| So much has happened in cancer care over the past 50 years - in diagnostic methods, treatment options, preventive care, early detection and patterns of cancers. From all over the state, cancer patients particularly women come with fear and uncertainty to Regional Cancer Centre [RCC], Thiruvananthapuram. Among them some come for treatment, some come for routine checkups and some others come with symptoms of cancer.
Dr. Ramachandran is Head of the Imageology Division, Regional Cancer Centre [RCC] ,Thiruvananthapuram. He is also Additional Director of RCC and President of Indian Medical Association, Thiruvananthapuram Branch. He has done his MBBS at TD Medical College Alappuzha and then MD and DMRD at Thiruvananthapuram Medical College. He then underwent training in clinical application of CT Scan at Kyokko, Japan and Mammotome at National Cancer Institute, Singapore. He also attended the Europian Congress of Radiology in 2003. He has also presented many papers in national and international seminars. He has published many articles related to the subject in different national and international radiology journals.
Thousands of patients have got relief after undergoing diagnosis under Dr. Ramachandran and his team at Regional Cancer Centre [RCC], Thiruvananthapuram, Kerala;the place inspires hope of cure. It is one of the finest centers for treatment and research in cancer in India and the world over.
In an interview to Sreeni K.R, Dr. Ramachandran gives a glimpse of Mammography and how Mammography helps in early detection of breast cancer.
. 1. What exactly is mammography?
Mammography is soft tissue radiography of the breast carried out with dedicated X-ray equipment designed to produce low voltage X-ray in the range of 24 to 28 kvp. The anode is molybdenum. Beryllium window, compression device, cone etc are used. A mammography exam, called a mammogram, is used to aid in the diagnosis of breast diseases in women.
2.What is the difference between digital mammography and computer aided detection?
Now, like Digital radiography, Full field digital mammography is available in which solid-state detectors that convert x-rays into electrical signals which produce images of the breast that can be seen on a computer screen. Computer aided detection is a screening test applied to either routine mammography film or digital mammogram to ensure a high yield of detection of early breast cancer 3.In Regional Cancer Centre, which type of detection test do you use?
We have a Siemens 3000 NOVA mammography unit with facility for steriotactic biopsy as well as a mammotome vacuum assisted breast biopsy unit. 4.How much early can you detect breast cancer in women through the mammography test?
 Screening, according to American College of Radiology, starts at the age of forty. In women with a strong family history of breast cancer, screening should start ten years before the age at which the first degree relative was diagnosed to have had breast cancer but breast cancer can start at a very young age, like below 20years. Mammography is unlikely to be diagnostic in very young breasts. Ultrasound and guided aspiration techniques are more productive in younger women. 5.What is the cost of a mammography test? Mammography test of both breasts costs Rupees one thousand only.
6.At what age do you recommend the mammography test for an Indian woman?
After 30years for suspected cases and after 40years for usual cases, tests are advisable . Below 30years, the referring doctor should use discretion in deciding whether mammography is to be recommended or ultrasound combined with guided procedures would be better
7.How should a patient prepare for mammogram and what precaution should she take?
There is no preparation required. Breasts are compressible during the first few days after the menstrual cycle. Hence the first ten days after the first day of the menstrual cycle is ideal. But this is not strictly adhered to.
8. How does a mammography machine work?
Mammography is soft tissue radiography of the breast. Low kilovolt age X-rays from a molybdenum target fall on the compressed breast and a latent image is produced in the film kept inside a carbon fibre cassette. The film is coated on one side only. The film is processed to get an image of the breast. Now Full field digital mammography is also available.
9.What will be the experience during and after the examination?
For taking mammography, the breast has to be compressed using a compression device. This may cause pain. If the pain is not tolerated by the patient, the technologist can stop the procedure any time. So compression is given till the patient complaints of pain.
10.What are its benefits and how frequently is the test done in India and especially in Kerala?
In Kerala mammography is done mainly when the woman presents with complaints like lump in the breast, nipple discharge, pain, nipple retraction, axillary swelling, etc. to diagnose or rule out breast cancer. Screening in asymptomatic women has not been popular due to lack of facilities and also the cost factor. The Kerala Government has not started any screening programmes. The same holds good for the Indian scenario also.
11.Are there any risk factors involved in the test and what are they? Being an X-ray imaging modality, radiation hazards are inherent. This test is to be avoided in pregnant women. Cumulative radiation for screening carries a low risk of inducing breast cancer. Young breasts are more sensitive to radiation 12.What is your advice to those women who have a genetic history of breast cancer?  Strictly start the screening test at an earlier age, also clinical examinations and procedures like steriotaxy, guided biopsies, etc, in suspected cases. Problem solving modalities like ultrasound and MRI are also useful in these women.
13.Once breast cancer is detected, what are your treatment options? Surgery, Radiotherapy and Chemotherapy are the treatment options. Now other modalities like hormone therapy, monoclonal antibody treatment etc are available. Conservation of the breast is the rule rather than exception. Early diagnosis offers the best hope of cure in this malignancy. Survival depends on the stage at which the disease is diagnosed. 14.As a radiologist, how long have you been dealing with mammography? As all of you know, Regional Cancer Centre , Thiruvananthapuram is Asias largest Cancer Hospital well equipped with all modern facilities to diagnose and treat cancer. We have the facility for mammography since the early 80s, which was the first in Kerala. For the last 25yrs I am dealing with mammography along with other radiological investigations such as Ultrasound, CT Scan, MRI, conventional X-rays etc. In this context, I place on record my sincere thanks to all staff of our department for their help and cooperation. 15.What are the safety or precautionary measures that you advise to the patients? All women should be aware of breast cancer. They should learn and practice breast self examination, undergo half yearly clinical examination and yearly mammography after 40years. Approach your doctor if you have symptoms like lump, nipple discharge, nipple retraction, skin thickening, swelling in the axilla, etc. 16.How do you look forward to tackling cancer in the years to come? Is it completely curable? If detected early, cancer of most organs is curable. But early detection occurs only in 1/3rd cases. Early detected cases can be controlled with surgery, chemotherapy and radiation. 1/3rd cases can only be palliated with pain relievers and symptomatic treatment. The present situation may exist at least for the next decade. | 
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