Spectrum Of Breast Diseases In A Tertiary Care Hospital In North India

Global Journal of Pathology & Laboratory Medicine
Volume 1, Issue 2, June 2021, Pages: 9-15
Received: June 06, 2021; Reviewed: June 08, 2021, Accepted: June 11, 2021; Published: June 14, 2021

Unified Citation Journals, Pathology 2021,
ISSN 2754-0952

Authors: Dr. Suraj ShikalgarFile:ORCID iD.svg - Wikimedia Commons, Dr. V.Nijhawan, Dr. Prem Singh

Department of Pathology, of Medical Science and Research, Mullana, Haryana

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Keywords: Benign Breast Lesion, Malignant Breast Lesion, Prospective study, Breast Lump


Breast lesions are the most prevalent among the women population with benign lesions most common in early post-puberty reproductive decades of life and malignant lesions one of the most common causes of morbidity and mortality proving one of the main causes of the global burden of disease among women population.

Materials and method:-
Two years of prospective study is performed at a tertiary care centre at M.M. Institute of medical science and research (Mullana), Ambala Haryana.

To determine the different profiles of breast lesions in the north Indian population by maintaining a record of a patient with breast lesions coming to the pathology department for a period span of 2yrs from 25 May 2019 to 26 May 2021.

Out of 256 cases 159 benign 97 malignant cases, 86 cases of fibroadenoma (33.59%), a most common benign lesion. invasive breast carcinoma with 59 cases (23.04%) was the most common malignant condition. Benign cases were more than malignant ones with B: M ratio of 1.6:1 Women’s ranging from 14-75 years were included in the study. Commonage group 20-40yrs with benign lesion and 35-65yrs with malignant conditions were seen to be involved. An urban population consisting of 63.55% compared to a rural population of 36.45% was most commonly involved.

Benign breast diseases are more common among early age groups of life compared to malignant ones. Among benign conditions, fibroadenoma is the most common condition & among malignant conditions, invasive carcinoma NST is the most prevalent condition among the north Indian population with a lump in the breast being the most common clinical presentation.

Breast lesions are the most prevalent condition among women population worldwide wide 2,261,419 cases (11.7%) of all sites with 684,996 deaths 6.9% of all sites according to globocan 2020 has even surpassed lung cancer in 2020 with 2.3million new cases worldwide.
Lack of knowledge and social awareness leading to failure of early-stage detection are the main causes leading to the worst outcomes and increased morbidity and mortality.

Materials and Method:-
A two-year prospective study is performed at the tertiary care centre of Mullana, Ambala from May 2019 to May 2021.

Sampling method:-
An observational study record was maintained of all patients coming to the pathology department .L+G and H+E stains were used for staining slides. Results were displayed in a tabulated form.

Inclusion criteria:-
All patients between 14-75yrs with breast diseases were included in the study. Along with women’s, men’s were also included in the study. Only confirmed benign and malignant cases were included in the study.

Exclusion criteria:-
Already treated patients were excluded from the study. Patients with inadequate samples were excluded from the study.

Total 256 cases ; B:M = 1.6:1 ; B>M cases. Fibroadenoma’s most common benign lesion 86 cases ( 33.59%) 0f total cases followed by inflammatory breast lesions with 30 cases(11.71%) of total cases. Invasive breast carcinoma NST most common malignant lesion with 59 cases ( 23.04%) 0f total cases.

Lesions:- No. of cases % of cases
Fibroadenoma 86 33.59%
Inflammatory lesions 30 11.71%
Fibrocystic disease 24 9.37%
Fibroadenosis 9 3.51%
Benign phyllodes 6 2.34%
Gynecomastia 4 1.56%
Total:- 159 62.10%
Invasive carcinoma NOS 59 23.04%
Ductal carcinoma in situ 26 10.15%
Metastatic Ca 6 2.34%
Medullary ca 5 1.95%
Mucinous ca 1 0.39%
Total:-97 37.89%

Age-wise distribution of most prevalent benign lesions in the study [Table 1]

Age group Fibroadenoma Fibrocystic Inflammatory
0-15 yr 1 0 0
15-30yr 43 6 16
31-50yr 20 17 13
51-70yr 1 1 3
71-90yr 0 0 1

Result:- Benign Lesions most common between 15-45yrs of age group [Table 2]

Age-wise distribution of most common malignant tumors in study.

Age group Invasive Ca NST DCIS Metastatic Ca
0-15yr 0 0 0
15-30yr 2 1 0
31-50yr 22 9 1
51-70yr 34 15 4
71yr-90yr 1 1 1

Result:- Malignant lesions are more common between 40-60yrs of age groups [Table 3]

Benign lesions are most common in the reproductive age group with most cases between 15-30 yrs of age [Table 2] and malignant lesion with most cases between 51-70yrs of age. [Table 3] Breast lump is the most common clinical presentation among 128 cases (50%) of total cases [Table 4]

Symptoms No. of cases % 0f cases
Lump 128 50%
Lump with pain 80 31.25%
Lump with pain and nipple discharge 26 10.15%
Redness 14 5.46%
Ulcer 8 3.12%

Breast lump most common clinical presentation [Table 4]

The breast is a dynamic organ undergoing physiological changes throughout the reproductive period of a woman right from the onset of puberty till menopause due to the action of hormones and growth factors leading to most of the breast pathologies. [1]

It is one of the common diagnostic problems both to the general practitioner and to the surgeon. The surgeon in the breast clinic has two important tasks when confronted with a patient with a breast lump he has to decide whether the lump is truly an abnormality or is a benign lesion within the spectrum of normality. And if the lump is a true abnormal, he has to determine whether it is malignant. [2]

Breast cancer in India is the first common cause of death with 178,361(26.3%) new cases adding each year newly causing near about 90,408(10.6%)deaths with a 5-year survival of (69.28%). Proving one of the important causes of mortality and morbidity among the Indian population as well as the global burden of disease worldwide. [3]

Common risk factors are reproductive factors, alcohol intake, high breast density, postmenopausal hormone replacement therapy importantly family history of BC. [4]

Family history of other cancers such as colon, ovary, and prostate is also a known risk factor for BC. [5]

The chief complaints can include abnormal enlargement, asymmetric growth, nipple discharge, breast pain, skin changes, or a palpable mass. [6]

Incidence of benign breast diseases begins to rise in the second decade and peaks in the fourth and fifth decade of life. [7]

FNAC is one of the best outpatient, procedures of choice on both economical and timeless procedures helping in making an early diagnosis. The technique of FNAC was used as far as back as 1847 by Kun, who first published a report of needle biopsy in 1847. [8]

In 1930, Martin and Ellis also reported their experience with FNAC. [9]

Some of the factors contributing to false-negative results may be due to the small size of the tumor; hypocellularity; inadequate sampling during aspiration; lack of experience in interpreting samples and the presence of both malignant and benign lesions in the same sample. [10]

Therefore FNAC followed by a follow up of core biopsy can give an accurate diagnosis helping in allotting the proper line of treatment to a patient. Therefore a core biopsy can be handy and give the most accurate diagnosis proving the golden standard in diagnosis making. Comparison of our study with different studies from various parts of India as well as from other developing countries with similar outcomes showed In a study by M.Pote breast lump was the most common clinical presentation and among benign conditions fibroadenoma most common benign surgical lesion followed by malignant lesions with B>M cases like our study. [11]

In a study by S. Manjiri, it is observed that Benign breast lesions can be found in early adolescent age too. In the age group between 11-14 years. In our study too we had a 1 case in 14 yrs range of fibroadenoma diagnosis. [12]

In a study by H. Muhammad age range from 12-74 yrs included with benign lesions more compared to malignant ones. With fibroadenoma most common benign lesion followed by inflammatory lesion findings similar to our study. [13]

Vani Dayanand in her study had benign lesions more common compared to malignant ones with fibroadenoma most common benign lesion and invasive breast ca NST most common malignant lesion similar to our study. [14]

A study by B.A.Eke in a developing country like Nigeria benign lesion were more compared to malignant ones with a B>M ratio of 135 /114 i.e. 1.18: 1 similar to B>M with B: M ratio of 1.6:1 with fibroadenoma common benign lesion and invasive ca common malignant lesion just like our study. [15]

Harihar Devkota in his study had come to the conclusion that benign diseases were seen mostly in the younger population while malignant diseases were common in an older population. Females formed the main population with breast lesions compared to the women population with only 4male cases just like our study. [16]

In an article by Samir S Amr fibroadenoma was the most common benign lesion in the reproductive age group with maximum cases in 20-30 yrs of age group these findings are similar to our study. [17]

Arunima Mukopadhay had more no of benign breast lesions compared to malignant ones in her five-year study on female breast lesions. And most patients presented to opd with a chief complaint of a lump in the breast. with benign lesions most common in the age group between 15-45yrs and malignant lesions most common among age groups between 46-60yrs. [18]

Gurmeet Singh in an article on the profile of breast diseases in Jammu had more benign lesions compared to malignant ones with a lump in breast common presenting complaint and pain associated with lump common in malignant conditions mostly findings just like our study. [19]

Bhupinder Singh Walia in his survey article on breast diseases in Amritsar north India has mentioned the prevalence of benign lesions more common compared to malignant ones in Amritsar city of Punjab a north Indian state finding similar to our study. [20]

The overall incidence of breast diseases in different population groups in India is still incompletely documented and has different patterns of presentation. [21]

Knowledge about the disease and social awareness needs to be raised in under progressed and rural parts of the northern countryside of developing countries like India. The need for a proper screening program and self-examination and palpation methods and an early-stage approach to nearby tertiary care centres can definitely help to control the morbidity and increase survival interval in women dealing with the condition throughout India and other such developing countries facing similar problems.

Conflict of interest:-

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[3] Globocan2020 International agency for research on cancer (WHO)
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[5] Ronco AL, De Stefani E, Denso-Pellegrini H. Risk factors for premenopausal breast cancer: a case-control study in Uruguay. Asian Pac J Cancer Prev 2012;13:2879–86
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[11] M.Pote To study the spectrum of breast diseases in reproductive age, women in rural population; International Journal of Surgery Sciences 2020;4(3): 348-352
[12] S.Manjiri A Prospective observational study of breast lumps in adolescent girls: Indian journal of Surgical Oncology(September 2018) 9(3):402-406
[13] H.mohammad Clinico-pathological profile of patients with breast diseases aslam et al.Diagnostic Pathology 2013,8:77
[14] Vani Dayanand Spectrum of breast neoplasms in females: a 10 years histopathological review in a tertiary care hospital: International journal of Scientific Study/May 2015/Vol 3/Issue 2
[15] B.A.Eke The spectrum of breast diseases in Nigeria North Central: A Histopathological survey Eke et al.: JAMPS, 13(3):1-6, 2017; Article no.JAMPS.32384
[16] Harihar Devkota Spectrum of breast diseases in a rural Himalayan region of Western Nepal: A hospital-based study: JCMC/Vol 10/No.3/Issue 33/Jul-Sept,2020
[17] AMR ET AL: The Spectrum of breast diseases in Saudi Arab females: A 26-year pathological survey at Dharan Health Center: Annals of Saudi Medicine, Vol 15, No 2, 1995
[18] A. Mukhopadhyay: Female Breast Lesions- A Five Year Study in a Tertiary Care Centre.: International Journal of Anatomy, Radiology, and surgery. 2017 Jan, Vol-6(1): SO10-SO14
[19] Gurpreet Singh et al: Profile of Breast Diseases In Jammu Vol. 18 No.3, July- September 2016
[20] Bhupinder Singh: Survey of Breast Diseases in Women in ISSN: 2249-9571
[21] Ankur B Pachani: Breast Diseases Managed at a tertiary care center with a rural set up in the rural area of India: Critical analysis: Int J Med Res Prof.2016;2(3);213-22

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To citation of this article: Dr. Suraj Shikalgar, Dr. V.Nijhawan, Dr. Prem Singh, Spectrum Of Breast Diseases In A Tertiary Care Hospital In North India, Global Journal of Pathology & Laboratory Medicine

Dr. Suraj Shikalgar

Department Of Pathology, Maharishi Markendeshwar Institute Of Medical Sciences & Research, Mullana, Ambala

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