Breast Cancer Diagnosis and Surgical Management

No, a BRCA1 and BRCA2 test should be done first. Indications for testing are all triple-negative breast cancer, a strong first-degree family history (a sister, mother, or maternal or paternal aunt with breast cancer), and any history of male breast cancer in the family, which alone is enough to warrant testing. If the BRCA test comes back positive, mastectomy of the affected breast should be combined with prophylactic mastectomy of the opposite side. If BRCA testing isn't available locally, it can be arranged through Dr. Jain's centre.

There is no single definitive treatment; breast cancer, like all solid tumours, requires multimodal treatment. Chemotherapy alone, radiotherapy alone, or hormone therapy alone cannot cure it. Surgery has to be part of the treatment plan for a cure, combined with hormone therapy, chemotherapy or radiation as indicated, though surgery alone is occasionally sufficient in very select cases.

It's mandatory, and Dr. Jain considers it roughly 95% of overall cancer management. Physical rehabilitation covers arm exercises and lifelong protection of the affected arm, no rings, blood pressure cuffs or needles on that side. Psychological rehabilitation matters just as much, since patients carry real emotional weight after a cancer diagnosis, and in some settings social rehabilitation is needed too, since patients can lose their jobs, or in some communities face marital breakdown, because of the diagnosis.

Prognosis is improving steadily. Five-year survival is around 97-98% for stage one, 90-95% for stage two, 80-85% for stage three, and even stage four disease has a 25-30% five-year survival rate. Triple-negative and locally advanced cases carry a higher recurrence risk specifically, so they need especially stringent follow-up to catch any recurrence early enough to treat.

Surgery alone, all-inclusive, costs roughly $5,000. Chemotherapy adds around $10,000, and radiation is roughly $3,500 to $4,000. Extended targeted therapy such as trastuzumab can add another $10,000, though that portion can often be continued at the patient's home location. As a rough guide, surgery plus basic chemotherapy runs around $15,000 for most patients, and cases involving genuine financial hardship can always be discussed.

The full pathway from diagnosis and imaging, staging, surgical decision-making (breast conservation versus mastectomy), axillary management, adjuvant therapy decisions including when chemotherapy can be avoided, BRCA testing, reconstruction, and rehabilitation.

Principal Director, Surgical Oncology at BLK-Max Super Speciality Hospital, New Delhi, with 26 years of experience across breast, head and neck, gynaecological, soft tissue, uro-oncological and GI cancer surgery.