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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 ?.

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Breast Conservation Surgery; A new concept in Pakistan

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  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. Staging Classification of Breast Tumour

  6. Breast cancer 5 year survival rates (UK) by stage at diagnosis

  7. Study Period June 2003 to May 2004 n = 64

  8. n = 64

  9. n =64 No. of Patients AGE GROUPS & MENOPAUSE Age PREMEUPAUSE 39 POSTMENOPAUSE 25 Range 24-65yrs Median 46yrs

  10. Tumor in different quadrants 15 04 20 11 03 02 07 02 LEFT RIGHT

  11. QUADRANTS OF BREAST

  12. NO. of patients TUMOR SIZE (cm)

  13. AXILLARY LYMPH NODE DISSECTION (ALND) • RANGE 9 - 30 • MEDIAN 15

  14. METASTATIC AXILLARY NODES No. of patients No. of Lymph Nodes Range 0-11 Median 01

  15. Histopathology n=64 • Lobular Ca 02 • DCIS 05 • IDC with lobular features 05 • IDC II 17 • IDC III 35

  16. ER+ 12 (30%) PR+ 12 (30%) Her neu2+ 25 (62%) ER - 27 (70%) PR - 27 (70%) Her neu2 - 14 (38%) HORMONE STATUSPremenopausal n = 39

  17. ER+ 16 PR+ 16 Her neu2+ 10 ER- 9 PR- 9 Her neu2 - 15 HORMONE STATUSPostmenopausal n = 25

  18. 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

  19. Pattern of Metastatic Disease

  20. 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.

  21. 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!

  22. THANK YOU

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