Oncoplastic Breast Surgeon at Apollo Spectra Hospital
Dr. Rajinder Kaur Saggu
Oncoplastic Breast SurgeonIndraprastha Apollo Hospitals,
New Delhi
Oncoplastic Breast Surgeon at Apollo Spectra Hospital
Dr. Rajinder Kaur Saggu has an overall experience of 18 years as a Surgeon and 13 years of rich professional experience as a Surgical Oncologist.
Her area of expertise is Breast cancer and non-cancerous conditions of breast. She has wide experience in performing all types of breast surgeries.
She strives to treat each breast cancer patient with personalised attention, the best diagnostic and treatment options and follow up care to improve quality of life after treatment.
After completion of post-graduation in General Surgery from GMC Patiala, Punjab, she moved to New Delhi and joined Lady Hardinge Medical College as a Senior Registrar in 2004. While practicing General Surgery, she found herself drawn to patients with breast problems especially breast cancer.
To fulfill her passion, Dr.Rajinder Kaur Saggu moved to her true calling and joined , Tata Memorial Hospital, Mumbai, Asia’s largest cancer centre, as a Senior Research Fellow in Breast Oncology in 2008.
Under the able guidance of Dr.Rajendra Badwe, she learnt latest technology and reconstructive techniques and multimodality treatment of breast cancer.
She still wanted to enhance her capabilities to the global level and stretch herself more. This made her move to M.D. Anderson Cancer Centre Houston, Texas as a Trainee in Breast Oncology under the able guidance of Dr Kelly Hunt.
After returning from Texas, Dr Saggu is associated with Indraprastha Apollo Hospitals, New Delhi since 2010.
She currently practices at various locations in Delhi, one of them is Apollo Spectra Hospitals, New Rohtak Road, Karol Bagh, New Delhi, 110005. The contact number for appointments with Dr. Rajinder Kaur Saggu is 098710 56323.
Importance of breast cancer awareness
The importance of Breast Cancer Awareness is to educate women about breast cancer and early detection tests so that they could take charge of their breast health.
As, breast cancer is the most common cancer in women worldwide and incidence is increasing rapidly in India, where the majority of cases are diagnosed in late stages.
So, Need of the Hour, is awareness about breast examination and regular screening, so that it can be detected early and treated successfully.
Risk Factors in Breast Cancer
What is a risk factor?
A risk factor is anything that increases your chance of getting breast cancer. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.
Am I at risk for getting breast cancer?
• Your risk for breast cancer rises as you get older.
• About 80 % of breast cancers are found in women over age 50.
• 75% percent of the women who develop breast cancer have no identifiable risk factors.
• We don’t fully understand why some women get breast cancer and some don’t.
Research suggests that breast cancer is caused by lots of different factors, many of which we can’t control.
RISKS YOU CAN'T CONTROL (NON-MODIFIABLE)
Age: The chances of breast cancer increase as one gets older. Most breast cancers are diagnosed after the age of 50.
Gender: The chances of breast cancer increase as one gets older. Most breast cancers are diagnosed after the age of 50.
Family history : The chances of breast cancer increase as one gets older. Most breast cancers are diagnosed after the age of 50.
Genes: Inherited Genes: About 5 to 10% of breast cancer cases are hereditary, caused by abnormal genes passed from parent to child. Most inherited cancers are associated with mutations in BRCA 1 & BRCA 2.
Acquired Genes: Remaining 90% of breast cancer are due to acquired gene mutation. These genes changes happens over a course of lifetime as a result of natural ageing process or exposure to chemicals in environment.
Past History: If you were treated for breast cancer in one breast, the chances of developing it in the other breast increases.
Mensuration: If you began having menstrual periods before age 12 or went through menopause after age 50, your risk of breast cancer is slightly higher than average. This may be because of the amount of the female hormone estrogen that your breasts have been exposed to throughout your lifetime. But the precise cause is not known.
Dense Breast Tissue: Women with dense breast tissue (as documented by mammogram) have a higher risk of breast cancer.
RISKS YOU CAN CONTROL (MODIFIABLE)
Obesity: Excess weight increases your risk of breast cancer. It also increases the possibility that breast cancer will return after treatment, particularly after menopause. The likely reason is that being overweight increases the level of estrogen in the body. Being overweight is defined as having a body mass index (BMI) of 25 or higher. Obesity is defined as having a BMI of 30 or higher.
Pregnancy: Women who have never been pregnant have a greater risk of breast cancer. Also giving birth to a child after age of 30 increases the risk.
Breast-feeding: No Breast-feeding or feeding for less than one year slightly increases the risk of breast cancer.
Alcohol: Women who consume 3 or more alcoholic drinks each week have a 15-20% higher incidence of breast cancer as compared to non drinkers. Excessive alcohol consumption also increases risk of other cancers and slightly increases the risk of breast cancer.
Hormone replacement therapy: Women treating to get relief from menopausal symptoms with combined estrogen and progesterone pills have an increased risk of breast cancer. This added risk disappears about three to five years after you stop taking the hormones.
Poor Dietary Choices: A diet high in saturated fat and lacking fresh fruits and vegetables can increase the risk for breast cancer. Avoid foods that contain chemicals, preservatives and excess hormones.
Methods of Early Detection of Breast Cancer
Breast Screening
A screening test is done routinely for people who appear to be healthy and do not have any signs and symptoms of Breast Cancer.
Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat.
Methods used to screen breast cancer are :-
- BREAST SELF EXAMINATION (BSE)
- CLINICAL BREAST EXAMINATION (CBE)
- MAMMOGRAPHY
Breast Self Examination
A breast self-exam, is an at-home breast exam you give yourself. You’ll want to check your breasts for anything that feels unusual. You should look for breast lumps, changes in size or shape, leaking of fluid from the nipples, or irregular thickening of tissue.
We recommend breast self-exams monthly for all women but they are not a substitute for the routine breast cancer screenings performed by breast specialist. BSE makes you familiar with how your breasts look and feel. Make sure you know what is normal for you. For some women, breasts become enlarged, tender and lumpy just before a period, and then return to normal once the period is over, others may have swollen breasts throughout their cycle.
When and how to do Breast Self-exam?
Once a month, preferably 5-7 days after your periods. If you are pregnant, no longer have periods or your period is irregular, choose a specific day each month.
Follow the procedure as illustrated below to do self-examination of breast:
1. Stand in front of a mirror
Stand in front of a mirror with your breasts exposed and your hands pressing firmly down on your hips as shown in Figure 1.
2. Notice changes in breast
Look in the mirror for any of the following changes in your breasts (see Figure 2):
* Any discharge from nipple
* Changes in textures (size, shape, or contour)
* Dimpled or depressed skin
* Nipple turning inward
* Visible lump
* Lymph discharge
3. Examine underarm
Raise one of your arms slightly and examine that underarm (see Figure 3). Feel that underarm for any changes or lumps. Do the same thing with your other underarm. Don’t raise your arm straight up because this tightens the tissue in this area and makes it harder to examine.
4. Lying down
Lie down on your back and place your right arm behind your head. When you lie down, your breast tissue spreads out as thinly as possible, making it easier to feel all the tissue.
5. Use finger pads
You’ll need to use 3 different levels of pressure. Use all 3 pressure levels on each spot to feel the breast tissue before moving on to the next. Use pads of your 3 fingers as shown in Figure 5.
Use light pressure to feel the tissue closest to your skin.
Use medium pressure to feel a little deeper.
Use firm pressure to feel the tissue closest to the chest and ribs. It’s normal to feel a firm ridge in the lower curve of each breast.
6.Examine entire breast
Next, examine your entire breast using an up-and-down pattern. This is sometimes called the vertical pattern (see Figure 6). Start in your underarm and move your fingers downward little by little until they reach the bottom of your rib cage. Then move your fingers slightly toward the middle and move back up until you reach your collarbone. Continue this pattern, covering your entire breast all the way to the middle of your chest bone (also called sternum or breastbone).
Repeat the exam on your left breast using your right hand. If you notice any changes in your breast(s), call your doctor.
Clinical Breast Examination
A clinical breast exam is a physical exam of the breast performed by a doctor. It includes an examination of both breasts, your underarms, and your collarbone area to check for any signs of breast cancer.
Mammography
Mammography is simply an X ray of the breast using low dose radiation. During a mammogram, you will stand in front of the x-ray machine while the person who takes the x-rays places your breast between two plastic plates. The plates flatten your breast in order to produce a clear picture of the tissue inside.
Screening mammograms have been shown to significantly reduce the number of women who die from breast cancer.
Mammograms are used for both screening and diagnosis.
Screening mammogram
A screening mammogram is used to find breast changes in women who have no signs of breast cancer.
Diagnostic mammogram
If you found a breast lump that needs to be checked, you may have a diagnostic mammogram. During a diagnostic mammogram, more x-ray pictures are taken to get views of the breast tissue from different angles.
Breast Tomosynthesis (3-D Mammography)
Breast tomosynthesis, also called 3-D mammography, is a new technology. It takes images of the breast from many different angles and creates a three-dimensional picture of the tissue. Like breast ultrasound, breast tomosynthesis may be particularly useful for women with dense breasts.
Contrast-Enhanced Digital Mammography (CEDM)
Contrast-enhanced digital mammography, or CEDM, combines digital mammogram with the injection of a special dye called a contrast agent. Because cancers absorb more of the contrast agent than the surrounding healthy tissue, it is easier for doctors to detect cancers on the mammogram. CEDM is still a relatively new technology, it may have a role in screening for breast cancer in women at above-average risk or women who have dense breasts.
Breast Ultrasound
Breast ultrasound (or ultrasonography) uses sound waves to create images of your breast tissue. Breast ultrasound plays an important role in evaluating breast lumps.
- It is complimentary to mammography in detecting breast cancer.
- It is patient friendly and requires no compression.
- It is used primarily to differentiate between a cyst and solid mass.
- Recommended in younger women with dense breast.
- Screening of pregnant women.
Breast MRI
Breast MRI involves the use of radio waves and a powerful magnet linked to a computer that creates detailed pictures of your breast.
During an MRI test, fluid/contrast are injected to improve the visibility of the inside of the breast. It requires breast coil also.
Studies show that having regular mammography plus breast MRI may offer some advantages over other screening methods for women who are at high risk for the disease.
Myths & Facts About Breast Cancer
There are many myths regarding breast cancer and combined with lack of awareness, it delays the diagnosis and proper treatment. Here are some common myths and the truth about breast cancer:
Myths
Facts
Finding a lump means you have breast cancer
If you find a lump in your breast there is no need to panic. Only 10% - 15% of these lumps turn out to be cancerous. However, a breast lump should never be ignored & undergo evaluation by breast specialist.
Breast cancer is contagious
Cancer is not contagious, just as diabetes or heart disease are not contagious. You cannot catch cancer by touching or hugging someone who has it.
All breast cancers are life threatening
Not all breast cancers are life threatening. Some breast cancers detected by screening & early breast cancers are completely curable.
Having a family history of breast cancer means "I WILL" get breast cancer
Only 10% of women with strong family history can have breast cancer, caused by abnormal changes (or mutations) in certain genes passed from parent to child. The vast majority of women who get breast cancer have no family history, suggesting that other factors must be at work, such as environment and lifestyle.
Men do not get breast cancer
Although rare, men also get breast cancer. As the breast tissue in men is less then that of women, It makes it difficult to detect cancer early and spreads more quickly to the surrounding tissue.
Antiperspirant & deodorants causes breast cancer
There is no evidence suggesting use of underarm antiperspirant or deodorant causing breast cancer.
Wearing a undersize bra causes breast cancer
Scientific evidences does not support a link between wearing an under size bra & breast cancer risk.
If I eat right, exercise daily, don't smoke and don't drink alcohol, I won't get breast cancer.
A person can do everything "right" & still get breast cancer. For It, most risk factors like exercising & eating healthy only have a small effect on risk. This means there is no one behavior that will prevent breast cancer.
Older people are not fit for cancer treatment
There is no age limit for cancer treatment. Oncologist can individualise and modify treatment regimens according to the health of patient.
Mammography is painful
The pressure caused by compressing and stretching the breast tissue may be uncomfortable but not painful.
Mammogram are unsafe & causes radiation hazards
It is indeed safe. Mammogram require very small dose of radiation, the risk to health from this is insignificant. Screening mamograms is a Gold Standard method for detecting breast cancer early. The medical benefit of early detection outweigh any potential risk.
Mammogram is 100% accurate in detecting breast cancer
Like other screening tests mammograms are not accurate. It is good at finding breast cancer early, but overall sensitivity of mammography is only about 87 percent. The reasons are :
• Some cancers are difficult to see on the mammogram
• The doctor reading the mammogram can miss the cancer.
So, it is always advisable to get an ultrasound of both breasts along with mammogram for better accuracy
Younger women do not get breast cancer
All women are at risk of breast cancer, Although majority of breast cancer occurs in women over the age of 50, about 7% of all breast cancer cases happen in women under 40. Younger women ignore the warning signs as they believe they are too young to get breast cancer.
Risk Reduction Tips
Can I lower my risk of Breast Cancer?
There is no sure way to prevent breast cancer. But there are things you can do that might lower your risk:
Physical exercises & healthy lifestyle
According to reports, lack of physical activity contributes to 9% of breast cancer cases. People who are more physically active have reduced risk of breast cancer as well as other cancers. 240-300 minutes of exercise per week is a good target. Pick any activity you enjoy like brisk walking, tennis, swimming, cycling or dancing. Do it to the point that your heart hastens.
Limit alcohol intake and do not smoke
Drinking alcohol is tightly linked with breast cancer and the more you drink, the greater your risk. A study showed that even light to moderate drinking e.g. 3 or more alcoholic drinks increases risk of breast cancer in women by 15%. Research indicates women who have survived breast cancer, curbing alcohol reduces the risk of recurrence. If you enjoy alcohol, try weaning yourself to sparkling water. Stay away or give up smoking.
Avoid menopausal hormone replacement therapy
Menopausal hormone therapy should not be taken long term to prevent chronic diseases like osteoporosis & heart diseases. Studies shows it has a mixed effect on health, increases the risk of breast cancer. If women do take menopause hormone replacement therapy, it should be for the shortest time possible.
Healthy diet
Eat meals, rich in fruits & vegetables and less meat. Eat more brightly colored vegetables & fruits. Plant pigments called flavonoids have anti cancer properties and reduces risk of breast cancer. Foods containing flavonoids include onions, broccoli, eggplant, celery, lettuce, tomatoes, apples, oranges, melons, coffee, green tea & aromatic herbs.
Keep weight in check
Maintaining healthy weight is an important goal for everyone. Being overweight can increase the risk of many different cancers, including breast cancer especially after menopause. To lose weight, you need to either reduce calories intake or burn more calories.
