70 year old Mrs S… visited me in my clinic the other day. While taking bath a few days earlier, she had noticed small lump in her right breast which prompted her to visit her family doctor who advised a few tests and confirmed that it was indeed “the dreaded C…   Cancer’”. The preliminary suggestion by the doctor was that “the breast needs to be removed at the earliest” and referred her to an oncologist.

As expected, the patient and her family became really anxious at hearing both the diagnosis and the “suggestion” for treatment. Though 70 years old, this lady was “socially active” – she had a close group of friends practising yoga and meditation, used to attend religious meetings, conduct charity activities and fund raisers. She also had a large joint family which was very attached to her. The thought of losing a breast disturbed her emotionally and she feared becoming a social recluse.

Distant family relative who was a doctor referred them to me.  As I began conversing with her, she blurted out in a low voice the question that was racking her “I have Breast cancer. Does that mean I need my entire breast to be removed?”

On examining her, she had a barely palpable lump just about the size of a small grape. Her Mammogram showed a solitary lesion.  There was no spread to the nearby lymph nodes or to distant organs. I reassured her and advised a lumpectomy (removal of the tumour with a small margin) and a sentinel lymph node biopsy.

The surgery was performed as a day care procedure the next day. She got admitted in the morning. The surgery was completed in an hour.Fortunately, frozen section (real time microscopic evaluation) of the sentinel lymph node showed no spread. She was discharged same day evening. She had her favourite “dal rice” that night. She could perform all her activities normally. When she came to me a week later for follow up, she showed pics of a marriage she had attended a day earlier. The smile on her face said it all – it was worth a million and made my day.  

The pathology report was ready and showed a low grade, first stage tumor which was hormone receptor positive. This meant that she just needed radiation and an additional tablet a day for a few years.

The supposedly fearsome “Radiotherapy” was started the following week. She needed just 5 fractions (or doses) of RT – this actually meant lying down under a machine which looks like a CT scanner for 5-10 minutes a day. This was completed in 5 days – she hardly spent half an hour a day at the hospital every day for this therapy. She was flummoxed after her first fraction of RT and asked the radiation nurse – Is your machine really working? I didn’t feel anything going through my body”. The nurse had to reassure her that she had actually received treatment.

We started her off on hormonal therapy medications which is a substitute to chemotherapy in this kind of early stage cancer. She only needs to undergo some regular follow up tests once in 6 months and as per statistics the chance of cancer recurring in her is < 1%.

Moral of the story:

• All breast cancers do not need total breast removal.
• Age is not a bar for breast conservation. The mindset that older women do not need breast conserving surgery (BCS) and are better off with removal of the entire breast needs to go.
• Whether we perform BCS or mastectomy for an early stage breast cancer patient, the cure rate is the same.
• Even in intermediate stage cancers (large tumors), chemotherapy can be given to make the cancer smaller and breast conservation is still possible
• In fact, women who have undergone breast conservation surgery live longer than those who undergo mastectomy (stage matched)
• The earlier a woman reports to a doctor with symptoms, the simpler and easier the treatment would be.

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