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Dr.(Mrs.) S. Muthulakshmi Reddy 1886-1968 Founder

BREAST CANCER IN INDIA CANCER INSTITUTE EXPERIENCE. Dr.(Mrs.) S. Muthulakshmi Reddy 1886-1968 Founder. Cancer Institute (WIA), Chennai, India. Carcinoma of the Breast Estimated Annual Burden in 2005 Global : 1,218,000 45% Occur in Developing Countries India : 79,000

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Dr.(Mrs.) S. Muthulakshmi Reddy 1886-1968 Founder

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  1. BREAST CANCER IN INDIA CANCER INSTITUTE EXPERIENCE Dr.(Mrs.) S. Muthulakshmi Reddy 1886-1968 Founder Cancer Institute (WIA), Chennai, India

  2. Carcinoma of the Breast Estimated Annual Burden in 2005 Global : 1,218,000 45% Occur in Developing Countries India : 79,000 Source: GLOBOCAN 2002, IARC

  3. Breast cancer – CIR & Risk World Pattern India Source: NCRP Consolidated Reports Affluent countries Other Developing countries Source: Parkin et al., 2002 – CI5, Vol VIII, IARC

  4. Trend of ASR* of Breast Cancer in Indian Registries (1982-2002) Trend of ASR* of Cervical and Breast Cancers Urban India : 1982-02 * Age Standardised Rate

  5. ASR* of Breast Cancer in India * Age Standardised Rate Source: Individual Registry Reports, 1993-02

  6. CARCINOMA BREAST, 1993-97 AGE GROUP DISTRIBUTION (%) India over 20% Affluent countries about 6% Source: Parkin et al., 2002 – CI5, Vol VIII

  7. CARCINOMA BREASTDISTRIBUTION (%) BY MENSTRUAL STATUS $: <50 years of age; * : 50 years of age Source: Parkin et al., 2002 – CI5, Vol. VIII, 1993-97 Menstrual status & Receptors in Breast cancer Cancer Institute (WIA)

  8. Stage Distribution Carcinoma Breast : 1960-1999 : HBCR No change in stage of disease

  9. Carcinoma Breast : 1960-99 - Cancer Institute(WIA), Chennai All cases accepted for treatment (All Stages & All modalities of trt) survival by  calendar period – statistically significant * 9 year survival All cases accepted for treatment (Stages llB-IIIB), LABC survival by  calendar period – statistically significant LABC: 58.3% of all cases * 9 year survival

  10. Carcinoma Breast : 1990-99 - Cancer Institute(WIA), Chennai 5 Year Survival among neo-adjuvant* concurrent CT+RT followed by surgery (LABC) n=1259 * Includes CMF, ANTHRA cases; $ Excision done outside cases; OS – Overall Survival; DFS – Disease Free Survival Stage IIB, III A & III B constitutes 59.3% of all cases

  11. Carcinoma Breast : 1990-99 - Cancer Institute(WIA), Chennai Study of Tumour response by type of chemotherapy among neo-adjuvant* (LABC) n=1259 Tumor Sterility *Includes CMF & ANTHRA # Excludes ETNM Cases (117) Study of path. Node response by type of chemotherapy among neo-adjuvant* (LABC) n=1259 Nodal Downstaging * Includes CMF & ANTHRA; # Excludes axillary clearance not done cases(3) Node sterility: CMF > Anthra – Statistically significant Occult met. : CMF < Anthra – No statistical difference

  12. Eliciting independent prognostic factors for survival among neo-adjuvant cases* (LABC), n=1259 Carcinoma Breast : 1990-99 - Cancer Institute(WIA), Chennai $ p<0.05 *Includes CMF, ANTHRA cases • Path node status emerges as the only independent prognostic factor for survival from breast cancer • 2.7 folds  risk of dying among +ve cases compared to –ve cases • – statistically significant

  13. Carcinoma Breast (1990-99): LABC Overall Survival by Calendar Period – Neo adjuvant and Adjuvant @ 9 year survival *Includes CMF, ANTHRA, OTHERS & PRE OP-RT ONLY cases Survival by neo-adjuvant significantly  than adjuvant in all calendar periods

  14. Carcinoma Breast : 1990-99 - Cancer Institute(WIA), Chennai Survival by family income (All treated cases, n=3325) SURVIVAL BY INCOME GROUP – STATISTICALLY SIGNIFICANT Survival by Education (All treated cases, n=3325) SURVIVAL BY EDUCATION – STATISTICALLY SIGNIFICANT

  15. ONGOING PROGRAMMES: • Hereditary cancer detection and prevention programme • Genetic polymorphisms in breast cancer HEREDITARY CANCER DETECTION AND PREVENTION PROGRAMME • The first in the country. • Components • Population based Hereditary cancer registry • Comprehensive hereditary cancer registry • Mutation analysis for relevant genes (entire coding region of BRCA1, BRCA2, MSH2, MLH1) FUTURE PROGRAMS PLANNED • Gene expression studies in breast cancer using microarray based technology – development of low density arrays, relevant to our population for routine use, for predictive and prognostic applications,.

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