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Breast Conservation Surgery; A new concept in Pakistan. Dr. Arif R Khawaja FRCS (Ed),FRCS (Gen Surg) Consultant Surgical Oncologist, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan . Why Breast conservation ?.

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breast conservation surgery a new concept in pakistan

Breast Conservation Surgery; A new concept in Pakistan

Dr. Arif R Khawaja

FRCS (Ed),FRCS (Gen Surg)

Consultant Surgical Oncologist,

Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

why breast conservation
Why Breast conservation ?

“How do you say goodbye to a breast? I’ve had it for forty five years. I think I’ll miss it. But I am playing it cool.”

“………… it is more complicated than I thought. I was’nt going to be bothered by losing a breast. I am. I don’t like how I look. I look amputated. I am different. I am a cancer patient. Will I ever be unaware of my chest?”

Barb Sullivan

My Broken Breast Book

difference from the west
Difference from the West
  • Incidence low (Probably 1 in every 40-50).
  • Occurs in younger women.
  • Histopathology more aggressive.
  • Present late.
  • Poor understanding of disease.
  • Opinions sought from spiritual healers and homeopaths.
  • Strong social taboos and lack of support.

1. Family pressure

2. Husband and in-laws attitude.

3. Negative ideas about treatment.

  • Higher mortality due to late presentation.
breast cancer in pakistan
Breast Cancer in Pakistan
  • Commonest malignancy. Between 1994-2004, 21% of all patients seen at our institution was Br Ca.
  • 25% of all adult cancer
  • 42% of all female malignancies.
  • Family history is present in only 2%.
  • Median age is 42 years (range 19-77 yrs)
  • 57% are premenopausal.
study period
Study Period

June 2003 to May 2004

n = 64

slide9

n =64

No. of

Patients

AGE GROUPS & MENOPAUSE

Age

PREMEUPAUSE 39

POSTMENOPAUSE 25

Range 24-65yrs

Median 46yrs

tumor in different quadrants
Tumor in different quadrants

15

04

20

11

03

02

07

02

LEFT

RIGHT

slide12

NO. of

patients

TUMOR SIZE (cm)

metastatic axillary nodes
METASTATIC AXILLARY NODES

No. of

patients

No. of Lymph Nodes

Range 0-11

Median 01

histopathology n 64
Histopathology n=64
  • Lobular Ca 02
  • DCIS 05
  • IDC with

lobular features 05

  • IDC II 17
  • IDC III 35
hormone status premenopausal n 39
ER+ 12 (30%)

PR+ 12 (30%)

Her neu2+ 25 (62%)

ER - 27 (70%)

PR - 27 (70%)

Her neu2 - 14 (38%)

HORMONE STATUSPremenopausal n = 39
hormone status postmenopausal n 25
ER+ 16

PR+ 16

Her neu2+ 10

ER- 9

PR- 9

Her neu2 - 15

HORMONE STATUSPostmenopausal n = 25
follow up
Follow up
  • Follow up Mammogram n=60
  • Lost to Follow up n=04
  • Follow up Clinically n=59
  • Margin Positive n=00
  • Local recurrence n=00
  • Distant metastasis n=05
  • Death n=02
conclusion
CONCLUSION
  • Breast conservation surgery followed by XRT is now an established and accepted surgical procedure in the management of early stage Br Ca all over .
  • It is safe, cosmetically acceptable and easy to follow up.
  • In Pakistan, it is still not considered to be an option by surgeons as there is a fear of local recurrence and poor follow up.
  • By presenting a local study, it might be possible to convince colleagues and peers regarding its safety and may provide the confidence to offer patients an option of breast conservation in the management of this disfiguring disease.
closing remarks
Closing Remarks
  • As a surgeon, we may not be able to improve the quantity of life when a patient presents, but we can improve the quality of life of our patients.
  • 4 out of 5 unmarried patients have been married or engaged or proposed!