 Hi everyone, I am Dr. Harish, Consultant Head, Department of Surgical Oncology, KMC Hospitals Mangaloe. October month is observed as breast cancer awareness month all over the world. We all know breast cancer is the most common cancer all over the world and also in India. So breast cancer is something which can be detected at an early stage and it can be cured once it is detected. So that is the main reason we all over the world this awareness program is done and most of the patients in India are presented at the later stage that is in stage 3 or stage 4 but other parts of the world most of the patients are presented in stage 1 or stage 2. So once the patient presents in early stage we have very good treatment available we can cure the disease. So that is the reason. So these kind of awareness programs are done. So all over the world they have done these programs and they are able to cure the same thing. So breast cancer is something which is preventable. So with normal healthy lifestyle in the sense having a good diet which can maintain your body mass index that is called BMI less than 25. So you can avoid obesity is the thing which can prevent breast cancer and also avoiding smoking alcohol can prevent breast cancer. New mothers can feed the child for at least one year if they are feeding for 2 years breast feeding is always good. If breast feeding is done at least for one year it is tend to it is known to reduce the risk of breast cancer. So breast cancer is a preventable cancer. So at the same time so what are all the signs and symptoms of breast cancer? So the common signs and symptoms of breast cancer are generally they present with a lump in the breast or lump in the breast along with nipple retraction or nipple discharge can be bloody discharge or serious discharge they can be an ulcer over the breast or there may be change in the shape of the breast that is called the symmetry compared to the opposite breast there may be any recent changes in the symmetry can also an important thing which they have to consult the doctor. So there are few advanced breast cancer symptoms like back pain they are having jaundice, having pain abdomen, abdominal distension, breathlessness all these things the difficulty in breathing all these things are the symptoms which are little advanced stage symptoms. So if somebody is having all these symptoms they have to consult the doctor immediately. So what are all the risk factors for this breast cancer? Breast cancer risk factors can be divided into modifiable and non-modifiable risk factors can advance the age that is post menopause a lady more than 60 years early menarche that is the menace which is starting at very early age and it is stopping at a very late age in the sense more than for 50 years. So that is called menopause if women having more than expected late menopause is one thing which can hormonal risk factor for breast cancer. Now a days females who are giving birth after the age of 35 is also a risk factor for if compared to a women who has given child birth before the age of 30 is a risk factor for breast cancer because there are lots of hormonal changes women who has been noticed. So other than that there are other family history something first degree family member is having breast cancer then the chance of other person in the family getting breast cancer is high. So there are few mutations like BRCA1, BRCA2 and P53 that is the genetic mutation HNPCC is a syndrome which runs in families these people can also have breast cancers. So any family history is there then they have to cancel the doctor immediately. So in this situation the other risk factors and this is modifiable risk factors are obesity, smoking, increased alcohol intake and few radiation exposure like people who are working in some factories who are known to get exposed to certain type of radiations they are also at higher risk factors and also previously it was hormone replacement therapy which is having more estrogen level. Nowadays the recent hormone therapy is having less estrogen so it is there are hormone replacement therapies was one of the risk factor nowadays it is not. So these are few modifiable risk factors if the patient comes with all the symptoms which I have mentioned before then there are certain tests we are doing at the hospital level that is one is the clinical examination. Clinical examination means it is a doctor who is doing the examination there is one more thing called self breast examination where the patient themselves examination of the breast. So at least once a month six steps in that so you can do yourself at least what the recommendation is at least once a month self breast examination is important. So now mentioning is the clinical examination. So clinical examination is more important than self breast examination because so many trials over this whether self breast examination itself is enough so it is not so it is always any if you have suspicious of any of any lump or ulcer or discharge you have to consult the doctor immediately. So that is where you have to visit the hospital. So where a doctor will do the examination that is called clinical examination. So in clinical examination we will see whether the lump is having is it cancerous or not then we do other imaging like one more imaging is the mammogram or MRI depending on whether family history is there or patient is whether the if the patient is very young 25 to 30 years MRI is the best or any family history having BRCA mutation in family or the person is known to have genetic mutation then the MRI is best better than mammogram otherwise for most of the people we generally recommend mammogram. So once you do the imaging the next test is the biopsy. Biopsy can be true cut biopsy or FNSE generally true cut is preferred over FNSE because we can do other markers IHC markers over the specimen. So these are the three tests that is clinical examination imaging and biopsy that is called triple test which can be done within 30 minutes in a good hospital. So it is possible to identify breast cancer in one day and so that you can take a better treatment. So early detection is the main thing in breast cancer. So once you detect the breast cancer so then next step is the treatment staging. Staging wise you have to do staging one to stage one to stage four stage four is something metastatic so it is already spread to other organs stage one and stage two are early breast cancers. So we do either CT scan plus bone scan or a PET scan so that we can identify whether it has spread to other organs. Once the stage is identified the next best treatment surgery chemotherapy radiotherapy hormonal therapy and targeted therapy. So a patient who is surgery is the main modality of treatment because all the stages except stage four there are few patients even in stage four requires surgery. So other treatment modalities we call them as urgent treatments so where they are actually helping surgery along with surgery we are giving other treatments so that the recurrence chances are less or we are able to reduce the risk of recurrence in those patients and increase the survival. So in this situation surgery can be either total removal of the breast that is the total mastectomy that is or you can remove the partial removal of the breast that is called the breast conservation surgery. So it is possible to conserve breast in patients who are early breast cancers and there is no increase in the risk compared to total removal because most of the patients require radiotherapy along with breast conservation surgery so that we call it as breast conservation therapy so it is almost equal to recurrence wise no difference in mastectomy. So chemotherapy is something which we are giving along with surgery most of the patients require chemotherapy except few early breast cancers and there are nowadays there are tests like oncotype DX and mamma print and also can assist which can help few patients whether they can require chemotherapy or not we can completely avoid chemotherapy in some of the patients who are hormone receptor positive and heart to negative patients. So chemotherapy is having some of the complications but they are not intolerable it is possible to take complete chemotherapy hair loss is something many of the patients are worried but most of the times after 6 to 8 months of treatment most of the patients regain their hair growth so it is not a worry. So other than that the other treatment options are hormone therapy it is a we generally give tablets that is called tamoxifen or letrasol depending on the menopausal status. So these are tablets which are given for 5 to 10 years they are actually protective so it is good if some patient is ERP or positive and they are taking these tablets. Another thing is the radiation therapy as I mentioned locally advanced breast cancers or breast conservation surgery patients generally require radiation and it is also it has some of the complications but it is not like it is possible for all the patients to complete most of our patients in our hospital who have come across last year are alive who are leading normal life even after taking all the treatments which are mentioned and we are very happy in that sense that we have saved so many lives because cancer is not a simple thing so that is the reason we are here for this awareness program. Target therapy is something where transitive sumab is given it is an injection nowadays there are other targeted therapies also like patu sumab and other things who are had to positive they require transitive sumab and it is available in most of the centers even in nowadays in government centers these are these things are available if had to positive patient is there definitely they require this therapy for one year one in 17 cycles of injections once in three weeks so it is possible to give all these treatments with minimal complications in a good center so the most important thing about this program is spreading the awareness in the sense it is possible to prevent the cancer that we should all be aware at the same time we can diagnose this breast cancer at an early stage especially to look at the other part of the world most of the patients are at early stage but in India we are actually lagging behind we are the diagnosing this cancer at a later stage if we diagnose at early stage we can cure the cancer and we can save the life so the most important thing is that I pray for most of the people who are around who are watching this to have healthy life adopt healthy lifestyle so that we can avoid this cancer not only cancer healthy lifestyle can avoid cardiovascular diseases other cancers like endometrium GA cancer gastrointestinal cancer so definitely that is one of the method to avoid cancers thank you for watching