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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
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
SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… In the 1960’s, the conviction that breast cancer was a systemic disease at inception and not a local disease, prompted trials to address one question- ‘Are we doing too much?’ Radical mastectomy was replaced by modified radical mastectomy- a procedure not as mutilating as radical mastectomy ( the chest muscles were preserved)but still one, which involved loss of an organ. Moreover, to a woman, it meant much more than the loss of an organ. It probably entailed a huge psychological blow besides casting a shadow on her feminity. She, being the woman she was, in those days, came to terms with this loss, in the best manner possible. All that mattered to her was her getting well, on her feet and ready to discharge the duties of a wife, mother, daughter and more. And there was really no choice then because the doctors treating her were also convinced that sacrificing the breast was the only chance of getting well. More tomorrow.....on Evolution of treatment
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
Another year comes to an end.... a year full of challenges, some met ....some transferred to the next year.Professionally, I made an important decision ... of focussing my energies at one centre instead of hopping between two. Now, I head the breast services at Max Cancer Centre, Patparganj, alone. I am able to be involved in the entire process of entry to exit of my patients with breast cancer.The Support Group meetings, the academic meetings, the surgical work, the post operative care, the process of auditing my own work to constantly improve the care, have taken off and I believe these are a few steps in the right direction.The endeavour to excel continues...... The new year beckons.....It will be 2015 in a few hours. Tomorrow will be the first Breast support group meeting of the year. The enthusiasm of my champions is all pervasive and we will, together, celebrate life with renewed vigor and new hopes.Breast cancer will be a forgotten word....smiles, chatter, dancing, eating, sharing and a sense of camaradarie will dominate proceedings. I am looking forward to it..All are welcome to join!!! For further details, please contact Dr Geeta Kadayaprath, Head, Breast Services, Max Cancer Centre, Patparganj, Delhi
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