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SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… ………..And that brings us back to Neena. An MR mammogram was done keeping in view her age and dense breasts. The MR mammogram showed a solitary 2cm lump in upper half of the breast with no significant lymph nodes in the armpit. With this newfound information, I opined that I would offer her breast conservation surgery with oncoplasty (surgical technique to restore shape to the breast) and sentinel lymph node biopsy (few nodes in the armpit sampled guided by radio-isotope and blue dye, sent to pathologist to check for any spread of disease). Her joy knew no bounds and she opted to go ahead with breast conservation surgery. The surgery went off well and fortunately for her, the sentinel node biopsy came back as negative for spread. She did not require all the nodes in the armpit to be removed with its attendant 20% risk of developing arm swelling. Her risk of arm swelling is probably less than 5% now. She was discharged the next day, without any tubes coming out of her body. She was complete in a sense………….and there was really no way to tell she had undergone surgery for breast cancer! For more information on breast cancer, please contact Dr Geeta Kadayaprath, Delhi, India
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
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 was Breast Support Group meeting on Thursday, 18.12.14.The Champions who had been through the journey of breast cancer had come in to encourage the ones who had just started treatment. What is exceptional about this interaction is that the conviction of being able to go through treatment goes up manifold when the ones who have gone through the process and have recovered completely, counsel the new kids on the block. I believe it is the fear of the unknown and the feeling of isolation that puts you on the back foot. The interesting methods of coping with the situation related by the champions, is very encouraging. The smiles, laughters, jokes...... all give the impending process of treatment, the much desired sanity!!! For more information on breast cancer, please contact Dr Geeta Kadayaprath, Delhi, India
Breast cancer is a growing problem in India and all of Asia and threatens to deluge our health services by 2030.What is worrisome is that we do not have the resources to match the growing incidence. We have to start looking for indigenous solutions to our problem of breast cancer. We do have a good pool of talent especially in the autonomous institutions and the private sector, doing good work but there is very little support to encourage them to pool together data and make sense of it. The numbers that we see every year should, ideally, have provided us with a lot of answers, had we pooled our data and presented it to the world. In an attempt to push this possibility, I brought together like minded surgeons and created a group, the Delhi Breast Oncology Group (DBOG), on 6th November, 2014.We are in the process of giving it a formal shape and the first step in this direction will be taken on the 3rd of January 2014, when we meet again. Max Cancer Centre will host this meeting and the first CME(case discussions) as well on 3.1.15. All clinicians with an interest in breast cancer ( Surgeons, medical oncologists, radiation oncologists, radiologists, pathologists etc.)are cordially invited to attend this program. For further information, please contact Dr Geeta Kadayaprath, Head , Breast Surgical Oncology, Max Cancer Centre, Patparganj, Delhi, India
LETTING GO During my years in medical school, it was always tough to lay your hands on the best books available. They were outrageously expensive for a middle class student like me. My dad would still want me to have the best. He would put aside his needs and my mother would spend less on the essentials so that I could have expensive reference books in medicine and surgery. I devoured on Harrison’s Principles of Internal Medicine and Schwartz’s Surgical textbook. They were hard to reproduce in the exams but were succinct in their explanations of the various diseases that plagued the amazing human body. The last I read from these books is more than 20 years. They occupied a corner on my bookshelf and gathered dust. They would catch the corner of my eye, occasionally and I would clear the dust as a sweeping sense of nostalgia overcame me. With my daughter’s books jostling for space, I decided to make space for her while the house was being painted. I brought these old books down, turned a few pages with a lump catching my throat. I realised, there time was past.All the information I ever wanted was just a click of a button away. A lot has changed since the time they were the only prized possessions I ever had. They had to go... the new had to make space for the old. Their life had come one full circle!
THE ART OF SELFLESSNESS OF PURPOSE Three weeks ago, a thin built lady from a remote village in UP walked in with her sister and her nephew, who lived in Delhi. While they poured her story of being diagnosed with breast cancer, I could sense an underlying anger. The sister burst forth with the information that her elder sister’s husband is a farmer and had thrown her out on knowing the diagnosis. He refused to get her treated and had said that she was as good as dead to him. The sister was vehement and was certain that she would get her elder sister treated. That is exactly what she did. I operated upon the lady. On receiving the pathology report, I shared with her that her sister would require both chemotherapy and radiation. The patient’s husband also came for that consult and asked me if he could take his wife home before she started chemotherapy, to which I said he could. Hardly had they left the room, that the younger sister returned to my room, furious. She said, ‘ How did you even suggest that he could take her back home? He will not spare her. How could you undo the effort that I am putting in, to treat her?’ I was stumped!She went on to say that she would look after her and make sure she had her complete treatment. She told me that she was a person of modest means with a one room flat but she would arrange accommodation for her sister and get one of her nieces to look after her while she underwent treatment. There was that intense look of determination in her eyes when she said, ’ Doctor, no way am I going to let her go- I take her full responsibility!’ How many times do you come across such unsung heroes in your life? This young lady is a hero, championing the cause of her older sister who has no voice. Her sister has a husband who has only used her but refuses to stand by her as she readies herself for her biggest battle, yet. She has found an unlikely knight in shining armour in her younger sister, who, I am sure will brave the storms lying in store for her. It is not the money in your pocket that makes the world go round but it is the desire and the will to help that makes the world go round. I love the spunk of this lady and have loads to learn from her. Selflessness of purpose is what makes her so inspiring and restores my faith in humanity!!
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