DRGEETAKADAYAPRATH 546efbec4ec0a40e503fb7e5 False 108 1
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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!
...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… 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
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
One of the first decisions you may have to make is which type of operation you'll have. You may be offered a choice of breast-conserving surgery, (usually referred to as lumpectomy or wide local excision) or a total mastectomy (removal of all the breast tissue including the nipple area). Sometimes it can be helpful to talk through your choices with your breast care nurse and discuss how each would affect you. Dr. Geeta Kadayaprath - Breast Cancer Treatment in Delhi
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