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Thursday, July 24, 2014
Trinidad & Tobago Guardian Online
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Women more proactive in breast cancer fight—oncologist
T&T has catapulted to the 21st century with respect to its treatment and care of breast disease and breast cancer, says surgical oncologist and oncoplastic and reconstructive breast surgeon Dr Rajen Rampaul. There’s now a breast surgery unit and a breast centre which offer first-class facilities. “More women are now proactive and are more educated. There’s less cultural taboo and we are a far more open society than 50 or 60 years ago,” Rampaul said. He expects that “more and more” breast cancers will be diagnosed earlier and there will be an increase in numbers, but thinks that women will be in need of greater care.
Hollywood actress Angelina Jolie announced two weeks ago that after discovering she was genetically predisposed to cancer she had a preventive double mastectomy. A mastectomy is surgery to remove a breast. It is performed either to treat or to prevent breast cancer. Only high-risk patients have surgery to prevent cancer. Rampaul also performs nipple sparing mastectomy which “saves everything on the outside.” The patient’s breast skin, areola and nipple remain. “I rebuild the patient on the inside. “The strength of those decisions come from women who have seen somebody or lived with someone who has suffered from it. “These decisions become straightforward for them.”
On May 16, Rampaul was interviewed at Pink Hibiscus, Woodbrook, where he is the medical director. He said he was receiving a lot of questions about genetic risk and breast cancer in young women. He said, “I think breast cancer in Trinidad is a big problem. One of the problems is that it is much more common in young women in their mid 40s. “The other problem is that we are seeing very few cases being diagnosed in the last five years via screening which is being detected very, very early. So most cases are detected at a later stage which is not very ideal.”
T&T as good as any first world country
Rampaul boasted that he performed all forms of breast and breast cancer surgeries which includes prophylactic, reconstructive and sentinel lymph node biopsy. Since he returned home three years ago he’s seen close to 5,000 patients. He said, “I think we’ve catapulted to the 21st century. “I have worked hard to introduce many new, pioneering techniques and many of the things that I got involved in, I have introduced, as far as I know were not on the ground. “I could tell you that there was never a breast surgery unit before, there was never a breast centre before and I am proud to say that the stuff we offer women are the very things that celebrities get up on TV and say they have had...that women can get in this country. “There’s nothing in breast disease or breast cancer not offered locally now, nothing.”
But raising awareness is a tough job, he said. He said one of the biggest problems was cultural taboos and that lack of awareness which makes women put off going to deal with their problem. “Statistics show that five per cent in five years of breast cancers are detected at the stage of one to two which is at the screen...I mean 95 per cent are coming through at a point where it shouldn’t be coming through,” he said. Asked if T&T was as good as any first world country, Rampaul replied, “Easily I would say so. Absolutely. Absolutely.”
He sees many women who have cancer either on one side who choose to have preventative surgery on the other side. Many women test positive for BRCA (breast cancer). There are two genes—1 and 2. He said, “What happens is that when these genes get defective they cannot allow the breast tissue to repair itself properly. So the problem is when there are defects in the genes. “Basically it can’t make proteins that help it to repair properly and this inability to repair is called cancer.” BRCA1 is linked strongly to breast cancer. There is an 80 per cent risk if there’s an abnormality in the gene but a woman also carries the risk of ovarian cancer. Whereas in BRCA2, there is a smaller risk of breast but higher risk of ovarian cancer.
Rampaul said, “You can tell predictions of whether a woman carries a BRCA gene by doing a pedigree analysis and then you can use software to tell whether the patient has a high risk compared to the population, or no risk at all.” In an article titled A Tale of Two Titties, Rampaul said there were several approaches to assessing what can be done with a patient once she’s deemed to be high risk. One is to do nothing and accept that cancer can develop, consider doing a detailed assessment and surveillance which would be more frequent mammography, breast MRI or even consider surgery. He sought to clear the misconception that oncology surgery with reconstructive surgery of high quality does not compromise cancer care. “There’s been a lot of research and data on that. Ms Jolie underwent immediate reconstruction...these things are safe. “They have to be done by experts who know what they’re doing, who have good rates of success and low rates of complications.” Rampaul said the mastectomies are done and while the patient is asleep, reconstruction begins. “When she awakes, she has her breasts and cleavage. She’s not deformed.”
About Dr Rampaul: Rampaul graduated in general surgery and surgical oncology from the University of Nottingham, and plastic and reconstructive surgery from the University of Newcastle. He’s completed an oncology fellowship at the University of Kent awarded by the European Society of Surgical Oncology and has written 100 scientific publications on breast cancer. He’s also medical director of Pink Hibiscus Breast Health Specialists and head of the breast cancer surgery unit at St James Medical Complex.