Inclusion criteria: Female patients above age 18 years presenting to General Surgery OPD with breast carcinoma

Exclusion Criteria: Patient with benign breast diseases., inflammatory breast carcinoma. , systemic metastases & inoperable breast cancer.

Age: Patients who took part in the study were from 28-68 years of age. Majority of people were in the age group of 46-55 years (38%), followed by 36-45 years (30%) and above 55 years. Mean age of patients in this study is 48.9 years. Among 50 cases 6 cases showed recurrence. 3 patients are in above 55 years age group and 2 are from 36-45 years group and remaining one from 46-55 years group.

Clinical findings: Out of 50 patients, 45 patients presented with lump, 4 patients with ulcer, one with pain over the lump. None had the complaints of backache, bone pains, respiratory complaints, abdominal complaints.

Duration of complaints: Among 50 cases 20 presented with in 2-4 months of duration. 26 cases presented with 5-7 months of duration. 2 cases presented with history of 8-10 months and remaining 2 presented with more than 10 months history. Mean duration of the presentation in this group is 5.38 months.

Age at menarche: In the study conducted by taking detailed history out of 50 cases. 22 attained menarche at their 13 years age, 19 attained at 14 years age and 9 attained at12 years of age. Mean age of menarche is 13.2 years.

Breasst feeding: Among 50 cases 47 women breastfed their babies while remaining 3 did not. Age at menopause: While observing the menstrual history of 50 cases 24 completed their menopause and remaining 26 are still having their menstrual cycles.

Tumour size and nodal status by TNM staging: While observing the tumour size in the study group 6% patients presented with T1. 34% patients presented with T@/ 46% patients presented with T3. 14% patients with T4B stage. While observing the lymphnode status 96% of patients showed node positive status 4% showed node negative status. Percentage of recurrence is 12% among 50 cases. Percentage of recurrence among node positive cases is 12.5%.

TNM staging: 40% of patients in study group were in stage III A. 34% were in stage II B. 18% were in stage III B. 6% were in stage II A. remaining 2% were in stage I

Stage of disease: 42% of patients in study group are in EBC. 58% were in LABC. 9.52% patients showed recurrence in EBC group where as 13.79% patients in LABC group.

Lymphatic invasion: On HPE lymphatic invasion was found in 38 patients and not found in 12 patients. 5 cases of recurrence were noted out of 38 patients with lymphatic invasion and 1 out of 12 patients without lymphatic invasion. Percentage of recurrence in the patients with lymphatic invasion is 13.15% and in the patients without lymphatic invasion 8.3%.

Vascular invasion: Vascular invasion was found in 16 patients out of 50. Six cases of recurrence noted out of which 4 cases from patients with vascular invasion and 2 from patients without invasion. Percentage of recurrence in the patients with vascular invasion is 25% and percentage of recurrence in the patients without vascular invasion is 5.8%. Recurrence is more common in patients with vascular invasion which indicates poor prognosis.

Histological Grading: Modified Bloom Richardsons (MBR): Out of 50 patients based on HPE 24 patients are in Grade II Grade I and 9 are in Grade III. Among 6 recurrent cases 4 are from patients with Grade III, 2 are from the patients with Grade II. Percentage of recurrence is 44.4% from the patients with grade III. 8.3% is from the patients with grade II

Age: Patients who took part in this study were from 28 to 68 years of age. Majority of people were in age group of 46-55yrs (38 per cent) followed by 36 – 45 years (30 per cent) and aged above 55. The mean age of the patients in the study is 48.9 years which is much lower than 62yrs reported in study by Adedayo A onitilo et al.

Clinical presentation: Out of 50 patients in this study, 45 patients presented with lump in the breast, 4 patients with ulcer over the breast, 1 patient with pain over lump. None of the patients included in this study presented with nipple discharge. None of these 40 patients had the complaints of symptoms due to metastases like backache, bone pains, respiratory complaints and abdominal complaints. In this study conducted by Divyasree et al, out of 185 cases, 170 cases presented with a lump in breast and of the remaining 15 cases, 5 patients presented with nipple discharge alone while other 10 cases with both lump and nipple discharge. Most of the patients presented with lump, associated compliant was pain. These results were similar to my study.

Duration of complaints: Among 50 patients included in the present study, 20 patients presented with in 2-4 months of duration of symptoms. 26 cases presented with 5-7months of duration of symptomatology. 2 cases presented with history of 8-10 months and remaining 2 patients presented with more than 10 months of history. Mean duration of the presentation of the patients in this group is 5.38mnths.

Age at Menarche: Out of 50 patients taken in this study, 22 patients have attained menarche at 13years of age, 19 patients attained at 14years age, 9 patients attained at 12 years of age. Mean age of menarche of patients in my study is 13.2years.

Breast feeding: Among 50 cases recruited in this current study, 47 women have breastfed their babies exclusively for 1 year, while remaining 3 patients have not breast fed their babies.

Age at Menopause: Elaborate history was elucidated from all the patients participated in the study. While observing the menstrual history of 50 cases, 24 completed their menopause and remaining 26 are still having their menstrual cycles.

Comparison of axillary lymphnodal status: While observing the axillary lymph nodal status in my study, 96% of patients showed node positive axillary lymph node status. 4% of patients showed node negative status in the axilla.

Comparison of tumor size: By analysing the results from current study, • 6 per cent of patients presented with T1 lesion (less than 2cm). • 34 per cent of patients presented with T2 lesion (2 – 5 cm). • 46% of patients with T3 lesion ( more than 5 cm). • 14 per cent of patients presented with T4 lesion ( any size with one of following - i. skin involvement, ii. Chest wall involvement, iii. Both, iv. Inflammatory breast cancer). Most of patients presented with T3 lesion followed by T2 lesion in present study. In this study, six cases of loco regional recurrence were found on follow up. Among those three patients were T3 lesion, two cases were T4b lesion and the remaining one patient with T2 lesion. The patients who were recruited in my study presented with large sized lumps probably due to poor socio economic status, un awareness and lack of effective screening methods. As the tumour size increases, recurrence rate increases and prognosis also becomes poor with increasing in tumour size.

Comparison of Histology: Most common histologic type of breast carcinoma was Invasive Ductal carcinoma (NOS) type in the current study. Forty patients out of 50 patients in my study had Invasive ductal carcinoma(IDC-NOS). It is followed by Invasive ductal carcinoma, intra lobular carcinoma and Intraductal carcinoma-comedone. Among 6 cases of recurrence which were observed on follow up in my study, three cases were with Intra ductal carcinoma -not otherwise specified type, one case of Intraductal carcinoma-comedone, one case of medullary type and other case of NHL-Undifferentiated.

Tumor Grading: In our study, patients presented with Grade II tumours (48 per cent) were common followed by grade I (34 per cent) and then by grade III (18 per cent). But above results are in contrast to the reported observations in studies done in developed countries where well differentiated breast malignancies are more common when compared to poorly differentiated because of use of routine screening mammography which has led to detection of very early lesions.