Keywords : breast cancer
Cancers of the breast and uterine cervix are the two most common cancers in women. Breast is regarded as a symbol of feminity; there is a high degree of emotional attachment to this organ. Women are frightened of this cancer. Many feel that the treatment and its sequela are worse than the disease . This results in delay in diagnosis and initiation of treatment. Women often consult their gynecologist for their breast problems. They are more comfortable with their gynecologist, who has treated them earlier for pregnancy or benign gynecological problems, than with an oncologist. The gynecologist has to reassure the woman, if she has benign breast disease, or worried about cancer. On the other hand, if she has a suspicious lesion or frank cancer, the gynecologist should guide her to seek appropriate treatment without any delay.
Tremendous advances have been made in the detection,
diagnosis and treatment of this disease. Progress has
been made at the molecular level and in genetics of breast
cancer. There has been a paradigm shift in our approach
to breast cancer. Fifty years ago, the oncologist had only
one aim, to save life at any cost. Radical mastectomy was the gold standard of treatment. It was a sacrilege
even to question its rationale.Today, our objective is not
only to save life, but also to preserve cosmesis and
function. In the case of breast cancer, it means cosmetic
considerations and restoration of the body image. The
object of this article is to review our status of knowledge
and practice of management of breast cancer.
Breast cancer is the most common cancer in women in the developed countries. It is estimated that nearly a million new cases of breast cancer are diagnosed annually all over the world" .Its incidence is increasing, perhaps due to the adoption of Westem lifestyle. In USA, 183000 new cases are detected annually- .In India, it is estimated that about 80000 new cases of breast cancer are seen every year- .Fig. 1 shows the incidence of this disease in North America, Europe, Africa, Mumbai, Delhi, Chennai and Barsi in rural Maharshatra" .In Mumbai, Delhi and Kerala, it is the commonest form of cancer in women. In rest of India and particularly in rural areas, cancer cervix is the number one cancer. Breast cancer is a disease of the affluent and has a high incidence in developed countries, urban areas and in higher strata of society. In contrast, cervical cancer is more prevalent in rural areas and in the low socioeconomic strata of our society. There is also a high incidence in the Parsee community, and in single and nulliparous women"
An important consideration is the age of the woman at the time of her first pregnancy. Women who are thirty at time of first pregnancy have a higher chance of getting breast cancer than women who have their first child at twenty':" .In the first pregnancy, the epithelium of the ducts and alveoli of the breast undergoes a process of maturation to prepare them for lactation. These mature cells have a longer cell cycle, allowing them more time in the G1 phase to repair any damage to the DNA and are more resistant to neoplastic change",
The most important single cause of breast cancer is
prolonged stim u lation of the breast epithelium by
endogenous or exogenous estrogen. Women, who have
early menarche and late menopause are candidates for
this disease? .Average age of menarche has come down
in developed countries and in higher strata of society.
Women, who attain their menopause before the age of
45, have 50% less chance of developing this cancer as
compared to women, who attain their menopause after
the age of 558. Removal of ovaries in young women also
reduces the chances of their getting breast cancer",
