Pattern of Breast Cancer Presentation Faryal Azhar, Tausief Fatima, - PDF document

Journal of Rawalpindi Medical College (JRMC); 2017;21(1): 42-44 Original Article Pattern of Breast Cancer Presentation Faryal Azhar, Tausief Fatima, Tabinda Aqsa, Usman Qureshi, Gohar Rasheed, Jahangir Sarwar Khan. Department of Surgery Unit I, Holy Family Hospital and Rawalpindi Medical College Abstract and the incidence is increasing particularly among women aged 50-64, probably because of breast Background: To study the various types of breast screening in this age group. 2 cancer presenting in local hospital to ensure better Of every 1000 women aged 50, two will recently have facilities, early diagnosis and better treatment had breast cancer diagnosed and about 15 will have options had a diagnosis made before the age of 50, giving a Methods: In this descriptive study all breast cancer prevalence of breast cancer of nearly 2%. 1-4 In an patients, over a period of two years were included. initial report, we suggested that such a major change Triple assessment of patients done for diagnosis and in breast-cancer incidence occurred in 2003 in the treatment given all were included in data. United States. Compared to the 1990s when we saw Results: Total number of patients who presented an increase in the annual age adjusted incidence of were 1982. Benign breast disease patients were 1746 breast cancer by an average of about 0.5% per year, the (88.0%). Breast cancer were 236(11.90%). Five rise that was particularly evident among women who hundred and two mammographies were done, 197 were 50 years of age or older. 4 With this finding of were BIRAD 5. Preferably confirmation was done fluctuation in incidence of carcinoma in breast it is through trucut biopsy (35), FNAC was done in 74 important to find the current trends in our society. and where needed incisional biopsy in fungating Changes in reproductive factors, use of menopausal tumors (n=15) and excisional biopsy where in spite hormone-replacement therapy, mammographic of all modalities diagnosis was not confirmed ( screening, environmental exposures, and diet have all n=11). Age varied from 24 to 75 years. Majority (126) been proposed to explain the trend. Of these factors, were in stage 3. Forty two patients received only the use of hormone replacement therapy altered neoadjuvant chemotherapy. Modified radical considerably between 2002 and 2003. So it is most mastectomy (n=114), Breast conservation ( n=13) and important to study incident and associated factors in simple mastectomy (n=17) were performed .Receptor patients with carcinoma breast. 6-10 status was dtermined. Despite the fluctuations in incidence research shows Conclusion: The most common stage of that as an outcome of changing experiences to presentation is stage 3. Such patients need down reproductive and nutrition related factors over time staging and then surgery. They required proper women are at high risk of breast cancer. 11 Incidence counseling and support for their treatment. Females rates is rising in most countries and areas of the world usually present late due to domestic issues. Early in the past few decades. The most rapid upsurges are diagnosis, treatment and full support is required to seen in developing countries, where breast cancer risk treat breast cancer. This study will help to provide has previously been low relative to industrialised better facilities for early diagnosis and treatment. countries. 12 Increasing tendencies in developing zones Key Words :Breast Cancer, Triple Assessment, are often considered the result of the 'westernisation' Modified Radical Mastectomy. of lives, an ill-defined replacement for changes in Introduction factors such as dietary habits, childbearing and exposure to exogenous oestrogen, towards a dispersal With 1 million new incidents in the world each year, closer in report to that of women in industrialised breast cancer is the commonest malignancy in women countries. 12 and encompasses 18% of all female cancers. 1 In the Many early breast carcinomas are asymptomatic, United Kingdom, the age standardised incidence and especially when discovered during a breast screening mortality is the maximum in the world. The incidence program. 13 Larger tumors may present as a painless among women aged 50 approaches two per 1000 mass. The breast cancer presentation is usually late in women per year, and the disease is the single our setup. There are various ways of presentation of commonest cause of death among women aged 40-50, breast cancer usually with painless lumps, hard fixed accounting for about a fifth of all deaths in this age masses, ulcerated or fungating masses. 14 The worst group. 1 There are more than 14 000 deaths each year, 42

Journal of Rawalpindi Medical College (JRMC); 2017;21(1): 42-44 presentation is with bone pain, fracture, jaundice and conservation (n=13) and simple mastectomy (n=17) breathing difficulties. Triple assessment is used for were the common surgical procedures performed diagnosing breast cancer, so that a diagnosis can be .Commonest complication was mostly seromas (n= obtained with minimum degree of invasiveness. The 15).Thirty nine patients left against medical advice. aims of evaluation of a breast lesion are to judge Table 3. Carcinoma Breast- Operation whether surgery is required and, if so, to plan the most performed. appropriate surgery. Name of operation Number of operation Patients and Methods MRM 114 In this descriptive and cross-sectional study all breast WLE 11 cancer patients , over a period of two years were BCS 13 included. Triple assessment of patient was done for diagnosis and treatment . Cases with benign breast Mastectomy 17 diseases were also noted to assess ratio of malignant to MRM, modified radical mastectomy. WLE, wide local benign disease that presented in breast clinic. Data excision. BSC, Breast conservative surgery . was collected regarding the number of biopsies Table. 4. Carcinoma Breast- Stages of Disease done.Number of patients in different stages were recorded. Surgeries done for breast Carcinoma Number of patients in different cancer.Complications due to surgeries breast stages noted.Histopathology types weree assessed. Number Stage 1 8 of patients sent for down staging and the number who Stage 2 86 left against medical advice were recorded. Stage 3 126 Results Stage 4 16 Total number of patients presented were 1982. Benign breast diseases were n=1746. Breast cancer were n=236 Discussion (Table 1). Five hundred and two mammography were Cancer of the breast is the most common cancer in done out of which 197 were BIRAD 5. Preferably both developing and developed countries. 15,16 In confirmation was done with Trucut biopsy (n=135). Pakistan deficiency in cancer registries at national FNAC was done in 74 patients. Invasive ductal level, lack of awareness, limited access to facilities and carcinoma was commonest (Table 2). For 15 patients insufficient breast clinic services attribute to the delay with fungating tumors incisional biopsy was done. in diagnosis and increase mortality rate. 17 Recent Modified Radical mastectomy was the commonest studies concluded that more than half of the patients procedure performed (Table 3)Age groups presented who visited breast clinics suffer from benign diseases. was from 24 to 75 years. N=8 in stage 1. Commonest As in our study, 88% are benign and 12% are stage was 3(Table 4). malignant. Breast lump is a very sensitive issue for the Table. 1: Breast - Benign and malignant disease patient so a reliable, non invasive and prompt Diseases Number of patient diagnosis helps to lessen the associated anxiety and leads to early definitive treatment. In conclusion, TTS Benign breast diseases 236 is an accurate and least invasive diagnostic test based Malignant breast disease 1746 on which definitive treatment can be initiated. 18 Diagnosis in our study was much accurate and easier with triple assessment i.e, physical examination, Table.2: Number of different types of mammography and biopsy. 19 Mammography is an malignant cancers . important screening tool which can effectively detect Types of carcinoma Number of breast cancer earlier before it becomes palpable on patients breast self-examination. 20 Ultrasound is investigation Lobular carcinoma 5 of choice in young patients < than 35 years of age in Invasive ductal carcinoma 205 our study. 21 After confirmation of breast cancer, Tubular variety of invasive 23 mammography was done in all young patients. Study ductal cancer in Iran , in 1500 patients, the mean age at diagnosis Medullary carcinoma 3 was 46.0 + 12.0 (SD) years. 22 Compared to our Forty two patients were sent to NORI for down study mean age group was 45 and most common age staging. Modified radical mastectomy(n=114), breast groups presented were between 35 to 45 years of age. 43