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Indian Journal of Surgery, Vol. 65, No. 6, November-December, 2003, pp. 521 Letter to Editor Conservative surgery in breast cancer: Comments Mallika Tewari F-15, AIIMS Residential Campus (Western), New Delhi 110029, India. E-mail: mallika_vns@satyam.net.in Code Number: is03116 Sir, It was a great pleasure going through the review articles in the special issue of IJS on Conservatism in Oncosurgery. The most striking was an exhaustive review of the Breast Unit, Tata Memorial Hospital, Mumbai regarding conservative surgery in breast cancer (BC). According to the authors, the proportion of cases undergoing BCS in operable BC and locally advanced BC (LABC) has increased from 12.6% and 0.4% in 1997 to 59.3% and 34% in 2001 respectively with remarkably low local recurrence rate (2%). This indeed points to an "increased awareness of BC" in Indian women. However, of about 75,000 new BC cases diagnosed every year in India, 50% - 70% are LABC.1 The treatment requires multiple disciplines and is resource intensive. The prevailing socioeconomic conditions of our country, made worse by the geographical isolation of many rural areas, accounts for the delayed diagnosis and increased treatment drop out rates. From the regional perspectives of breast cancer in developing countries it is obvious, that surgery is the most readily available treatment modality. Various types of mastectomy and lumpectomy with or without axillary clearance are done. Added to it is inappropriate adjuvant treatment. Follow-up and record keeping is also inadequate. Thus many patients undergo unconventional therapies before reaching standard medical care. The fate of other similarly treated patients who fail to reach a proper center, can only be imagined. Only a handful of sufficiently aware and economically sound urban elite patients reach the centralized and specialized cancer centers. In a study conducted at the Institute Rotary Cancer Hospital of the All India Institute of Medical Sciences, the duration of illness as well as time to first visit was significantly shorter in urban patients, those who were educated and aware of the disease.2 BCS may be becoming the "gold standard" in early BC but it demands specialized surgery with intensive radiotherapy and chemotherapy backed up by a long term follow up, making it out of reach of many of our patients. Let us not forget that a one time procedure comprising of meticulous modified radical mastectomy with good axillary clearance leads to good locoregional control and still remains an important tool in the management of patients with BC in India. REFERENCES 1. Chopra R. The Indian scene. J Clin Oncol 2001;19:106-11. 2. Goel AK, Seenu V, Shukla NK, Raina V. Breast cancer presentation at a regional cancer. © 2003 Indian Journal of Surgery. Also available online at http://www.indianjsurg.com |
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