Article Written By Dr. Lyronne Oliviere (Breast Surgical Oncologist, Consultant Oncoplastic & Breast Reconstructive Surgeon)
The “Chime of a bell” symbolises the completion of her breast surgical oncology therapy, representing the epiphany of joy. This is the memory over the past week, a video sent from one of my breast cancer patients. The pleasure of patients surviving the ordeal of diagnosis and the treatment that promotes cure. Comradery of fellow breast cancer patients and their relatives lending psychological support during breast oncology care. These are two elements witnessed during my interactions with my patients, not apparently visible during breast surgical oncology care, reflecting the humanistic side of cancer therapy.
Current Situation
Breast cancer has surpassed other cancers as the number one cancer in both incidence and mortality amongst women. This reality has also held true within our twin island republic of Trinidad and Tobago. Breast cancer accounts for 31.6 percent of cancers in females and 25.7 percent of female cancer-associated deaths.
Recent data between 2014 to 2018, demonstrates that the breast cancer incidence and the mortality numbers were 1982 and 1100 patients respectively during this five-year period. Therefore, per year 396 patients were diagnosed and 220 patients died primarily of breast cancer in Trinidad and Tobago.
What are the causes?
Most breast cancers are sporadic whilst only approximately five to 10% have a genetic and familial predisposition. However, there are some risk factors associated with breast cancer. Advancing age, early menarche, late menopause and familial link are some non-modifiable factors. Conversely, alcohol consumption, obesity, lack of exercise, no children and lack of breastfeeding are some modifiable factors. However, lifestyle modifications may render a 30 to 40 percent reduction in lifetime risk of breast cancer.
What are the symptoms of breast cancer?
Early breast cancer may have no symptoms and may only be an incidental finding on imaging or routine breast cancer screening. Most cancers may present with a palpable breast lump, skin dimpling, nipple inversion, nipple discharge, swelling within the armpit and breast skin changes. However, not all breast lumps are cancerous.
Unfortunately, in our country, most of the cancers are palpable on presentation and locally advanced. Local data also reflect significantly high presentation of breast cancer with distant disease.
Breast cancer diagnosis
Clinical examination and radiological investigations followed by breast biopsy are the tenets of a breast cancer diagnosis. Mammogram and Breast ultrasound are the initial image work-up. Further testing such as Breast MRI, staging CT-scan and bone scan may be required but would be determined by the surgical and medical oncologist.
What are the treatment options?
Individualization of breast cancer care is one of the ideals set forth by a breast surgical oncologist. Each patient treatment plan should be precisely carved with patient factors and tumour characteristics specific to the patient. Treatment options include surgery, hormone therapy, chemotherapy, targeted therapy and radiation therapy. The individualization also involves the sequencing of the aforementioned therapies if found to be required.
Do all cancers require breast removal (Mastectomy)?
This is one of the myths of breast cancer care. Many patients desire breast preservation and the avoidance of mastectomy. There is no difference in overall survival if one undergoes breast preservation versus removal of the breast. This approach is facilitated by the medical therapies and oncoplastic surgical approach. Oncoplastic surgery utilises the principles of breast preservation and plastic surgical techniques to retain breast symmetry and shape.
If one requires breast removal, are there options?
Breast reconstruction can be performed immediately at the time of the first surgery or delayed after breast cancer management. Immediate breast reconstruction allows the option of nipple sparing and skin sparing mastectomy. All patients undergoing mastectomy should have the discussion about breast reconstruction. This was a mandate for breast cancer care in many first world countries such as the United States of America and Canada.
How to detect breast cancer?
The delay in presentation is directly related to prognosis and outcomes. Early breast cancer, if diagnosed, has the greatest potential for cure and overall survival. Therefore, breast screening in the form of mammography offers one such avenue to identify suspicious lesions. Self and clinical breast examinations also allow the patient the potential benefit of early identification of breast abnormality and hence seek consultation.
Do men get breast cancer?
Male breast cancer accounts for less than one percent of all breast cancers and the presentation tends to be more advanced and at a later age. The management is similar to female breast cancer.
Breast cancer has steadily increased throughout the world. Early identification simplifies the treatment options and ensures the potential for cure. Self-awareness of one’s breasts with regular self monthly exams seven days after menstrual cycle offers standardization of findings in non-menopausal patients. If an abnormality has been identified please seek consultation by a Breast Surgeon within a three to four week period. However, for menopausal patients, any abnormality identified should be assessed urgently without any delay.
Dr Lyronne Olivier
Breast Surgical Oncologist
Consultant Oncoplastic and Reconstructive Breast Surgeon
Dr Lyronne Olivier graduated as medical doctor from the University of the West Indies in 2006. He has been in the field of surgery from 2007 and completed the Doctor of Medicine in Surgery to become Consultant Surgeon in 2016. Dr Olivier was awarded the Prakash Scholarship by the University of Toronto, Canada in 2020 to pursue his Fellowship in Breast/Breast Surgical Oncology. He currently works as Consultant Breast Surgeon/General Surgeon in the public and private sector as well as Associate Lecturer in the Department of Clinical Surgical Sciences, UWI. He is a fellow of the Caribbean Fellowship of Surgeons and American Society of Breast Surgeons.
Dr Olivier Career and personal goals aligned with improving Breast disease and Breast cancer care in Trinidad and Tobago. Training of General Surgery residents in Breast Surgical Oncology is another passion of Dr Olivier.