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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…(contd.) The treatment of breast cancer has undergone major improvements and this has been reflected in how the outcomes have changed dramatically for the better. While curing the disease is a priority, maintaining quality of life is as important. The journey that has been covered before us is no less fascinating and the constant endeavor to make it better for the patient has driven the change. Mutilating surgeries in the form of amputation of the breast and then radical mastectomy (removal of the breast, muscles of the chest and the lymph nodes in the armpit ) or the extended radical mastectomy( same as radical mastectomy but with the additional removal of lymph nodes inside the chest) remained in vogue for a larger part of the 20th century. ...to be continued.....More history in the next update
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
WHEN THE CHIPS ARE DOWN.... There are times when one feels trapped, not knowing which way to turn. All spaces close in on you as if to smother you. That is the kind of feeling which had crept into this young patient from Kenya. She had undergone two botched up surgeries on her leg for a tumour, which had now, returned with a vengeance. She is to have more surgery but her spirits are dwindling. She is away from home and only has her twin brother for company. The money is drying up quickly and she, an accomplished dancer, is confined mostly to the bed or the wheel chair as the leg fails to take her weight. Today, she was particularly distraught and her tears flowed freely. Our physiotherapist came to me and asked if we could cheer her up by bringing her to the Breast Support Group meeting, where a troupe of youngsters was coming to get our Champions to perform Zumba. I thought it was a great idea and she was carefully shifted on a wheelchair to the building next door where the program was to be held. And right in front of our eyes began the transformation. The girl could not stop clapping and moving to the beat on the chair while her brother kept pace beautifully with the trained Zumba troupe. The 25 odd Champions, doctors and support staff all got going, only stopping to catch their breath or a sip of water.This little girl got caught in a whirlwind of foot tapping music and an all pervading gush of positive energy. She laughed and spoke to the Champions and believed everyone when they said she would be fine. She left with the promise that when she recovers from surgery and is back on her feet, she will come back for a Theme party and she would lead the dance! So when the chips are down.... DANCE!!
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