Breast Cancer Awareness Month: Diagnostic Techniques For The Detection And Precise Treatment

Breast cancer is a global disease with each region having its own uniqueness even though the underlying causes are similar. Breast cancer is now the most common cancer in India with a significant increase in recent years, and second most common in the rural areas. A lot of this increased incidence can also be due to more awareness and improved diagnosis. Breast cancer also affects men, with about a 1% incidence amongst them.

Detection of breast cancer

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The conventional way of detecting breast cancer in most developing countries, such as India, still involves conducting self-examination or accidentally finding an undiagnosed lump in the breast area. Self-examination involves inspecting the breast for dimpling or for any changes in shape or symmetry. Light pressure is applied to check for any lumps near the surface of the skin and the pressure is increased a little to check for lumps in the deeper tissue. Earlier, this was of relevance because it was the primary method of detecting breast cancer.

Next, one would undergo a clinical breast examination, and then proceed to undergo ultrasounds and mammograms. However, in the West, a routine mammography and ultrasound are recommended for women above the age of 40.

It is seen that women who are diagnosed with breast cancer at the earlier stages have negligible symptoms. The sooner breast cancer is diagnosed, the better the chances of getting it successfully treated. Hence, a screening test is crucial in order to prevent symptoms or signs of breast cancer from developing any further.

A mammogram is key imaging test to learn more about the changes in the breast. A mammogram is an x-ray of the breast. The differences in the tissues of the breast, if any, will then show up as different shades of grey on the X-ray. The screening generally uses two views of the breast: a view from above and an oblique, angled view. Diagnostic mammograms are further used to get a closer look of any change that is seen through a screening mammogram.

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Nowadays, Mammography has improved dramatically, from wire guided localization of smaller lesions for tissue diagnosis of cancer in a digital mammography. Surgeons also get a good visual assistance to plan their surgery. In this current technique, a Digital Breast Tomosynthesis ¨C or DBT ¨C constructs a 3D image out of all the 2D images using specific computer systems and software. This allows the entire breast to be screened in thin sections (tomosynthesis) as can be witnessed in CT scan images.

In rare cases, breast MRIs (magnetic resonance imaging) is used in mammography. Albeit the most detailed and sensitive scanning technology, it is not used very often as it has its own drawbacks and is also relatively expensive.

We have all heard of liquid biopsies, molecular imaging and imaging biomarkers. These are non-invasive tests that can help identify features relevant to diagnosing breast cancer. Liquid biopsy involves testing the blood to examine for the presence of circulating tumor cells. They identify any mutations in DNA or any changes in other genetic material that is shed by a tumor, if present. Molecular imaging, on the other hand, identifies disorders at the molecular level. However, most of them are currently not routine in translational practice as the data is not substantial.

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Once a diagnosis of breast cancer is established, your Oncologist may want to order genetic profiling of the tumors in some special subset.

This profiling is done through the certain tests like:

- Oncotype Dx - This looks into the activity of the 21 genes of a patient¡¯s breast tumor tissue which results in tailor made information which in turn will help in providing the patient with the right therapy, specific to the biology of his/her disease.

- Mamma Print ¨C In both the US and internationally, this test is used only during the early stages of cancer where cancers such as hormone-receptor-positive are analyzed.

- Endo Predict - This is also a gene profiling patented test. It is a multi-gene test that provides information which can be used to construct a personalized treatment method.

Based on the above tests, risk stratification is done. The level of stratification, categorized as being a good risk, immediate risk or high risk, then defines the mode of treatment. Once detected, it is relatively simpler to identify the suitable path of treatment for the cancer. Owing to the staggering developments in medical technology and related fields, the treatment of cancer is no longer elusive and unachievable. Regular checkups, scans and tests go a long way towards keeping the threat of cancer at bay.

About the author: Dr. Niti Raizada is the Director of Medical Oncology and Haemato-Oncology at Fortis Group of Hospitals, Bangalore. All views/opinions expressed in the article are of the author.