How Can We Reduce the MORTALITY due to CANCER
Breast Cancer is among the most common cancers around the world. It is the most common cancer among women in India and around the world. Women in the North American continent have a 1 in 8 lifetime risk of getting cancer. In India Ratio is better, it is 1 in 28. Any cancer when detected early, is better treated. However, India is a densely populated nation. Breast cancer accounts for about 14 percent of cancer in women. Breast cancer mortality is 1.7 times higher than maternal mortality indicating the direness of the situation. Every 4 minutes, an Indian woman is diagnosed with cancer and every 13 minutes an Indian woman dies of cancer. The goal is to reduce mortality due to cancer.
HOW CAN WE DO IT?
1) Reduce the incidence: Less cancer, Lesser mortality.
2) Promote screening and early detection: Early cancers are better treated and have a good prognosis. Screening Mammogram has to be advocated in women with age > 40. Once in a year screening mammograms is very useful in a community.
3) Encourage women to present to the doctor early: Ignorance and Nihilism are detrimental in the fight against cancer.
Ignorance: Any lump can be cancerous. People have a very bad perception of cancer. They think cancer is painful to present with. Actually, it is the advanced stages that are more painful. People have to be told to present early. Lump in the breast, Skin changes in the breast, Recent retraction of nipple, Changes in the nipple-areolar complex are the early presentations that should be carefully evaluated.
Nihilism: “Cancer is a word – Not a Sentence” summarises my thought. Diagnosing cancer doesn’t mean the end of the world. Prognosis and treatment for cancer has evolved over the past decade. There are better treatments with even better results. There is a scientific way of seeing, diagnosing and treating cancer. When promptly done the treatment and prognosis does not vary much, no matter in which region the patient is getting treated. Surgery is the main mode of treatment of Breast cancer. Also important is the timing of the surgery and the proper use of adjuvant and neoadjuvant concepts. The use of chemotherapy and Radiation therapy is important when needed.
Modified Radical Mastectomy, popularly called MRM is the gold standard of surgery. It involves mastectomy (Removing the breast tissue completely) and axillary dissection (Removing the lymph nodes from the axilla, which are the next station of the spread of cancer). Then things have evolved over time. With the changes, patients suffering can be reduced. Lumpectomy (Removing the tumour ONLY with adequate margins) and Axillary dissection is the lesser surgery whenever possible. The breast is conserved and hence the name Breast Conservation Surgery. In this surgery, there are times when the contour of the breast is disturbed beyond cosmesis.
So recently we started concentrating on the aesthetics and rebuilding the breast architecture, hence called Breast Oncoplasty. Axillary dissection when done may lead to a long term complication of Limb Oedema due to Lymphoedema. This can happen in up to 20 percent of the people undergoing axillary dissection. Recently we have thought over this and scientifically formulated plans. Nowadays we do axillary dissection in patients only when axillary nodes are involved. In other patients after proper selection, we may avoid axillary dissection after Negative Sentinel Node Biopsy. A Sentinel node is a single or a group of nodes that are the first station of lymphatic flow. We can surgically identify this node, biopsy them and if negative aptly avoid an axillary dissection.
To summarise, the Breast is a superficial organ and we should not miss an opportunity to identify and diagnose early breast cancer. Screening has to be popularised among women. People should know and understand the easier modalities of treatment hence alleviating the treatment process. People should understand and take the benefit of better modalities of treatment.
Dr Karthik KS
Note: On the occasion of World Cancer Day, which was on 4 February with the theme: “Close the Care Gap”, this article is by Dr Karthik KS, Surgical Oncology, KMC hospital, Mangaluru