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Women with either breast cancer (BC) or ovarian cancer (OC) have a 1.5-2 times higher risk of developing the other. Discerning discrete primaries versus metastases from either can be challenging. Clinico-pathological and outcome details of patients diagnosed with both BC and OC from December 1994 to August 2018 were retrospectively evaluated at a single tertiary cancer centre. We report the pattern of presentation and recurrences with case-based illustrations. Out of 139 patients, presentation was BC-first in 66.2%, OC-first in 24.5% and synchronous cancers (SC) in 9.3% of women. The median age at diagnosis in BC-first, OC-first and SC was 42 years, 48 years and 49 years, respectively. The most common histological subtype was invasive breast carcinoma-no special type (74.8%) in BC and serous cystadenocarcinoma (81.3%) in OC. BC presented at an early stage in 67.6% while OC presented at an advanced stage in 48.2% of patients. Germline mutation results were available in 82% with 61.4% of the cohort exhibiting a mutation- BRCA1 mutation being the most common. The median time to development of second cancer was 77.4 months and 39.4 months in BC-first and OC-first, respectively. At a median follow-up of 9.47 years, disease-free survival was 32.6%, 32.4% and 30.8% in BC-first, OC-first and SC, respectively ( p  < 0.001). In hereditary breast and ovarian cancer, BC-first patients have a better prognosis while synchronous malignancies have worse oncological outcomes. Deaths are mainly due to OC progression. Appropriate surveillance and prophylactic intervention in young patients with breast cancer may improve overall outcomes., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Breast cancer is no longer considered a single disease, and with better understanding of cancer biology, its management has evolved over the years, into a complex individualized use of therapeutics based on variable expressions of predictive and prognostic factors. With the advent of molecular and genetic research, the complexity and diversity of breast cancer cells and their ability to survive and develop resistance to treatment strategies became more evident. At the same time, targeted therapies evolved, as specific targets were discovered such as HER2 receptor, and androgen receptor. More recent is the development of immunotherapy which aims at strengthening the host immune system to identify and kill the tumor cells. In breast cancer treatment, use of molecular tests has been a target of controversies, due to their high costs and inaccessibility in limited resource situations. Research in breast cancer is also proceeding at a rapid pace, but it is important to remember that breast cancer continues to be a complex interplay of alterations at molecular and genetic level, with the variability in expressions at protein level leading to difference in behavior and responses to treatment and overall outcome. In the succeeding paragraphs, we will try to review the available evidence in literature and attempt to understand the molecular complexity of breast cancer in order to simplify the art of treating the disease and improving outcomes., (© Indian Association of Surgical Oncology 2019.)

Breast cancer in India appears to be diagnosed more in the young women, but whether this is an actual higher incidence, and hence a matter of concern, needs more clarity, and the extent to which correctable measures can be taken to reduce or overcome this additional disease burden, if any, has to be better understood. The article analyzes these and more in a systematic manner and highlights the important issues in the very young women which makes the clinical management of breast cancer more complex.

Breast conservation surgery after large volume excisions for women with relatively larger or multicentric operable breast cancer (OBC) and in some locally advanced breast cancers (LABC) post neo-adjuvant chemotherapy (NACT), is known to be a feasible option using a latissimus dorsi flap. However, the oncological safety of such a procedure is not well reported in literature. Two hundred and twenty one women with breast cancer (148-OBC, 73-LABC) underwent BCT plus LD during March 1998 to August 2009. One hundred and forty six women (72-LABC, 66-OBC) received prior NACT for downstaging, followed by completion of adjuvant therapy in all, including postoperative radiotherapy and hormone therapy where indicated. Women aged 20-62 years, with tumors 1.5-15 cm (median 5.0 cm), underwent volume replacement surgery with LD flap. All positive cut margins (total-4.9%, gross positive-1.3%) were re-excised to ensure negative margins. The mean surgical time for excision of primary with axillary clearance followed by volume replacement by LD was 5 h and mean hospital stay 6 days. Donor site morbidity was seen in 11 patients and 3 had minor recipient site infection. At a median follow up of 36 months, ten of 221 patients (4.5%) had failed locally (7-OBC, 3-LABC). The determinants of local recurrence were presence of lymphatic vascular invasion (p = 0.016) and axillary metastasis (p = 0.003). BCT plus LD flap is an oncologically safe, technically quick procedure with minimal morbidity, and should be offered to all eligible women as an extended breast conservation procedure.

Absence of breast cancer screening in India, lack of awareness in rural population, social inhibitions and poor socioeconomic status leads to a situation where a large proportion of women in India are still presenting with locally advanced breast cancer (LABC) at the time of initial diagnosis, although, there are relatively more of early stage cases detected in the metros and urban areas than maybe a decade ago. With advances in care and introduction of newer chemotherapeutic agents, it has now become feasible to offer neoadjuvant therapy with effective tumor downsizing, thus making it possible to even consider breast conservation surgery in select patients with locally advanced and unresectable disease at presentation. With reports suggesting apparent safety of the procedure, breast conservation treatment after chemotherapy is now being offered as routine care in most major centers for selective women with LABC. Multimodality therapy is the standard of care with neoadjuvant systemic therapy for all women with LABC.