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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
Today, the first Delhi Breast Oncology Group (DBOG) CME was held in Max Patparganj, Delhi. There is a palpable enthusiasm in the creation of this group which will be one of the subspecialty arms of the Oncology Forum. The meeting started with myself introducing the proposed functional unit of DBOG. The proposal was to have coordinators for various tasks assisted by committees.There will be stock taking at each CME to be held on the first saturday, every two months. The Secretary will coordinate the pre-CME meetings at each of the CMEs. The CME itself was an academic feast with 3 case discussions and review of literature relevant to each topic. Dr Vineeta Goel, Radiation Oncologist at Max Cancer Centre, Patparganj, presented the relevance of radiation in 1-3 positive axillary nodes. Dr Randeep Singh, Medical Oncologist at Max Cancer Centre, Patparganj, presented a case of metastatic triple positive breast cancer and the current treatment options and Dr Rohan Khandelwal, Breast Surgeon at Max Cancer Centre, Saket presented a case of Triple negative breast cancer and brought in Dr Amit Verma, Genetic consultant, to unravel the rogue pathways involved in Triple negative breast cancer. The meeting ended with Dr Vaishali Zamre, Senior Consultant, Surgical Oncology, Action Balaji Hospital, Delhi, accepting the responsibility of holding the next meeting at Action Balaji Hospital. The presence of 80 attendees at this CME was a reaffirmation of the fact that like minded people need to work together to achieve larger goals.A beginning has been made.....and there is a lot to do to make big strides in the right direction. I thank all the participants for being part of this endeavor and hope to see you all on 7th March, 2015 at Action Balaji. For further details, please contact Dr Geeta Kadayaprath, Head, Breast Surgical Oncology, Max Cancer Centre, Patparganj Delhi
Exclusive breast surgical oncologists are far and few.It is happening in India. Subspecialisation is the way to go to offer the best to the patient. At Max Cancer Centre, Patparganj, Breast Surgical Oncology is an important subspeciality.
I am a big fan of Angelina Jolie. So what is the big deal about it? Half of the human race is possibly her fan..her looks and her acting prowess has had the world swooning. I am her fan for a different reason. I haven’t followed her movies, her drop dead gorgeous looks or her personal life but I admire her for her courage. Some years ago, this remarkable lady announced to the world that she is having both her breasts removed. She knew that she was carrying a genetic mutation which made her susceptible to breast and ovarian cancer. Her family history was strong for both breast and ovarian cancer and once she tested positive for the mutation, she knew she carried a 60-80% risk of developing either of these cancers. She was faced with the prospect of prophylactic breast and ovarian surgeries. I can only imagine the sleepless nights, the battle within-to do or not to do, several rounds of long discussions with her doctors, family and friends, the impact on her career which relied heavily on glamour, her children... and so much more. And then she made that decision to have both her breasts removed and subsequently her ovaries. She shocked the world but at the same time catapulted herself to that realm of courage and fortitude that rarely people of her standing dare to tread. I joined her fan club and her story of courage became the benchmark for women caught in a similar situation. Why I recalled this story was when I encountered my own Angelina Jolie. This young lady of 35 had a very strong family history of breast, ovarian and colon cancer on her maternal side.Her husband was gutted when she was diagnosed with breast cancer. I advised her for a genetic consult while planning for her surgery. The genetic consultant had barely advised her gene testing and was discussing the possible implications, when she said that she had made up her mind. She very calmly told the consultant that irrespective of what the test says she was going ahead with bilateral prophylactic mastectomies and bilateral ovarian surgeries in the same sitting. She came to be and conveyed the same to me. It shook me inwardly and took me a while to gain my composure as her husband stood by her, rock solid in his support of her decision. ‘COURAGE’ as a word probably does not do justice to the tenacity with which one arrives at this supremely difficult decision. I have done these surgeries before and this one was certainly not the last. Such decisions are rationalised within the multidisciplinary board, the molecular oncologists, the psychologists, the family and most importantly, the patients!! While I see more of these Angeina Jolie clones, I will always hope and pray that these amazing ladies’ decision translates into long, meaningful and inspiring lives!
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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