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   Table of Contents - Current issue
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April-June 2018
Volume 7 | Issue 2
Page Nos. 67-158

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EDITORIAL  

Editorial p. 67
Purvish M Parikh, Shyam Aggarwal, Sachin Hingmire
DOI:10.4103/sajc.sajc_144_18  
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ORIGINAL ARTICLES Top

Role of magnetic resonance imaging in breast cancer management p. 69
Selvi Radhakrishna, S Agarwal, Purvish M Parikh, K Kaur, Shikha Panwar, Shelly Sharma, Ashish Dey, KK Saxena, Madhavi Chandra, Seema Sud
DOI:10.4103/sajc.sajc_104_18  
Magnetic resonance imaging (MRI) of the breast is primarily used as a supplemental tool to breast screening with mammography or ultrasound. A breast MRI is mainly used for women who have been diagnosed with breast cancer, to help measure the size of the cancer, look for other tumors in the breast, and to check for tumors in the opposite breast. For certain women at high risk for breast cancer, a screening MRI is recommended along with a yearly mammogram. MRI is known to give some false positive results which mean more test and/or biopsies for the patient. Thus, although breast MRI is useful for women at high risk, it is rarely recommended as a screening test for women at average risk of breast cancer. Also, breast MRI does not show calcium deposits, known as micro-calcifications which can be a sign of breast cancer.
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Practical consensus recommendations for tumor margins and breast conservative surgery p. 72
R Sarin, SP Somsekhar, R Kumar, Gupta Pawan, Jain Sumeet, Jindal Pramoj, Zamre Vaishali, Pasha Firoz, PM Parikh, S Aggarwal, R Koul
DOI:10.4103/sajc.sajc_105_18  
My suggestion: There is no difference in survival of breast cancer patients treated with either mastectomy or with breast conservation therapy combined with external beam radiotherapy. A positive margin (s) is an important factor contributing to the increased risk of local recurrence. However, in published literature, there is a lack of consensus on the definition of acceptable margin (s). As a result decision process about need for re-excision after positive margins remains uncrear.
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Practical consensus recommendations regarding role of mastectomy in metastatic breast cancer Highly accessed article p. 79
SP Somsekhar, K Geeta, R Jain, R Nayyer, S Halder, VK Malik, Purvish Parikh, S Aggarwal, R Koul
DOI:10.4103/sajc.sajc_106_18  
Whether to recommend mastectomy in metastatic disease or not has been a matter of debate. Is local therapy, such as mastectomy, of any benefit in advanced breast cancer is the main question. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.
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Practical consensus recommendatons for Paget's disease in breast cancer p. 83
A Gaurav, V Gupta, R Koul, S Dabas, R Sareen, K Geeta, V Arora, Purvish M Parikh, S Aggarwal
DOI:10.4103/sajc.sajc_107_18  
Paget's disease of the breast is a rare type of cancer of the nipple–areola complex and that is often associated with an underlying in situ or invasive carcinoma. Diagnosis and treatment of Paget's disease is controversial. Expert oncologists discuss on the update on the approaches of Paget's disease diagnosis and its treatment options. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Practical consensus recommendations regarding role of postmastectomy radiation therapy p. 87
D Singh, G Saini, R Koul, V Gupta, D Abrol, S De, P Kulshrestha, SN Hukku, SJ Lakshmi, Purvish M Parikh, S Aggarwal
DOI:10.4103/sajc.sajc_108_18  
The use of radiation therapy after mastectomy (PMRT) has been limited to those patients who are at significant risk of cancer recurring in the chest wall or in the nodal basins. The use of PMRT has been widely accepted for patients with four or more positive lymph nodes, [1],[2] but there is still controversy regarding the value of PMRT for those with one to three positive nodes. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.
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Practical consensus recommendaton for adjuvant bone-modifying agents in breast cancer p. 91
A Bharatuar, M Kar, S Khatri, V Goswami, R Sarin, S Dawood, R Iyenger, M Ganvir, Purvish M Parikh, S Aggarwal, Vineet Talwar
DOI:10.4103/sajc.sajc_109_18  
Bone-modifying therapy is a primary research interest in breast cancer. Several features contribute to the importance of the bone environment in the management of breast cancer. Firstly, bone metastases represent the most common site of breast cancer metastases and secondly, the emergence of cancer treatment-induced bone loss (CTIBL) among breast cancer survivors and patients is of increasing concern. In the adjuvant setting, bisphosphonates can be given to prevent and treat tumor therapy-induced bone loss in premenopausal and postmenopausal women and, owing to their beneficial effect on bone turnover, have also been evaluated for prevention of bone metastases occurrence. Expert oncologists discusses on the update on the approaches of Bone-modifying Agents and its treatment options. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Practical consensus recommendations on management of HR + ve early breast cancer with specific reference to genomic profiling p. 96
S Aggarwal, A Vaid, A Ramesh, Purvish M Parikh, S Purohit, B Avasthi, S Gupta, S Ranjan, V Kaushal, S Salim, R Singh, S Minhas, D Doval
DOI:10.4103/sajc.sajc_110_18  
Breast cancer is a heterogeneous disease and patients are managed clinically based on ER, PR, HER2 expression, and key risk factors. The use of gene expression assays for early stage disease is already common practice. These tests have found a place in risk stratifying the heterogeneous group of stage I–II breast cancers for recurrence, for predicting chemotherapy response, and for predicting breast cancer-related mortality. Most guidelines for hormone receptor (HR)–positive early breast cancer recommend addition of adjuvant chemotherapy for most women, leading to overtreatment, which causes considerable morbidity and cost. Expert oncologist discussed about strategies of gene expression assays and aid in chemotherapy recommendations for treatment of HR + ve EBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Practical consensus recommendations regarding the management of HER2 neu positive early breast cancer p. 102
A Bahl, R Singh, J Wadhwa, S Gupta, M Ahmed, PN Uppal, Purvish M Parikh, S Aggarwal
DOI:10.4103/sajc.sajc_111_18  
Over-expression of HER2 is generally considered to be a negative prognostic feature because it accompanies an increase in breast cancer mortality. However, the development of agents that specifically target HER2 has improved the management of patients with these tumours. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations with regards to the use of these agents and the management of HER2 neu early breast cancer for the benefit of community oncologists.
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Practical consensus recommendation on when to do BRCA testing p. 106
Purvish M Parikh, J Wadhwa, S Minhas, A Gupta, S Mittal, S Ranjan, P Mehta, R Singh, SP Kataria, S Salim, M Ahmed, S Aggarwal
DOI:10.4103/sajc.sajc_112_18  
BRCA-mutation associated breast cancer and to future cancer risks and sensitivity to systemic therapies. Now that rapid genetic testing for BRCA1 and BRCA2 mutations is available, BRCA mutation status can be considered when making treatment and prevention decisions for BRCA testing, BRCA mutation carriers with breast cancer. Expert group used data from published literature, practical experience, and opinion of a large group of academic oncologists, to arrive at practical consensus recommendations for use by the community oncologists.
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Practical consensus recommendations on fertility preservation in patients with breast cancer p. 110
Jyoti Bajpai, A Majumdar, R Satwik, N Rohatgi, V Jain, D Gupta, R Agarwal, S Mittal, SK Verma, PM Parikh, S Aggarwal
DOI:10.4103/sajc.sajc_113_18  
Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Expert oncologists along with reproductive medicine specialists discuss fertility preservation options in this chapter since fertility preservation is becoming a priority for young women with breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.
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Practical consensus recommendations for gestational breast cancer p. 115
JS Sekhon, N Naik, P Bansal, I Bansal, A Dhull, A Goel, CS Ramachandran, S Shinde, S Aggarwal, PM Parikh
DOI:10.4103/sajc.sajc_115_18  
This manuscript provides a practical and easy to use consensus recommendation to community oncologists on how to manage gestational breast cancer.
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Practical consensus recommendations on Her2 +ve breast cancer with solitary brain mets p. 118
Nitesh Rohatgi, A Munshi, P Bajpai, M Singh, S Sahai, M Ahmad, K Singh, H Singh, Purvish M Parikh, S Aggarwal
DOI:10.4103/sajc.sajc_116_18  
Breast cancer is a common cause of brain metastases, with metastases occurring in at least 10–16% of patients. Longer survival of patients with metastatic breast cancer and the use of better imaging techniques are associated with an increased incidence of brain metastases. Current therapies include surgery, whole-brain radiation therapy, stereotactic radiosurgery, chemotherapy and targeted therapies. However, the timing and appropriate use of these therapies is controversial and careful patient selection by using available prognostic tools is extremely important. Expert oncologist discussed on the mode of treatment to extend the OS and improve the quality of life ofHER2-positivebreast cancer patients with Solitary brain metastases. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Practical consensus recommendations regarding the management of hormone receptor positive early breast cancer in elderly women p. 123
Govind Babu, A Goel, S Agarwal, S Gupta, P Kumar, BK Smruti, V Goel, R Sarangi, M Gairola, S Aggarwal, Purvish M Parikh
DOI:10.4103/sajc.sajc_117_18  
Breast cancer is a leading cause of death among women, and its incidence increases with age. Currently the treatment of breast cancer in older patients is almost identical to their younger counterparts. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists regarding the management of early breast cancer specifically in elderly women.
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Practical consensus recommendations on management of triple-negative metastatic breast cancer p. 127
R Rangarao, BK Smruti, K Singh, A Gupta, S Batra, RK Choudhary, A Gupta, S Sahani, Vedant Kabra, Purvish M Parikh, S Aggarwal
DOI:10.4103/sajc.sajc_118_18  
Patients with breast cancer along with metastatic estrogen and progesterone receptor (ER/PR)- and human epidermal growth factor receptor 2 (HER2)-negative tumors are referred to as having metastatic triple-negative breast cancer (mTNBC) disease. Resistance to current standard therapies such as anthracyclines or taxanes limits the available options for previously treated patients with metastatic TNBC to a small number of non-cross-resistant regimens, and there is currently no preferred standard chemotherapy. Clinical experience suggests that many women with triple-negative metastatic breast cancer (MBC) relapse quickly. Expert oncologist discussed about new chemotherapeutic strategies and agents used in treatment of mTNBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Practical consensus recommendations regarding the management of sentinel lymph node issues in early breast cancer p. 132
Vedant Kabra, R Aggarwal, S Vardhan, M Singh, R Khandelwal, S Jain, S Sahani, S Saini, N Deo, R Kaul, PM Parikh, S Aggarwal
DOI:10.4103/sajc.sajc_120_18  
Axillary lymph node involvement is a very important poor prognostic factor in the clinical staging and management of breast cancer patients. Traditionally, axillary lymph node dissection (ALND) has been used for determining the status of the axillary lymph nodes. More recently the sentinel lymph node biopsy (SLNB) procedure has gained wider acceptance as the standard of care, having the advantage of being less invasivewhile providing good accuracy. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations in regards with the use of the two different procedures and other issues in patients with early breast cancer for the benefit of community oncologists.
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Practical consensus recommendations regarding the use of hormonal therapy in metastatic breast cancer p. 137
Senthil Rajappa, J Bajpai, M Basade, M Ganvir, C Goswami, A Murali, AK Rathi, V Kaushal, S Jain, Purvish M Parikh, S Aggarwal
DOI:10.4103/sajc.sajc_121_18  
Metastatic breast cancer (MBC) is cancer that has spread from the breast to another part of the body or has come back in another distant location. Treatment options for MBC depend on several factors. One of these factors is the levels of hormone receptors (HRs) in the tumor. Cancers with high levels of HRs, called HR-positive, use the hormones estrogen and progesterone to grow and spread. Hormonal therapy is a type of treatment specifically for HR-positive breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations in regards with the use of hormonal therapy and the management of HR-positive MBC for the benefit of community oncologists.
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Practical consensus recommendations on duration of adjuvant hormonal therapy in breast cancer p. 142
S Gupta, M Singh, Amish Vora, G Babu, M Walia, V Nautial, R Saha, BK Smruti, JB Sharma, R Koul, Purvish M Parikh, S Aggarwal
DOI:10.4103/sajc.sajc_122_18  
Optimization of adjuvant systemic therapy in women with early-stage hormone receptor-positive breast cancer includes the consideration of chemotherapy and duration of hormone therapy. Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). Expert oncologist discussed on the duration of adjuvant hormonal therapy for improvement of OS and quality of life of breast cancer patients by providing reduction in recurrence and mortality. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Practical consensus recommendations regarding the management of HER2 neu positive metastatic breast cancer p. 146
M Basade, M Singhal, AK Rathi, M Nandi, S Minhas, C Goswami, S Shinde, PM Parikh, S Aggarwal
DOI:10.4103/sajc.sajc_123_18  
Metastatic breast cancer (MBC) is cancer that has spread from the breast to another part of the body or has come back in another distant location. Treatment options for MBC depend on several factors, including where the cancer has spread, the patient's overall health, and the levels of hormone receptors and HER2 in the tumour. Over-expression of HER2 is generally considered to be a negative prognostic feature because it accompanies an increase in breast cancer mortality. However, the development of agents that specifically target HER2 has improved the management of patients with these tumours.[7],[8],[9],[10] This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations in regards with the use of these agents and the management of HER2 positive MBC for the benefit of community oncologists.
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Practical consensus recommendations on ovarian suppression in early breast cancer (adjuvant) p. 151
M Singhal, TP Sahoo, S Aggarwal, A Singhvi, V Kaushal, S Rajpurohit, KM Parthasarthi, A Vora, M Ganvir, S Gupta, Purvish M Parikh
DOI:10.4103/sajc.sajc_125_18  
Substantial survival benefits exist for patients with early-stage breast cancer who undergo treatment with single-modality ovarian suppression, but its value is uncertain. Expert oncologist discussed to determine whether additional benefits exist with ovarian suppression plus multiple adjuvant therapy which provides a new treatment option that reduces the risk of recurrence in early breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Practical consensus recommendations for neo-adjuvant chemotherapy in triple negative breast cancer p. 156
GS Bhattacharyya, M Walia, M Nandi, A Murli, S Salim, S Rajpurohit, S Shinde, S Aggarwal, PM Parikh
DOI:10.4103/sajc.sajc_126_18  
This manuscript provides a practical and easy to use consensus recommendation to community oncologists on how to use neoadjuvant chemotherapy in triple negative breast cancer patients.
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