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Home News and Update Year 2010 War Against Breast Cancer Can Start Early

War Against Breast Cancer Can Start Early

Times of India
28 August 2010
By Sumitra Deb Roy
Mumbai, India

War Against Breast Cancer Can Start Early
Breast cancer is fast becoming the bane of the urban Indian woman, with one in 22 developing the malignant tumour. But a new technique studied by doctors in a city hospital just might change the way the disease is treated and managed. It detects cancerous cells in their primitive avatar and even predicts future tumours. Called ductoscopy, the endoscopic technique, allows doctors access to cells that line the milk duct of the breast, where 85–90% of cancers originate.

In a five–year long study conducted by the P D Hinduja Hospital at Mahim, doctors were able to detect and map cancerous changes in patients with nipple discharge. All the women had been given a clean chit by standard protocols like mammography. But the doctors were able to pick up preliminary changes in cells that could possibly turn cancerous after a decade or more. Surgical oncologist Dr Vinay Deshmane, who made the findings, said that ductoscopy can pick up early genetic changes occurring in the cells before the cancer develops. They focussed on women who had approached the hospital with complaints of nipple discharge, which is associated with early breast cancer in 20–40% of cases.

During a ductoscopy, a fibre–optic scope less than a millimetre thick is inserted into the milk duct at the nipple and threaded deep into the breast through the duct. (See box). Of the 60 women who had undergone ductoscopy to find out the cause of nipple discharge, 30% were found to be in the early stages of breast cancer. But what doctors discovered was that 77% of the affected women were certified as health by mammography, sonography and clinical examinations that did not detect any anomaly. Early detection increases the odds of a quick recovery.

Deshmane said milk ducts, have remained out of reach for long. "Now we have the technology to access the duct cells, monitor every change and even remove it as soon as any abnormality is noticed,’’ he said, adding that that ductoscopy cannot never replace mammography–the benchmark test for breast cancer detection.

A senior oncologist from a suburban hospital said: "Cancer treatment has not managed to keep up with advancements in diagnostic technology. So while we may be able to identify high–risk groups and even predict the cancer, we have very few solutions to offer.’’

The pioneering efforts to nurture this technique had begun in the 1980s in France. But few centres, in India or for that matter, across the world are known to use it. This is because the technique has one significant drawback: it can only be used on women who experience nipple discharge.

"It is a very good precision technology. But it’s usage is best suited for women with complaints of single duct nipple discharge,’’ said Dr Rajendra Badwe, head of department, surgical oncology and director of Tata Hospital, Parel. The cancer institute had also used the technique for a while but chose not to pursue it for this reason. New Technique Promises Early Detection Mammography is the main test for early detection of breast cancer.

But the newly developed mammary ductoscopy allows doctors to detect cancerous cells or abnormalities that mammograms and ultrasounds do not catch

Findings Of Study
Over the last five years, around 60 women who complained of nipple discharge underwent ductoscopy The presence of abnormal findings or localised cancer was detected in 37% patients. Around 27% of the patients, approximately five women, had early invasive treatment In none of these cases, per–operative mammography or sonography could suggest any malignant change Number Crunching
In India, 1 in 28 women develops breast cancer during her lifetime . In urban areas it can even be as high as 1: 22. In rural India, it is 1 in 60 women
In India the average age of the high–risk group is 43–46 years. In the West women in the age group of 53–57 years fall in the high–risk category

What Is Ductoscopy? About 85–90% of breast cancers originate in the cells lining the milk duct of the breast A fibre–optic scope less than a millimetre thick is inserted into the milk duct at the nipple and threaded deep into the breast via the duct It allows direct visualization of ducts and sampling of cells The biopsy can also help diagnose early premalignant and malignant changes

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