In an intimate discussion about how there is no need to remove breasts even in breast cancer cases ( except few conditions), Dr. Wasim said,” In the last few years, I have witnessed an increase in the incidence of breast cancer, especially in Konkani women.
As per Oncology book teachings, breast cancer occurs in the 5th and 6th decade of life. Contrary to this, I see breast cancer in Konkani women at an early age (3rd and 4th decade).
There are various reasons for this trend shift: late marriages, first child at a late age, fewer children, less breastfeeding, etc.
As far as the treatment is concerned, what I have noticed is shocking.
Due to awareness, most breast cancers are diagnosed in the early stages.
As a part of treatment, most of the women in our region undergo a surgical process called Modified Radical Mastectomy. The lady has to lose her whole breast even in the early stages.
I don’t know the reason for this, and I am constantly researching it. But those days are gone when a lady had to lose her breast. In this modern era, the Oncology world is moving towards organ preservation. A lady with breast cancer needs not to lose her breast as part of her treatment ( except few conditions).
There is a procedure called BCS (Breast Conservative Surgery) where a surgeon removes only the tumor without any change in shape or contour of the breast.
There is a fear in people’s minds of recurrence of the tumor if we keep the breast intact.
If we see the medical literature, there is strong evidence saying no difference in the treatment outcome, whether it is a mastectomy or breast conservative surgery.
It is an EBCTCG study (early breast cancer collaborative trialist group), where they have compared thousands of women undergoing mastectomy versus women in whom breast has been saved. They followed up with these women for 20 years, and at the end of 20 years, they found no difference in terms of treatment outcome or survival, whether you do mastectomy or breast-conserving surgery.
This is probably the most extensive study in Oncology literature, which has changed the practice worldwide from a Radical mastectomy to breast conservation.
This change in practice across the globe happened in early 2000 when I was pursuing my post-graduation in Oncology at Tata Memorial Hospital.
It’s been two decades since that study was published, but I still see women from our area coming to me for treatment after having already lost their breasts.
I don’t know whether it is ignorance from the physician or our women themselves are not keen on breast conservation due to fear of recurrence.
The breast is a physical identity for a lady. Losing her identity is a significant psychological trauma for that lady, and it is devastating. In a hasten fear, they ask the surgeon to take out the whole breast, but later they regret it for the rest of their lives once they know that their breast Could have been saved.
Once they lose breasts, they avoid going out, especially in social gatherings, they isolate themselves, this thought of incompleteness keeps eating them, affecting their social and marital life. I hope the ladies in this group can feel how losing one identity, especially physical identity.
In the end, I would like to conclude by saying that you don’t need to lose your breast even if you have breast cancer.
Contraindications for breast conservation are:
- Absolute contraindications Pregnancy, although such surgery may be done during the third trimester with irradiation following delivery.
- Two or more primary tumors in separate quadrants of the breast or diffuse calcification
- Previous irradiation of the breast
- Persistent positive tissue margins after surgery
- Collagen- vascular disease
- Large breast size (sufficient to pose technical difficulty with breast RT)
- Large tumor size relative to breast volume.
Apart from the above few conditions, In all women, we can save breast in breast cancer patients In Sha Allah. “
Medical literature evidence for the above claim. ( This is one of the many Randomized trials and meta-analyses proving my claims )
Director-Dept of Oncology, International Oncology
Dr.L.H.Hiranandani hospital | Apollo hospital, Belapur | Reliance Hospital, Koparkhairne |
Healthcare Global Lady Ratan Tata Hospital, Church gate