15 Frequently Asked Questions : Breast Cancer Treatment and Surgery in India for Zambian Patients

Q1 · What Breast Cancer Treatments Are Available in India?

Breast cancer treatment in India may include one or more of the following:

Surgery

• Breast-conserving surgery/lumpectomy
• Mastectomy
• Modified radical mastectomy
• Skin-sparing mastectomy in selected patients
• Nipple-sparing mastectomy in selected patients
• Sentinel lymph-node biopsy
• Axillary lymph-node dissection
• Oncoplastic breast surgery
• Breast reconstruction

Medical Treatment

• Chemotherapy
• Hormone/endocrine therapy
• HER2-targeted therapy
• Immunotherapy
• Other targeted treatments where appropriate

Radiation Treatment

• External-beam radiotherapy
• IMRT/IGRT in selected cases
• Other advanced radiation techniques where clinically appropriate

The exact combination depends on the patient's cancer subtype and stage. Indian clinical guidance describes surgery followed by individualized adjuvant treatment for early breast cancer, with systemic therapy decisions guided by factors including ER, PR, HER2 and Ki-

Q2 · What Is the Cost of Breast Cancer Treatment in Zambia Compared with India?

For planning purposes, the following exchange rates are used:

• US$1 ≈ ZMW 19.5
• US$1 ≈ INR 96

Indicative Cost Comparison

Published Indian hospital estimates currently place lumpectomy around INR 1–2.5 lakh, while Yashoda Hospitals gives an approximate lumpectomy cost of INR 1.8 lakh and modified radical mastectomy around INR 2.5 lakh. Other published Indian estimates show wider ranges depending on hospital and complexity.

Breast reconstruction and oncoplastic surgery can add substantially to the total cost. BMCHRC currently reports broad Indian ranges of approximately INR 1.5–5 lakh for oncoplastic surgery and INR 1–5 lakh for breast reconstruction.

Important: These Zambia figures are indicative private-healthcare planning estimates rather than standardized national tariffs. The final cost should always be confirmed through a hospital quotation.

Q3 · Which Major Indian Cities Can Zambian Patients Consider for Breast Cancer Treatment?

For international patients, the most appropriate city should generally be selected according to the specific treatment required, surgeon experience, availability of pathology and imaging review, reconstruction services, radiation facilities and the ability to provide the complete treatment pathway.

Q4 · Which Hospitals in India Can Zambian Patients Consider?

Important: Not every hospital listed necessarily provides every breast-cancer treatment or reconstruction technique. The patient's exact requirements should be confirmed with the treating breast-cancer team.

Q5 · What Types of Breast Cancer Surgery Are Available in India?

Breast-Conserving Surgery

Also called lumpectomy or partial mastectomy.

The surgeon removes the tumour along with a margin of surrounding tissue while preserving most of the breast.

For appropriately selected early breast cancers, breast-conserving surgery followed by radiation is an established treatment approach.

Mastectomy

The entire breast is removed.

Different forms may include:

• Simple mastectomy
• Modified radical mastectomy
• Skin-sparing mastectomy
• Nipple-sparing mastectomy in selected patients

Sentinel Lymph-Node Biopsy

The first lymph nodes likely to receive drainage from the breast are identified and removed for pathological examination.

Axillary Lymph-Node Dissection

More lymph nodes from the armpit are removed when clinically indicated.

Oncoplastic Breast Surgery

Combines cancer removal with plastic-surgical techniques to preserve or improve breast shape.

Breast Reconstruction

Reconstruction may be performed:

• At the time of mastectomy
• After completion of cancer treatment
• Using implants
• Using the patient's own tissue
• Using a combination of techniques

Apollo's current breast-cancer programme lists breast-conserving surgery, mastectomy, modified radical mastectomy, sentinel-node biopsy, axillary dissection and reconstruction among the major surgical procedures.

Q6 · What Is the Difference Between Lumpectomy and Mastectomy?

Lumpectomy / Breast-Conserving Surgery

The surgeon removes:

• The cancer
• A margin of surrounding breast tissue

Most of the breast remains.

For many appropriately selected early-stage breast cancers, breast-conserving surgery is followed by radiation therapy.

Mastectomy

The entire breast is removed.

Mastectomy may be considered when:

• The tumour is large relative to breast size
• There are multiple tumour areas
• Breast conservation would not provide adequate cancer control
• There are other clinical reasons
• The patient prefers mastectomy after discussing the available options

The choice depends on the tumour, imaging, genetics where relevant, prior treatment and patient preference.

NCI notes that local surgical treatment may include breast-conserving surgery or mastectomy, with the choice influenced by factors such as tumour location and size, breast imaging, breast size and the patient's preference regarding breast preservation.

Q7 · Who May Be Suitable for Breast Cancer Surgery?

Surgery may be considered when:

• The breast cancer is operable
• The patient's general health permits surgery
• The tumour can be adequately removed
• The disease can be treated with a surgical approach
• The patient has been appropriately staged

However, some patients receive chemotherapy, HER2-targeted therapy or other systemic treatment before surgery.

This is called neoadjuvant therapy.

It may be particularly relevant for some:

• HER2-positive cancers
• Triple-negative breast cancers
• Locally advanced cancers
• Larger tumours
• Certain node-positive cancers

NCI notes that neoadjuvant therapy is particularly favored in many HER2-positive and triple-negative breast cancers because the pathological response can help guide treatment after surgery.

The final sequence of treatment should therefore be determined after complete assessment.

Q8 · What Medical Reports Should a Zambian Patient Send Before Travelling to India?

A complete medical record is extremely important.

Diagnosis

• Breast biopsy report
• Histopathology
• Immunohistochemistry
• ER status
• PR status
• HER2 status
• Ki-67 where performed
• Tumour grade
• Histological type

Imaging

• Mammography
• Breast ultrasound
• Breast MRI where available
• CT scan where performed
• PET-CT where clinically indicated
• Imaging of the axilla
• Actual scan images/files

Previous Treatment

• Previous surgery reports
• Chemotherapy records
• Radiotherapy records
• Targeted therapy
• Hormone therapy
• Immunotherapy
• Discharge summaries

General Health

• Complete blood count
• Kidney function
• Liver function
• ECG
• Cardiac assessment when required
• Current medication list

The ER, PR and HER2 results are particularly important because breast cancer treatment is strongly influenced by these biological characteristics.

Q9 · What Is the Typical Breast Cancer Treatment Process in India?

Step 1 – Breast Cancer Evaluation

The team reviews:

• Pathology
• Imaging
• Receptor status
• Stage
• Previous treatment

Step 2 – Staging

The medical team determines whether the cancer is:

• Early-stage
• Locally advanced
• Metastatic

Step 3 – Multidisciplinary Review

The patient may be evaluated by:

• Breast surgeon
• Surgical oncologist
• Medical oncologist
• Radiation oncologist
• Radiologist
• Pathologist
• Plastic/reconstructive surgeon

Step 4 – Treatment Sequence

Depending on the case, treatment may begin with:

• Surgery
• Chemotherapy
• HER2-targeted therapy
• Immunotherapy
• Hormone therapy

Step 5 – Surgery

When surgery is appropriate, the procedure may include:

• Lumpectomy
• Mastectomy
• Sentinel-node biopsy
• Axillary dissection
• Oncoplastic surgery
• Reconstruction

Step 6 – Histopathology

The removed tumour and lymph nodes are examined to determine:

• Tumour size
• Margins
• Lymph-node status
• Treatment response
• Other pathological features

Step 7 – Additional Treatment

After surgery, the team determines whether the patient requires:

• Chemotherapy
• Radiotherapy
• Hormone therapy
• HER2-targeted therapy
• Immunotherapy
• Other targeted treatment

ICMR's breast-cancer workflow recommends multidisciplinary assessment and adjuvant treatment planning after surgery, with systemic treatment decisions informed by pathology and receptor status.

Q10 · Are There Alternatives to Breast Cancer Surgery?

Yes, depending on the patient's diagnosis and stage.

Treatment options may include:

• Chemotherapy
• Hormone therapy
• HER2-targeted therapy
• Immunotherapy
• Radiotherapy
• Targeted therapy
• Neoadjuvant systemic treatment
• Palliative treatment for metastatic disease
• Supportive care

In some patients, systemic treatment is given before surgery to shrink the tumour and assess treatment response.

For patients with metastatic breast cancer, systemic treatment may be the main treatment, with surgery used selectively for particular clinical reasons.

Treatment should therefore be based on the cancer subtype and stage rather than on surgery alone.

Q11 · What Should Be Included in the Breast Cancer Treatment Quotation?

A Zambian patient should request an itemized quotation covering:

Surgery

• Surgeon fee
• Operating-room charges
• Anaesthesia
• Surgical consumables
• Sentinel-node procedure
• Lymph-node surgery
• Histopathology

If Mastectomy Is Planned

Ask whether the quotation includes:

• Reconstruction
• Implant
• Tissue-based reconstruction
• Plastic surgeon charges
• Additional procedures

Medical Treatment

Clarify the cost of:

• Chemotherapy
• HER2-targeted medicines
• Immunotherapy
• Hormone therapy
• Other targeted medicines

Radiation

Clarify:

• Simulation
• Treatment planning
• Number of sessions
• Radiation technique
• Daily treatment charges

Additional Costs

Also ask about:

• PET-CT
• MRI
• Molecular testing
• Genetic testing where indicated
• ICU stay
• Medicines
• Blood products
• Follow-up consultations

Published Indian cost estimates show that breast-cancer treatment costs vary considerably according to the treatment combination and complexity.

Q12 · How Long Should a Zambian Patient Stay in India?

The duration depends on whether the patient requires surgery alone or a complete multimodal treatment programme.

Apollo reports that patients undergoing breast-cancer surgery may be discharged the same day or after an overnight stay depending on the procedure and individual circumstances.

The actual India stay should be confirmed after the complete treatment plan is prepared.

Q13 · What Is Recovery Like After Breast Cancer Surgery?

Recovery depends on the operation performed.

After Lumpectomy

Patients may experience:

• Mild to moderate pain
• Swelling
• Bruising
• Temporary breast tenderness
• Arm discomfort

Many patients return to routine activities relatively quickly.

After Mastectomy

Recovery may include:

• Chest discomfort
• Wound care
• Drain management
• Arm movement exercises
• Gradual return to activity

After Lymph-Node Surgery

Patients may need monitoring for:

• Arm swelling
• Shoulder stiffness
• Numbness
• Reduced range of movement
• Lymphedema

After Reconstruction

Recovery may be longer and depends on whether reconstruction uses:

• Implant
• Tissue flap
• Combination techniques

After Chemotherapy

Possible effects include:

• Fatigue
• Nausea
• Reduced appetite
• Hair loss
• Low blood counts
• Increased infection risk

After Radiotherapy

Possible effects depend on the treatment area and may include:

• Skin irritation
• Fatigue
• Breast swelling
• Local discomfort

The treating team should provide an individualized recovery and rehabilitation plan.

Q14 · What Follow-up Care Is Required After Returning to Zambia?

Before returning home, the patient should collect:

• Final diagnosis
• Operative report
• Histopathology
• Lymph-node pathology
• ER/PR/HER2 results
• Ki-67 where applicable
• Molecular testing
• Discharge summary
• Chemotherapy summary
• Radiotherapy summary
• Targeted-treatment summary
• Medication list
• Follow-up schedule
• Imaging plan

Ongoing Follow-up

Depending on the cancer, follow-up may include:

• Clinical breast examination
• Mammography
• Ultrasound
• MRI where indicated
• Blood tests
• Bone-density monitoring for selected hormone treatments
• Cardiac monitoring for selected HER2-targeted treatments
• Assessment of treatment-related side effects

Hormone Therapy

Patients receiving endocrine therapy may need long-term follow-up and monitoring for treatment effects.

HER2-Targeted Therapy

Patients receiving HER2-directed treatment may require appropriate cardiac monitoring.

Reconstruction

Patients who undergo reconstruction may require separate plastic-surgery follow-up.

The Indian oncology team should provide a written follow-up plan that can be continued with an oncology team in Zambia.

Q15 · Is India a Suitable Option for Zambian Patients Seeking Breast Cancer Treatment?

India can be considered by Zambian patients seeking comprehensive breast cancer evaluation and treatment.

Indian breast-cancer programmes can combine:

• Breast surgery
• Surgical oncology
• Medical oncology
• Radiation oncology
• Breast reconstruction
• Pathology
• Radiology
• Supportive care

The appropriate treatment depends on the cancer subtype and stage. ER, PR and HER2 status are particularly important because they influence systemic treatment decisions.

For appropriately selected early-stage patients, breast-conserving surgery followed by radiation is an established treatment pathway, while mastectomy with or without reconstruction is another surgical option.

Patients with HER2-positive or triple-negative disease may be considered for neoadjuvant systemic treatment before surgery in appropriate circumstances.

For Zambian patients, a useful first step is to send the complete biopsy, histopathology, ER/PR/HER2 results, imaging and previous treatment records for an Indian breast-cancer specialist's review before travelling.

The final treatment plan should be based on the patient's individual diagnosis and multidisciplinary assessment.