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Breast Cancer-5


Welcome to part 5 of educational series on breast cancer. In fourth part, we learned about strategies for prevention of breast cancer in women who are average risk.

Question: Before we go ahead, I would like to ask you a query raised by one of our readers. Dr. Anilbhai Mehta, from Nadiad has raised an interesting question about role of tumor markers in early diagnosis of breast cancer?

Answer: Thank you Dr. Anilbhai for this important question. It would be nice to have a simple blood test to make diagnosis. However, at present there is NO one blood test or a series of blood tests that can definitively establish diagnosis of breast cancer or rule out such a diagnosis if negative. These tests e.g. CEA or CA 15-3 have a limited but useful role in the follow up of some patients whose cancer has spread. This question is important since often patients get a profile of blood test when they feel a breast lump. When they find that all tests are normal, they consider that they cannot have a serious illness like cancer, and do not go for further evaluation.

Que: Now Dr Shah, what can a “High Risk” woman do to Prevent Breast Cancer?

Ans: “High Risk” women are as defined in last part. Approach is individualized and a detailed counseling is necessary. Since options include radical surgical options, and few medical therapies, a complete discussion of pros and cons is important. Note that diagnosis of BRCA1/2 mutation is available in India, with a simple blood test, although expensive at this time.

Following options are available to reduce risk of breast cancer.

  1. Mastectomy – Bilateral Radical: reduces risk by more than 90%. The psychological impact needs discussion. Women with extreme fear of breast cancer prefer this option, however. Mastectomy can be followed by immediate or delayed breast reconstruction plastic surgery, reducing psychological impact.
  2. Salpingo Oophorectomy – Bilateral: after child bearing. Reduces risk of breast ca by over 50%. It is also recommended in patients with BRCA1/2 as they have a high risk of ovary/fallopian tube cancer as well, and there are no good tests to diagnose ovary ca at an early stage.
  3. Tamoxifen – an oral hormonal agent, for 5 years. In women defined as High-Risk in last article, as well as in women with moderate risk defined by score on GAIL model, women with atypical hyperplasia in breast biopsy. Benefit in High-Risk women, especially with genetic abnormality, is not well defined and hence surgical options are preferred. Reduces risk of breast ca by about 40%. Long term benefit i.e. after 7 years, is not known. Tamoxifen has small but significant risk of deep vein thrombosis/pulmonary embolism, uterine cancer. This is important as drug here is being used in otherwise healthy women.

Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA),
Diplomate American Board of Oncology and Hematology.
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad. 079 26754001