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SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… With improvements in chemotherapy, radiation therapy, hormonal treatment and targeted therapy, breast conservation surgery has now become the treatment of choice in select patients. While it is possible to conserve the breast in early breast cancer, it is possible to offer this treatment in patients with locally advanced breast cancer also, where chemotherapy is administered first to shrink the tumor. If the tumor shrinks towards the centre and is marked while the patient is on chemotherapy, it may be possible to conserve the breast when surgery is performed after completion of chemotherapy. The philosophy behind this paradigm shift is quite obvious- that long term outcomes in terms of disease free survival and overall survival is not different with either surgical procedures. The choice is real and scientific… For more information on breast cancer, please contact Dr Geeta Kadayaprath, Breast Surgeon, Max Cancer Centre, Delhi, India
It is not rare for me to see patients presenting with locally advanced breast cancer or metastatic cancer. Many times, I would wonder why they came in late. Till a few years back, I would judge the educated ones more harshly and enquire in my mind what education had done for them. I stopped judging them a few years ago especially after scratching their tough exteriors a bit! Six years ago, this elderly lady, speaking in impeccable English almost stumbled into my office. She was pale and weak and her daughter informed me that she had a bleeding ulcer in her left breast. I examined her and found a 15 cm large bleeding, ulcerated mass in her left breast. Her blood tests showed she was awfully low on Hemoglobin. I quickly arranged for a biopsy and also had a PET CT done, almost certain, that her disease would have spread. Thankfully, I was proved wrong. She was given blood transfusions and chemotherapy was started. She was an epitome of courage and went through her chemotherapy, surgery and radiation with a quiet resilience. During the course of her treatment, I asked her why she had presented so late. What she said shook me!She said she had a paralysed husband to look after and she had been doing that for the past 4 years. She knew about the lump and that it was growing. It is just that her husband’s need was greater. That is when the judging stopped. We may boast of a secure social fabric but many times we see these lone wagers, fighting their own battles. Their health becomes secondary. Life is not easy for many. Bless her!She is well. Her dear husband passed away 3 years ago and she runs an NGO to promote forgotten skills among women in rural Haryana. I am truly proud to have known her!
For many types of breast cancer, the most effective treatment has been surgery followed by chemotherapy. But how quickly patients should undergo chemotherapy has always been an open question. Dr. Geeta Kadayaprath - Best Breast Oncologist in Delhi
Surgery is usually the first treatment for breast cancer, although sometimes chemotherapy or hormone therapy is offered first. This is to begin treating the whole body or to shrink the cancer so that surgery may be less extensive. Dr. Geeta Kadayaprath - Best Breast Cancer Specialist in Delhi
SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… While all this continued as the standard of care for the first 65 years of the 20th century, some smart minds in the medical field started questioning the necessity of performing such radical surgeries to get optimum results. Trials got underway to compare mastectomy versus breast conservation surgery in the 1970s. A pathologist turned surgeon, Dr Umberto Veronesi, pioneered the most convincing trial in Milan. He was able to show that breast conservation surgery (removal of the lump with a surrounding 1 cm margin of normal breast tissue) followed by radiation therapy to the rest of the breast in properly selected patients yielded the same results as a complete removal of the breast. I am quite convinced that it is the pathologist in this surgeon who urged him to go for this trial. He had probably seen while looking at the breast as a pathologist that far too much was being done to address small cancers in the breast. Finally, women with breast cancer had a choice…. For more information on breast cancer, please contact Dr Geeta Kadayaprath, Breast Surgeon, Max Cancer Centre, Delhi, India
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