When the diagnosis of breast cancer falls in the ears like a bomb shell!

Breast cancer is the most common cancer among women in the world. If it was a disease of the older age group in the past, currently, especially in the Indian subcontinent, it has become a disease of the young, especially in the reproductive age group, less than 30 in several instances.

Most of the causes which can initiate breast cancer are modifiable. Sedentary lifestyle, obesity, consumption of alcohol and smoking, early menarche (starting menstruation at very early age 7 to 8 years), delayed first childbirth, lack of breastfeeding, stopping of periods (delayed menopause) in the late 50s, hormone replacement therapy, consumption of high energy dense foods and of course genetic predisposition and family history, all can contribute. Essentially, Oestrogen is the main villain. Most of the factors except genetics, early menarche etc. are modifiable or controllable.

What are the psychological impacts of breast cancer diagnosis?

Whenever a person (whether a lady or a gentleman) is diagnosed with breast cancer, it first assaults his or her psychology and the impact is more on female psychology. The reason is multifold. It is not only about life expectancy, it is also about her dignity. The breast is, undeniably, a part of the female body which plays a huge role in her dignity, lifestyle and confidence.

The first response will be ‘Oh God! Why me?’ Then it will be depression, anger, mood changes, despair, fear of recurrence and death! The scenario may be much worse at a younger age. Most will be ascending the ladder of career or busy with children’s education or setting up business or busy in various professions since working women is the norm today. The major blow will be the general perception of ‘loss of breasts’ in breast cancer treatments.

Mastectomy or removal of breasts brings in yet other mental and physical trauma. Breasts are symbols of femininity, beauty, attraction, confidence and attractiveness in sexual life. So removal of the same for curing cancer poses an issue, which perhaps a lady can understand. Will I be acceptable to my partner, in the family or workplace ? How will others look at me with only one breast? Will wearing pads change my physical look? Can that bring attractiveness in a sexual relationship?

Hence in short, beyond just a cure for cancer; issues are multiple in managing breast cancer. It is not just about a cure; it is about giving back a meaningful, dignified life. It is about revamping a diseased body and mind into a strong soul with a socially acceptable physical body. It is a reincarnation in all senses.

What can we do for breast cancer patients as an Oncologist?

Two pertinent questions which are revolving around, which are to be answered in case of breast cancer treatment outcome are, first, what is the life expectancy? And second, does the patient have to live without one or both breasts for the rest of her life?

Breast cancer is treatable and curable. Early detection and protocol-based treatment is the key. In the modern world, there has been a lot of advancement concerning breast cancer. Starting from a multidisciplinary team approach to breast conservation surgery and breast reconstruction, medical science has come a long way as far as breast cancer treatment is concerned. A team approach of medical oncologist, surgical oncologist, radiation oncologist, radiologist and onco-pathologist, is giving a far better outcome in the recent world compared to the old world approach.

Currently, there are several methods to detect breast cancer in the very early stage. From simple ultrasound scans to digital mammography and MR mammography based on age; we have tools that can give us the power to do better. We need women’s participation and we need them to come forward for the same at least the high-risk group. We, as an oncologist, feel that nothing makes a female more attractive and dignified when she is more concerned about her body, soul and lifestyle and when she is motivated. A happy female is the key to a happy world; that is the norm.

Having a mammogram and clinical breast exam after the age of 40 in the normal female population and at the age of 25 years in high-risk groups is the recommended norm.

The general public should consider early detection if they expect a cure and get back the breasts in normal size and shape. Another neglected tool is Breast self-examination which doesn’t cost money but gives clinical benefits, almost the same as mammography. If detected early, breast oncoplastic organ-preserving surgery, by expert hands, is the choice. Recent studies have shown that preserving breasts in selected patients can give a better life expectancy, which is good news for a patient who is suffering from breast cancer.

We now have breast cancer surgery, where it’s not only saving breasts in breast cancer but discharging the patient 24 hours after surgery is a reality. We have the latest technology of Sentinel Lymph Node Biopsy, targeted axillary dissection, fluorescence-guided surgery and frozen section facility which can help us treat the patient in a way which will give minimal post-surgery morbidities and help the patient to get back to normal life as early as possible.

If tumours do not fall in the category of ‘surgery up front’, such patients receive chemotherapy to ‘downstage’, downsize the tumour and we still preserve breasts in many. If any patient needs plastic surgery, we do reconstruction so that a patient, when awake from anaesthesia, can see a normal-looking reconstructed breast, which gives her immense satisfaction and peace of mind.

The story will not stop there. Those women who after the unfortunate decision of mastectomy still living in psychological and physical trauma of ‘lost breasts’ could get new breasts with the help of plastic surgery and a new life.

Currently, even the patient with cancer spread in minimal form to other organs like bones, brain or lungs and liver could get a new life with the help of modern drugs and targeted therapies. We are heading for a new horizon in breast cancer care. But the best approaches will be prevention if possible, early detection always, breast preservation definitely and a new life.

An Oncologist’s Wish!

Treating cancer is not just a job of an oncologist. It is a sense of satisfaction at the end of the day when we go to bed, that a justice is delivered by our hand, a family has been saved by our decision and that tomorrow a lady can go out to the workplace, to home, family or to a social gathering with dignified feeling of a proud breast cancer survivor. Knowing the fact that the lady whom we are treating is equally participating in her survivorship is a feeling par excellence. Please help us and yourself to treat you, to give you a better life. That is how we give you a better life and a new world!

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