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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
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
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
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
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
Ladies in pink, celebrating life... A heady mix of survivors, doctors, volunteers, partners, friends ..... Can anyone tell the difference? That is where life wins and everything else, even breast cancer, becomes insignificant! For further details... Please contact Dr Geeta Kadayaprath, Head, Breast Surgical Oncology, Max Cancer Centre, Patparganj, Delhi
Delhi Breast Oncology Group will meet formally tomorrow and will hold its first CME at Max Hospital Patparganj, Delhi. I have had the pleasure of putting together a group which has been the dream of many like minded people.Tomorrow, there will be discussions on the formal structure of this group. We will meet on the first saturday of every 2nd month in all partnering institutes in alphabetical order. I will post the case discussions here. More from me tomorrow. For further details-please contact Dr Geeta Kadayaprath, Head, Breast Surgical Oncology, Max Cancer Centre, Patparganj, Delhi
How tough is the job of an oncologist? I am often asked this question and I have probably never admitted the whole truth. An oncologist is a strange amalgam of extremes of emotions....it is a never ending balancing act.While he or she has to create that environment of positivity to enable the patient to make the right choices for his/her treatment, without being overwhelmed by the side effects of treatment, he or she also has to ride the see saw of ups and downs that are likely to happen during the course of treatment with the patient. Being cheerful in the face of adversity yet remaining detached from the outcome of treatment is learnt painstakingly over years. The troubles don't end here. The oncologist is subject to scrutiny all the time....an innocuous expression could be read by the attendant or patient as despair or hopelessness, a phone call for another seriously ill patient could be extrapolated to one's own self by the patient across the table, a slight drop in the wattage of your smile could be interpreted as doomsday......and so on.It is a tough life but it becomes worth the effort when patients defy statistics, come back to meet you, year after year, treat you like a part of their extended family contributing to crucial personal decisions..... and threaten to outlive you! For more details, please contact Dr Geeta Kadayaprath, Head Breast Surgical Oncology, Max Cancer Centre, Patparganj, Delhi, India
Does cancer give you a new lease of life? Today, a patient, Mrs Sharma (name changed), I had treated 2 years back, came for follow up to my clinic with her very beautiful and supportive daughter.When I saw her two years ago, I was taken aback by the fact that an educated lady like her had ignored a lump in the breast completely to let it grow to the size she came to me with. Big it was....ulcerated, infected and bleeding. She had large lymph nodes in her armpit.She was weak and it made me wonder if it was the anemia due to chronic blood loss from the breast cancer or spread of disease to other organs which was contributing to this. I was almost certain she would have spread to other organs. Fortunately for her, her PET CT did not show spread to the other organs.The lady was amazing....she knew she was in big trouble, but she was most cheerful and accepting. She was dealing with a lot in life already....a husband confined to bed for two years prior to her diagnosis and a son who had lost his bearings.I knew then her reason for self neglect. She went through the entire treatment, cheerfully and recovered. She went back to looking after her ill husband till he passed away a few months back. Today she surprised me. She looked well.....and I thought a bit relieved.I examined her, went through her reports ....she was absolutely fine. She was her happy self. She dug out a packet from her bag and gave it to me.She said she had made that bag and told me how she had started this NGO to support women in Haryana. They made the bags according to her specifications.... Beautiful bag! She was putting her talent to good use and just talking about it lit up her face.Mrs Sharma had rediscovered herself and will soon embark on fulfilling yet another dream -to paint and hold an exhibition.And then she is off to Canada to meet her friend of 50 years.Wow!!I can only salute her resilience! I want her to know, she really made me proud!! For more details, please contact Dr Geeta Kadayaprath, Head Breast Surgical Oncology, Max Cancer Centre, Patparganj, Delhi, India
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