Too late to save patients

About 12-15 per cent of women with breast cancer walk into doctors’ offices with the disease already at stage four.

This statistic, collected between 2007-2011 in TT, was revealed by Dr Rajendra Rampaul, oncoplastic surgeon and medical director of Pink Hibiscus Breast Health Specialists. He was speaking at the organisation’s breast cancer symposium at the Guardian Group Corporate Centre, Westmoorings, last Wednesday.

“That’s quite high. That’s 12-15 per cent of women (with breast cancer) that medicine cannot cure. We can try to hold the disease, but we can’t cure them...

“Then there is a cost. Management of stage four disease is at least 30- 40 times higher than managing stage one disease. For every day lived, they have to have a huge amount of very expensive medication that isn’t going to cure them.”

He believed education and awareness would help bring the numbers down to three per cent in the next few years.

However, he said the breast cancer education programme in TT was not aggressive. He said some women would feel a lump in their breast and believe it would just go away, think screening was not worth doing, or that mammograms hurt, rather than accessing care.

He also gave averages of 20 per cent for stage one, 43 per cent for stage two, and 25 per cent for stage three cancers. He added that 40 per cent of patients had aggressive cancers.

He said about 9.1 per cent of patients were younger than 40, 41.5 per cent were between 41 and 55, and 36.5 per cent were 56-70. Also, 41.3 per cent were Afro-Caribbean, 38.3 per cent Indo-Caribbean, and 19.3 per cent mixed.

He added that 50 per cent of patients in TT ended up with mastectomies due to bigger lumps because they present too late, making it difficult to do breast-conserving surgery as well as personal preference.

Rampaul said one area of importance was genetic risk, and the country’s small genetic pool was one of the reasons cancer was common.

“We have a small population that has been living on the island (for over) 200 years. Nobody is migrating into Trinidad, and so we have a shrinking genetic pool. You don’t have to look far to have a relative who has had cancer.”

To doctors, he strongly recommended mapping the family history of patients. To those with a history of cancer, he suggested they should be screened at an earlier age and more frequently. Noting that women were having their breasts removed as a preventative measure, he said the move offered some protection, but stressed that it was no guarantee. It did not remove the risk of getting breast cancer.

Rampaul said even in trying to save the patient’s life, the impact of the cure could be negative in terms of quality of life. After mastectomies 80 per cent of patients became depressed, he said. Most of their partners left them within two years, and 60-70 per cent were unable to return to work.

He called for more supportive measures to help improve the patients’ quality of life. He listed several surgeries that could be done after a mastectomy that would not leave a woman “lopsided.”

These included therapeutic mammoplasty for large-breasted women. where the cancer tumour is removed from one breast and a breast reduction is done on the other; latissimus dorsi flap procedure, where skin, fat, muscle, and blood vessels from the upper back are used to reconstruct the breast; and TRAM ( transverse rectus abdominis) flap, in which skin and fat from the abdomen are used to rebuild breast tissue.