UAE doctor says breast cancer need not disfigure survivors

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Hospital staff from Umm Al Quwain hospital interviewing patients at the Pink Caravan.-Photo by Leslie Pableo
Hospital staff from Umm Al Quwain hospital interviewing patients at the Pink Caravan.-Photo by Leslie Pableo

Dubai - Unfortunately, women in Dubai still consider mastectomy (breast and tumour removal) to be a taboo subject.

By Asma Ali Zain

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Published: Sat 14 Oct 2017, 12:00 AM

Last updated: Sat 14 Oct 2017, 10:45 AM

D.A was just 32 years old when she was diagnosed with breast cancer in July 2016. The news broke her and her first thought was of her newborn as she has just delivered.
However, Diana's fighter spirit and the right time her cancer was luckily diagnosed helped her survive.
"I have a family history of breast cancer since my aunt had it," she told Khaleej Times. "And the news of breast cancer came to me as a shock.I always thought that it was a disease that happens to others and not to me."
Today she is cancer free after undergoing chemotherapy, radiation and having had mastectomy done on her left breast. While most women beat cancer and go on to live normal lives, many of them feel they have lost their femininity after having their mastectomies done.

Luckily, D.A was given a choice to have her removed breast reconstructed, a choice not many women are given.
Dr Dora Evangelidou, plastic and reconstructive surgeon at CosmeSurge, a subsidiary of Emirates Healthcare Company - where D.A. got her mastectomy done and breast reconstructed - said that even though breast awareness campaigns have been very successful in the UAE, many women are not aware of their reconstructive options.
Raising awareness on a woman's options after surgery during this month of breast cancer, Dr Dora added that the subject is still considered taboo.
"Unfortunately, women in Dubai still consider mastectomy (breast and tumour removal) to be a taboo subject as they view this as disfiguring or a loss of femininity," she said, adding that the number of women coming to seek such options was less.
"This is why October is not just about the colour 'pink'. It is so people can be reminded that they can do much more beforehand. Women who are diagnosed must be informed about their reconstructive options in advance of the mastectomy surgical session," she said.
For D.A after survival, it was about looking good too. "It was a difficult stage but I wanted to look normal and absolutely good too," she explains.
In the ideal scenario, the breast surgeon arranges for a consultation with a plastic surgeon that has breast reconstruction experience and qualifications.
"We make sure that this is the case for all the women diagnosed here at the hospital but before mastectomy, the patient is informed and educated about their breast reconstruction options," said Dr Dora.
According to the doctor, there are at least 20 types of breast reconstructive surgeries and some methods are less invasive than others depending on each patient.
Every reconstruction is tailor-made to fit the patients' needs and expectations," explained Dr Dora. "We do many types of immediate breast reconstructions during the mastectomy since this is the easiest way for a patient to initiate their post-cancer period," she added.
However, removal of a breast is not an easy time for any woman. "I see women who are depressed because to feel good you need to look good and breasts make a woman feminine."
Women who are diagnosed with breast cancer on one breast or bilateral receive a mastectomy but instead of waking up to the horror of an amputated chest, Dr Dora reconstructs a new breast from scratch during the same surgery.
Dr Dora said: "It is much easier to reconstruct the breast at the same time as the mastectomy rather than years later. I will always design the cuts for the breast surgeon to proceed and remove the breast and immediately after that a new breast will be reconstructed during the same surgery." Areaolas (nipples) are reconstructed through tattoos done by a specialist at the hospital and are made to look as original as possible.
There are also situations where prophylactic mastectomy is recommended (removing the breast that does not have a tumour). "Some women are diagnosed with extremely aggressive cancer, multi-focal cancer or have a family history of breast cancer and these women would be good candidates for prophylactic mastectomy. If women learn about their reconstructive options, they can not only survive this disease but thrive afterward."
Women who have undergone reconstruction surgery can live a normal life and indulge in any kind of activities including exercising or even swimming. Dr Dora has been published in various international academic journals and also has conducted a study that was published a few days ago regarding a mesh (a device that is used in breast reconstruction) that is less costly and has as low complications as its expensive alternative.
"This preliminary study renders breast reconstruction with implants available to everyone and everywhere," she added. She is also part of another study published in February 2017 where a special type of implant is used in patients that undergo radiation therapy that showed less complications than the regular implants.

Types of reconstruction procedures

 The most common type is implant reconstruction and is used in more than 65 per cent of the reconstructive procedures and also includes silicon gel which is a soft material, almost soft to touch. Autologous (or 'flap') reconstruction, which uses tissue transplanted from another part of the patient's body (such as belly, thigh, or back), is another less common option. There are also reconstructions that combine both methods.

How to detect cancer at an early stage

> Mammography: A mammogram is the best screening tool used today to find breast cancer early. It is an X-ray picture of the breast. A mammogram can find cancer before you notice any problems in your breast. It can find cancer when it is small and easier to treat often without losing the breast. It is recommended that all women have a screening mammogram every two years starting at age 40 (and perhaps earlier if you have a family history of breast cancer).
> Clinical Breast Examination (CBE): Your doctor and some other health care providers have been trained to perform a thorough physical examination of your breasts. They can verify that you are doing BSE the proper way. If you have a family history of breast cancer, your doctor is ready to discuss mammography screening guidelines and scheduling along with other options to limit your personal risks.
> Breast Self-Examination (BSE): Every woman should check her breast for lumps, thickening, or other changes every month. By examining your breast regularly, you will learn how your breasts normally feel. Moreover, practising monthly BSE may give you added peace-of-mind; it's a routine that gives you the opportunity to spot changes that need your doctor's attention.

Leading cause of cancer deaths in UAE

> Cancer is the leading cause of death in the UAE of which breast cancer is the highest at 19 per cent.
> In the UAE, approximately 4,500 new cases of cancer are reported in a year. In 2012, cancer was the third leading cause of deaths in Abu Dhabi.
> The UAE is determined to bring down cancer fatalities by nearly 18 per cent by 2021.
 > Women aged 40 years and above are urged to undergo mammogramm every two years which helps in early diagnosis and prevention.

Who is at high risk?

A woman is considered at higher risk of developing breast cancer if she has one or more of the following criteria:
> Previous treatment with chest radiation at a young age (between age of 10-30)
> Previous history of breast cancer
> Lobular carcinoma in situ (LCIS) or atypical ductal hyperplasia (ADH) on previous breast biopsy
> Strong family history or genetic predisposition
> Women who have a life time risk of 20-25 per cent as defined by models largely dependent of family history

The best time for breast self-exam:

> When the breasts are not tender or swollen, during 6 - 10 days after first day of menstrual cycle
> After menopause or hysterectomy, examine your breasts on the same day of each month. You may choose any date but it should be one you will remember

Top 5 cancers

In males
> Leukemia
> Colorectal
> Prostate
> Non-Hodgkins
> Brain cancer
In females
> Breast
> Leukemia
> Colorectal
> Thyroid
> Uterus

Steps of Breast Self-Examination:

>Lie down on your back with a pillow under your right shoulder
>Use the pads of the three middle fingers on your left hand to check your right breast
>Press using light, medium and firm pressure in a circle without lifting your fingers off the skin
>Follow an up and down pattern
>Feel for changes in your breast, above and below your collarbone and in your armpit
>Repeat on your left breast using your right hand
>These steps may be repeated while bathing or showering using soapy hands.
Look for changes:
>Hold arms at your side
>Hold arms over your head
>Press your hands on your hips and tighten your chest muscles
>Bend forward with your hands on your hips

What are you looking for?

See your health care provider right away if you notice any of these breast changes:
>Lump, hard knot or thickening
>Swelling, warmth, redness or darkening
>Change in the size or the shape of the breast
>Dimpling or puckering of the skin
>Itchy, scaly sore or rash on the nipple
>Pulling in of your nipple or other parts of the breast
>Nipple discharge that starts suddenly
>New pain in one spot that does not go away

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