are admitted on the morning of the operation undergo the operation and a discharge on the next day some even are discharged on the same day as the day of surgery after surgery there is no restriction on diet or any kind of physical activity in fact some of our women have gone back to work the day following discharge normally we advise a few shoulder and arm exercises following surgery especially if we have done a reception of the lymph nodes in the abdomen radiation after breast cancer surgery is usually started within four to six weeks time this time period is given for to allow wound to heal and for the normal tissues to recover from the effects of surgery. Radiation treatment can vary according to the stage of disease while the total dose delivered remains more or less the same the area which we cover can undergo a change during early stage disease only the breast is covered for radiation whereas in advanced stages in addition to the breast the lymph node area also undergo radiation radiation therapy differentiates between cancer cells and normal cells by using what is called as fractionation fractionation means total dose is divided into few equal number of sessions delivered over few weeks and every five treatments are followed by a two-days gap during this gap the normal cells recover from the effects of radiation whereas cancer cells are unable to recover that creates a difference between the effect of radiation on normal tissues versus cancer cells the cause of breast cancer is due to an interplay of multiple factors which could be lifestyle factors dietary factors environmental factors acting on the background of genetic factors the common lifestyle factors we talk about others role of urbanization where we are having late pregnancies lesser children less breastfeeding and all these can lead to increased risk of breast cancer dietary factors using fatty diets especially with increased red meat increased use of alcohol also has an increased risk of breast cancer having less exercise not being very active a sedentary lifestyle also increases the risk of breast cancer and then there's always the genetic risk of breast cancer where 5 to 10 percent of patients carry genes mutations of BRCA one and two mutations which can increase their risk of lifetime risk of developing breast cancer and also cancers like ovarian cancer preventing breast cancer involves talking to women encouraging them to have a very healthy lifestyle we encourage them to exercise regularly having a diet which is less in red meat having a preventing obesity which can happen and preventing a lot of weight gain this kind of a lifestyle is protective for breast cancer also regular follow-ups and checkups for breast lumps is important if a woman carries a hereditary BRCA one or two gene mutation then there are a ways by which they can prevent breast cancer which may involve surgery called prophylactic mastectomy and also sometimes we use hormonal tablets to try and prevent breast cancer in this high-risk population