I woke up to a cold morning with high speed winds chilling me to the bone. Work awaited me at the out patients. There was no surgery today. A 66 year old lady with a 3x3 cm lump in the left breast operated by me 2 weeks ago came to see me for a final decision on adjuvant treatment. Her histopathology report read-3.5x3 cm Infiltrating duct carcinoma, Grade III,No lymphovascular invasion,0/4 sentinel lymph nodes, ER-7/8, PR 5/8, Her-2 neu- 2 on IHC and negative on FISH. She was reluctant to undergo chemotherapy but on my insistence met the medical oncologist who explained to her the pros and cons of chemotherapy. She came back to me, almpost pleading with me to support her decision to forego chemotherapy. I went over the risks and benefits again, but it was almost, as if, she had made up her mind. It was a reasonable decision to stick to hormonal treatment alone. I broached the subject of Oncotype Dx or a PAM 50 test to arrive at a more objective decision. They declined and decided to go ahead with hormonal treatment only.
There are no hard lines when it comes to choosing treatment. There is something that is optimal but there is also that which makes sense to the patient.As a clinician, you have to step aside and support the patient's decision. It is actually hard on the patient to not have their treating doctor on their side, when such choices are being made.
Dr Geeta Kadayaprath
Head, Breast Surgical Oncology
Max Cancer Centre, Patparganj
I see a lot of lady patients in my practice since I deal with breast cancer and other breast related conditions all the time. What has struck me as the rule rather than the exception, is that, women don't have a complete say in matters dealing with not just their breasts but their life.....whether she should keep her breast or sacrifice it, whether she should go for chemotherapy or not, how much should she be told about the disease etc. etc.The people involved in these crucial decisions involve men ranging from a husband to the father-in-law to a second degree male relative or sometimes even an 'educated' male neighbor. Women empowerment is the only answer....her issues are her own, her body, mind and intellect are all her own.Only she must be allowed the right to decide what is good for her, with gentle gestures of support from her immediate family.
On the 1st of January, there was respite from cold. It was a beautiful day and since it was the first thursday of the month, our Breast Support Group Day......we decided to celebrate with our survivors, rather our champs. We were really not prepared for what followed.Mr Deepak Arora,our senior physicist in radiation oncology and a multi-talented man set the ball rolling with a beautiful backdrop and space for expression in the new year. Our partners in pink came in with their loved ones. There were care givers, volunteers, doctors, support staff.... all chatting with each other, surprising us with their talent, laughing, singing, acting,dancing.The bonhomie was visibly there, transcending the borders of age, colour, culture.... they were bound only by their common experience. There was lot of support for each other......the teary new kids on the block ( awaiting treatment), realised that it was not as bad as it was made out to be. LIfe is bigger than most woes.....and all roadblocks are only an opportunity to live it better. I could see it unfold in front of my eyes.Happy New Year,Champs!!!!