What drove you to specialize in surgery? Please give us some brief accounts of your work as a breast surgeon and other subfields.
When I was a young doctor, I was posted to various specialties, one of them being general surgery. So, I found a lot of satisfaction when I operated on the patients as you can comprehend the outcome almost immediately; a more hands on approach, as compared to prescribing medications. Thus, this was a major influence for me.
Subsequently, being a woman and the opportunities as a female surgeon were low during my time in Singapore, as compared to now where the numbers have improved. More so, a lot of female patients felt more comfortable and as with Breast Cancer, it can be a very intimate matter for the patient. Hence, I decided on this as a means to give something back to my own fraternity.
What are the common types of mutation from breast cancer? Would mammography suffice as a means of early detection in high risk individuals?
The most common types of mutations for breast cancer are the two types of genes: Brca 1 & Brca 2, this is an inherited gene. Most people assume that the inherited genes are the most common cause of cancer. Also, assuming that if their family members don’t have cancer, they are not at risk; which is wrong. Inherited cancer accounts for 20% of the cases, the rest 80% is what we call spontaneous cancer. If a family has many members having cancer such as the Mother, Mother’s Sister, Grandmother and Great Grandmother, then we would suggest to do the Brca test 2. This is a simple blood test and if it’s positive then they would fall in the high risk category. For High risk category patients a simple screening which is a mammogram and an ultrasound may not suffice. As because, high risk category patients starting age for screening is 25 years, as compared to low risk category patients which start from 35 onwards. More so, in a young age the screening might be ineffective due to density present in the women’s breast, making it difficult to screen for cancer. Hence, we suggest MRI for them.
How far does self-breast examinations go as a means of early detection?
Self-breast examinations definitely help. A high risk patient can start at the age of 25 and for low risk patients, from the age of 35; once every three months, as per the American standard. It’s important because Breast Cancer can be quite silent, painless and not show any signs at all initially. Hence, conducting a self-examination and finding a possible lump early, will allow for early treatment, given there are any presence of cancer.
How common is breast cancer in Asia? What are the risk factors that contribute to its development?
In Asia Breast Cancer is the most common type of cancer and also accounting for the highest related death in women. In Bangladesh- 22.5 per 100000 females and in case of Bangladeshi women, aged between 15-44 years, breast cancer has the highest prevalence. Risk factors are mainly comprised of two big groups. One of them is Inheritance, you cannot change that. The other one being mainly the lifestyle. Bad food habits which include fatty and processed food, more so food with high sugar or oil content and so on. Adopting vices such as smoking and excessive drinking and above all inactivity with no forms of conscious exercise; all add up in the risk factor for lifestyle. A note for the women of the Asia are that they consider their household activity as exercise, for example cooking or cleaning etc. These are not substitutes for physical exertions such as running or walking which make you actually sweat. Hence, a recommended rate would be a minimum of 3 times/week of proper exercise for women, as it can play a pivotal role in their future health.
In Asia Breast Cancer is the most common type of cancer and also accounting for the highest related death in women. In Bangladesh- 22.5 per 100000 females and in case of Bangladeshi women, aged between 15-44 years, breast cancer has the highest prevalence
Vices such as smoking or drinking have been shown to minutely mutate the genes, they are carsogenics… On the other hand, Inherent risk factors are not changeable. Factors such as age, early menses, which sometimes can start at the ages of 12-15 for girls exposes them to more estrogen putting them in a higher risk. Usage of contraceptive pills can create more estrogen exposure creating growth in the breasts early on. On the other hand, hormone replacement therapy for women undergoing menopause can be a risk factor. As the women are sometimes prescribed menopause hormone pills, if taken for more than 5 years it can lead to the development of Breast Cancer. Women who undergo early pregnancy and who have a higher frequency of pregnancies in their life, are more at risk due to higher estrogen exposure. Young age refers to before 30, so later pregnancies after that might increase the chances of developing Breast Cancer. However, these are never absolute and is more of an association as there are many other underlying factors which play key roles in the actual development of any cancerous cells.
What are the various forms of treatment and would early detection affect the recovery rate?
Early detection definitely affects the outcome. Due to the fact that early detection makes the treatment simpler firstly. Secondly, the number of years the patient will live without cancer and also the years and possibilities of the cancer coming back, reduces. For instance, Stage 1 Breast Cancer has a recovery rate of nearly 99%! Stage 2 is around 80%, stage 3 is at 50% and stage 4 is around 25%.
Early detection, in between stage 0 to stage 2, the quality of life goes back to near normality. Stage 3 and above, you might face more frequent visits to the doctors, undergo more treatments along with the side effects of these. Additionally, the psychological effect of this entire experience can be quite stressful and play a role in the quality of life after recovery. All in all, normality of life can be achieved as long as at risk patients come in early for screening and or treatments.
As per the treatments, Breast Cancer overall is not treated by just one modality. Consider, Leukemia which is solely treated through chemotherapy. For Breast Cancer Stage 3 and above surgery is a key form of treatment. More so, depending on your tumour biology and the different subsets present in Breast Cancer; the patient may need to undergo Chemotherapy, Radiotherapy and even hormone pills. Thus, this cocktail of means if treatment depends on the patient’s age, tumour biology and many others.
What are the types of screening methods offered at Farer Park Hospital? Give us a description of the new treatment Microdose Mammography at Farer Park Hospital.
At Farer Park Hospital, we have the standard 2D mammography and also Ultrasound for ladies of ages 40 and above. Microdose Mammography is a newer method of where the standard dose of radiation compared to a normal mammogram, is much lower. The technique is the same but the radiation dosage and the software present is more innovative than a standard mammogram. Farrer Park also offers MRI scans for high risk patients of Breast Cancer.
Could you give us an account of your work on Oncoplastic and Re-constructive Breast Surgery?
This has been present since the 90’s and has developed overtime. I was trained in this at UK at the Nottingham Institute of Breast Cancer, for a year. It’s been a practice so as to improve the aesthetic outcome of the breast. The removal of the cancer and the reconstruction are done together. What I do is, after removing the cancerous cells first, we do what we call remodeling of the breast where we shift the tissues in order to improve the overall aesthetic state and improve the final outcome. This is possible even for cases where total re-construction surgery of an entire breast as compared to partial reconstruction. The success rates depends on choosing the right technique for the right patient. The challenge is choosing the right method as the matter is highly subjective.
In Bangladesh, we have a serious issue of stigmatization, especially for women when it comes to being vocal about our ailments? How can we possibly come out of this mindset?
This is actually is prevalent all over Asia. In Singapore, the minority group consisting of the Malay and Indian populace, are quite shy in coming forward when it comes to these matters. They have many assumed fears and phobias for which they do not come forward. Hence, I think education and awareness is significant here in order to fill this knowledge gap. More so, Cancer survivors can come forward and showcase their individual cases to create awareness. In doing so, the women will be able to actually relate to them. They are already defensive when it comes to medical professionals advices on treatment. However a survivor group who come forward and share their experience can actually help in opening up their eyes to the significance of coming forward and being vocal. In Bangladesh the women are quite strong and thus they have room to come forward and form such communities to create awareness.
According to you, what are the prominent healthcare challenges of the 21st century?
I think the diseases which are present in the 21st century are lifestyle centric ones. Mainly diabetes, high blood pressure. Environmental factors which lead to Lung Cancer and lack if clean drinking water, leadings to problems from arsenic poisoning. Everyone is so caught up and have no time for important things like exercise or mental relaxation. We are all so stressed and whenever we are, we resort to our vices. Hence, it’s lifestyle that the problem and it’s related diseases.