| What is considered a successful outcome for the breast conservation approach? | satisfactory cosmetic outcome and the probability of tumor control or late sequelae are not inferior to mastectomy | 21 Consensus Document for Management of Breast Cancer 1-3 +ve nodes, it is being increasingly considered as discussed later. Accelerated Partial Breast Irradiation (APBI) with various techniques is an option for highly select cases in experienced centres. RT indications and dose regimes are described later. *Eligibility for BCT: The breast conservation approach would be considered successful if it produces satisfactory cosmetic outcome and the probability of tumor control or late sequelae are not inferior to mastectomy. | 411 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Breast_Cancer.pdf | *Eligibility for BCT: The breast conservation approach would be considered successful if it produces satisfactory cosmetic outcome and the probability of tumor control or late sequelae are not inferior to mastectomy. | 22 | page=22,block=0 | 0.700 | valid |
| What is the description of nuclei in Score 1 of the Modified Richardson Bloom grading system? | Small uniform nuclei, no pleomorphism | It requires revision surgery especially if EIC is present Modified Richardson Bloom grading system (Nottingham’s modification) Tubule Nuclear grade Mitosis/10hpf* Score1 >75% Small uniform nuclei, no pleomorphism 0-6 Score2 10-75% Moderate sized nuclei with pleomorphism 7-12 Score3 <10% Marked pleomorphism >12 Final score 3-5=Grade I, Final Score 6-7=Grade II, Final Score 8-9=Grade III *Could vary with microscope. Grade all carcinomas, including post NACT, special types and core biopsies. •• ER/PR estimation should be routinely performed. ERPR expression in >1% of cells is reported •• as positive for hormone receptors. For ER/PR estimation it is crucial to fix tissues in 10% neutral buffered formalin and employ pressure cooking methods for antigen retrieval. | 175 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Breast_Cancer.pdf | It requires revision surgery especially if EIC is present Modified Richardson Bloom grading system (Nottingham’s modification) Tubule Nuclear grade Mitosis/10hpf* Score1 >75% Small uniform nuclei, no pleomorphism 0-6 Score2 10-75% Moderate sized nuclei with pleomorphism 7-12 Score3 <10% Marked pleomorphism >12 Final score 3-5=Grade I, Final Score 6-7=Grade II, Final Score 8-9=Grade III *Could vary with microscope. |
| What is Optimal mammographic evaluation? | not possible due to breast reconstruction or implants | d. Optimal mammographic evaluation is not possible due to breast reconstruction or implants. | 38 | definition | 0.980 | https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Breast_Cancer.pdf | Optimal mammographic evaluation is not possible due to breast reconstruction or implants. | 19 | page=19,block=0 | 0.850 | valid |
| What does adjuvant treatment with Tamoxifen or radiotherapy after lumpectomy help prevent? | local recurrence of DCIS and invasive cancer24-26 | Simple mastectomy21 with or without reconstruction is performed for large or multicentric DCIS or when there is diffuse micro-calcification. Adjuvant treatment with Tamoxifen (for ER/PR +ve tumors) or Radiotherapy after lumpectomy reduces the risk of local recurrence of DCIS and invasive cancer24-26. Tamoxifen also reduces risk of contralateral DCIS and cancer. | 251 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Breast_Cancer.pdf | Adjuvant treatment with Tamoxifen (for ER/PR +ve tumors) or Radiotherapy after lumpectomy reduces the risk of local recurrence of DCIS and invasive cancer24-26. | 21 | page=21,block=0 | 0.800 | valid |
| What is the effect of longer chemotherapy duration for metastatic breast cancer? | modest improvement •• in overall and progression free survival | **Chemotherapy52-55,58 Combination chemotherapy is preferred in patients with high visceral burden and in other cases •• single agents can be used. Longer duration of chemotherapy for metastatic breast cancer is associated with modest improvement •• in overall and progression free survival. Chemotherapy duration should be individualized. | 228 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Breast_Cancer.pdf | Longer duration of chemotherapy for metastatic breast cancer is associated with modest improvement •• in overall and progression free survival. | 34 | page=34,block=3 | 0.800 | valid |
| Why is Ductal Carcinoma In Situ (DCIS) being increasingly diagnosed in the west? | widespread use of screening mammography | Ductal Carcinoma In Situ (DCIS) is being increasingly diagnosed in the west due to widespread use of screening mammography. The natural history of screen detected DCIS is variable and many of these will not progress and may have remained clinically silent during the women’s lifetime. | 83 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Breast_Cancer.pdf | Ductal Carcinoma In Situ (DCIS) is being increasingly diagnosed in the west due to widespread use of screening mammography. | 20 | page=20,block=4 | 0.800 | valid |
| Why is a population-wide mammographic screening program for asymptomatic women not considered feasible or useful in India? | lower breast cancer incidence and population structure in India13 | Population-based mammographic screening of asymptomatic postmenopausal women has shown a modest reduction in breast cancer deaths in high incidence affluent western countries but with associated over diagnosis and overtreatment12. However population-wide mammographic screening program of asymptomatic women is neither feasible in India nor it may be as useful due to lower breast cancer incidence and population structure in India13. Opportunistic screening may be considered for some high risk and concerned women in India. | 368 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Breast_Cancer.pdf | However population-wide mammographic screening program of asymptomatic women is neither feasible in India nor it may be as useful due to lower breast cancer incidence and population structure in India13. | 14 | page=14,block=2 | 0.800 | valid |
| What contributes to the low rates of breast conservation for early-stage breast cancer in Indian medical centers? | the lack of access to modern radiotherapy | reast cancer is the most common female cancer in the world with an estimated 1.67 million new cancer cases diagnosed in 2012. While the age adjusted incidence rates of breast cancer in India is lower than the western countries, because of the large population the burden of breast cancer is high. With an annual incidence of approximately 1,44,000 new cases of breast cancers in India, it has now become the most common female cancer in urban India1. There is general consensus in Indian oncologists regarding the use of surgery, with breast conservation when feasible and the indication for radiotherapy, chemotherapy and hormone therapy in various stages of breast cancer. Breast conservation rates are low even for stage I & II breast cancers in most Indian centres and reflects the lack of access to modern radiotherapy. | 782 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Breast_Cancer.pdf | Breast conservation rates are low even for stage I & II breast cancers in most Indian centres and reflects the lack of access to modern radiotherapy. | 12 |
| What contributes to the perception of higher breast cancer rates among younger women in India? | a combination of the population structure and inherent bias against referral, treatment and ascertainment of breast cancer in the elderly in India | n India the incidence of breast cancer is significantly lower than western countries. Breast cancer in India varies from as low as 5 per 100,000 female population per year in rural areas to 30 per 100,000 female population per year in urban areas11. There is an impression of higher incidence of breast cancer in younger women in India as most hospital based series report median age of breast cancer patients a decade younger than western series. However this may be due to a combination of the population structure and inherent bias against referral, treatment and ascertainment of breast cancer in the elderly in India rather than a true reflection. The incidence of breast cancer increases with age and this is true in India like rest of the world. | 475 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Breast_Cancer.pdf | However this may be due to a combination of the population structure and inherent bias against referral, treatment and ascertainment of breast cancer in the elderly in India rather than a true reflection. |
| What forms the basis for selecting systemic therapy in modern breast cancer treatment? | large RCTs consisting of several thousand patients and meta-analysis | ome form of systemic therapy with either hormone therapy, chemotherapy or targeted therapy in various combination and sequences is offered to almost all breast cancer patients. The choice of systemic therapy and combination of systemic therapy used in modern practice is based on large RCTs consisting of several thousand patients and meta-analysis and is outlined here. | 280 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Breast_Cancer.pdf | The choice of systemic therapy and combination of systemic therapy used in modern practice is based on large RCTs consisting of several thousand patients and meta-analysis and is outlined here. | 28 | page=28,block=2 | 0.700 | valid |