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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
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
Breast cancer can catch anyone by surprise. Why I say that is because the usual history is a lump felt in the breast over a few weeks to a month or two or more. Apparently innocent as it caused no pain or upset the rhythm of life. It was just there! I identify with this extremely unpleasant feeling of being caught out or cornered or ganged up against, when this innocuous lump is declared cancer, almost everyday. How could a lump which was just there till yesterday change life indelibly? The grief that accompanies the diagnosis is unfathomable in most. The denial that follows and the unfairness of the situation is quite hard hitting. I, as a Clinician, after so many years of being witness to this familiar response, still find it hard to say something sensible to console, especially if the affected is young. It is almost as if I am on their side, a part of their family, going through this heart- wrenching sequence. When I am at a loss, the best I do, is hold their hands and say everything will be alright. I want it that way and no other way, as every doctor would. And it works! I liken the situation to being in quicksand. If you struggle too much with the situation, you get pulled in, the brain gets clouded and wrong decisions are made. If you reach out to a helping hand, gently ease yourself out with coaxing and cajoling coming from your loved ones, you make it! How one handles the situation has a large part to play in what the final outcome would be. We do not choose situations in life and some situations do catch you unawares. What you can choose, is your response to the situation- accepting it, making light of it, taking it in your stride and going through treatment with the desire to heal and bounce back, is usually what winners do!!
Never too old to make choices Last week, I met this lovely lady, pushing 80 years. I’m reluctant to call her old for her lively demeanour would put the chronologically young to shame. How I met her was because she had been diagnosed with breast cancer. Fortunately for her, she had early breast cancer. This is a delight for a breast surgeon like me, who is used to seeing advanced breast cancer. After going through the investigations, it was decided that she should have surgery. I started discussing the surgical options and just as I would do with all my patients amenable to all the options, I discussed breast conservation surgery, mastectomy ( surgical removal of the breast)and mastectomy with reconstruction. She was quick in making her decision and said she wanted to have a breast conservation surgery. I liked her firmness but her daughter was not so sure. When the time came for her to be admitted, the daughter came up to me and said that she and her brother thought it would be better if she went ahead with mastectomy. It was surely concern for their mother. They wanted her to be disease free and also thought that at her age, it did not matter if she lost her breast. At the same time, they were not sure that breast conservation and mastectomy yielded the same results. I spoke to her again and said that her mother had made a choice, which was scientifically tenable .Ten years ago, my warped mind might have encouraged her to go for mastectomy. Now I know, choice has nothing to do with age.The instances when husbands, brothers, parents, relatives and anyone else( read neighbors!) influencing surgical decisions have been too many and every time, my heart has gone out, especially, to the young ladies who have had no say in the choices imposed on them.Losing a breast is a self esteem, body image issue- the loss and its impact is borne only by the one who loses it.The lovely dame stood by her choice and it was executed. Choices are not about being right or wrong. Choices are about the freedom to make a decision and stick by it. The comfort of having made one’s choice is a confidence booster and can bring about unexpected results. I do know that, for a fact!
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