Breast cancer is more feared and less understood. It is the most common cancer affecting women in our country. “While we cannot pinpoint a reason for developing the disease, it can be controlled to a great extent by being breast aware,” says Dr. Banira Karki, Consultant Breast Onco-Surgeon at
B&B Hospital and Norvic International Hospital.
Dr Banira is a professionally trained breast onco-surgeon who is passionate about alleviating both physical and emotional pain of the cancer patient. A mother of a five-year-old, Banira says, “As a female surgeon, I feel that it is my duty to bring world class treatment to Nepali women with added care because we have settled enough in our unprivileged status where women health is second to everything”.
In a conversation with WOW’s Ankita Jain, Dr Banira helps us better understand the surgical aspects of breast cancer treatment.
How is a surgical oncologist different from a surgeon?
A surgeon performs a range of non-cancer related procedures along with some cancer surgeries according to their level of skill, while an onco-surgeon has additional training and experience in the field of cancer and devotes his or her practice specifically in cancer management.
What do women need to know about breast cancer?
Breast cancer is the most common cancer worldwide with associated high death rates, however if detected and treated early, it has better outcome with good survival. Regardless of the age, women need to be aware of the risk factors and importantly know their breasts as to how they look and feel. Women should also have the knowledge of breast self-examination and the importance of regular screening.
What are the things to look for during the breast exam?
Breast exam involves examination of the entire breast, armpit and area around the collar bone during which we look for any breast lump, change in colour, texture of the overlying skin, size and shape of breast, nipple discharge or bleeding from the nipple, nipple retraction or any nodularity in the armpit or around the collar bone.
What if a change is observed during breast self-examination?
Any change noted during breast self-examination should be consulted with a breast surgeon. This would help early detection of any ailment that needs immediate intervention. On the other hand, it could also provide peace of mind if the changes are non-cancerous.
Who is more prone to breast cancer?
High risks include women having a strong family history of breast cancer, ovarian cancer or multiple cancers and carrying a genetic mutation. Woman having multiple breast biopsies in the past or women who have undergone chest wall radiation are liable. Women under hormonal treatment for a longer time are also more prone to breast cancer. Besides these, average risk individuals include women who have early start of menstruation, late menopause, late first pregnancy, shorter and no breast feeding.
What are the next steps after a cancer surgery?
Cancer surgery is always a multidisciplinary team approach which is not limited to surgery alone where an onco-surgeon, medical oncologist, radiotherapist, radiologist, pathologist and palliative care team play a major role. Depending on the type and presentation, there are multi-modality management after the cancer surgery including chemotherapy, radiotherapy and/or hormonal therapy. Conditionally these may be required prior to surgery as well.
How does a breast onco-surgeon decide if it is a lumpectomy or a mastectomy that needs to be performed?
Lumpectomy (breast conserving surgery, BCS) indicates removal of the tumour with surrounding tissue primarily focusing to preserve the architecture of the breast whereas mastectomy involves removal of the entire breast. BCS can be done in specific patient with early-stage disease, having smaller tumour with adequate breast size and is willing for regular follow ups. Besides, for patient undergoing mastectomy, breast reconstruction is always an option which provides both aesthetic and psychological support.
Signing a consent form before surgery is compulsory. What should the family members keep in mind before signing the consent?
Consent form is not merely a medico-legal document, it is also an added opportunity to discuss the patient’s health, treatment options available, possible complications and a chance to clear any queries the patient or family might have.
Do share best practices to remain healthy and cancer free.
It is very important to do regular exercise, eat healthy diet, maintain a healthy weight, limit consumption of red meat and processed meat, quit smoking and limit or avoid alcohol consumption that may lower the risk of cancer. But sometimes changing your lifestyle and habit may not completely prevent you from cancer especially if you have unavoidable risk factors. For this; early consultation at breast family clinic would be the best option.
What role can men play in breast cancer screening?
Men – as a part of the family and society – are equally responsible for the health status of the entire family in which women are the epitome. For this the encouragement towards healthy practices and screening should be initiated from them as well. In context of rural and semi-urban localities where men are usually more educated and have more access to medical education, I think they should play a pivotal role in motivating women for cancer screening. Having said that, men are not immune to this problem either. One percent of the diagnosed breast cancer is seen in men as well. Hence, they should be equally aware of the situation.