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To chop or not to chop. Tuesday, April 20, 2010 Breast Cancer Treatment Is Breast Conservation Treatment a Safe Alternative to a Mastectomy for Breast Cancer? by Dr. Tan Mona More Articles by Author Although a diagnosis of breast cancer is devastating news, a positive aspect is that effective treatment is available. Even better news is that if detected early, breast conserving treatment provides similar cure rates as a mastectomy (the removal of the breast).1 As surgery is pivotal in the treatment of breast cancer, a woman who has been diagnosed with the problem is often given the choice between breast conservation treatment, often termed ‘lumpectomy’ and a mastectomy. In my practice, I have often been asked which would be the safer alternative. The majority of women I see have the concept that mastectomy provides the best protection against recurrence and death from breast cancer. This is understandably an instinctive response. I wish, however, in this article to offer available data in support of breast conservation treatment (BCT) as this is the appropriate mode of therapy for the majority of cases. In medicine, there is a continual effort to make recommendations based on rigorous studies. Some of these may show evidence that contradicts what may appear on the surface to be logical and reasonable. The results of the studies on BCT is one such example. Allow me to delve a little into history of surgery for breast cancer. The radical mastectomy was the mainstay of treatment for breast cancer for the greater part of the twentieth century after it was described by a surgeon named Halsted in 1891.2 This procedure was unchallenged for 70 years. However, surgery did not reduce death from breast cancer significantly. In 1907, Halsted reported the results of his procedure. Only 2 of 44 patients with metastasis were alive 5 years after undergoing radical surgery.3 Contrast this with a report from the Middlesex Hospital in London. From 1805 to1933, women who were diagnosed with breast cancer did not receive any form of treatment, but were cared for in the hospital until their deaths. 18% of these women survived 5 years and 4% 10 years from the time of diagnosis. From this, it may be concluded that no treatment (conservative management) is superior to the Halsted mastectomy. Is it therefore reasonable to recommend such a deforming and debilitating surgery for ALL women with breast cancer? Unfortunately, for want of another effective way to remove the cancer, doctors continued to offer the radical mastectomy for more than 70 years. Thankfully, there were some that recognised this issue and ventured to offer a different operation from the ‘stalwart of breast cancer operations’. These included breast conserving surgery which was introduced in the late 1970’s and early 1980’s. Performing well-designed studies and making recommendations based on the results of these studies allows the present generation of doctors to avoid the mistakes of our predecessors. Two of these studies have demonstrated that 20-year survival of women who have been treated with breast cancer is the same regardless of whether a mastectomy or breast conservation has been performed.4,5 This means that surgical treatment makes little difference to a patient’s longevity. The stage of the disease (size of cancer, spread to lymph nodes or other parts of the body) is more significant in determining a patient’s likelihood of cure. Surgery is not the only component of breast cancer treatment. Other modalities of therapy include radiotherapy, chemotherapy and hormonal therapy. The ultimate objective is to minimise the risk of recurrence and long term remission. One question that is often asked: if breast conservation treatment results in equivalent survival rates as a mastectomy, why do women opt for the latter? There may be a few reasons. Firstly, is that having been the dominant operation for breast cancer for the most part of the last century, there is possibly a reluctance to accept anything less ‘complete’. It is easy to rationalise that complete removal of the breast rids a woman of the problem and it will not bother her again. As explained above, this is not necessarily so. Secondly, breast conserving surgery is challenging. In order to avoid breast deformity after surgery, there are certain preoperative considerations that need to be made and technical manoeuvres applied during the course of surgery.6 Surgeons who are not familiar with these would be less likely to offer breast conservation. Studies have shown that it took time for breast conservation to be widely accepted in North America.7 It is now accepted as the recommended procedure for early breast cancer in Canada.8 A mastectomy is still performed if this is the patient’s preference, or if there are other factors that make breast conservation unsuitable. In summary, breast conserving surgery is appropriate treatment for early breast cancer and provides equivalent survival rates to a mastectomy. For those who would like to research further into this topic, we have enclosed the references: References 1. Schwartz GF et al. Consensus Conference on Breast Conservation, Milan, Italy, April 28-May1, 2005. The Breast Journal 2006;12(4):398-407. 2. Frykberg ER, Bland KI. Evolution of Surgical Principles and Techniques for the Management of Breast Cancer. In: The Breast – Comprehensive Management of Benign and Malignant Disorders. Bland & Copeland (eds). Saunders, Missouri, 2004. 3. Beenken SW et al. History of the Therapy of Breast Cancer. In: The Breast – Comprehensive Management of Benign and Malignant Disorders. Bland & Copeland (eds). Saunders, Missouri, 2004. 4. Veronesi U et al. Twenty-year follow-up of a randomised study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347(16):1227-1232. 5. Fisher B et al. Twenty-year follow-up of a fandomised trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347(16):1233-1241. 6. Anderson BO et al. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol 2005;6:145-57. 7. Lazovich D et al. Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma. Cancer 1999 Aug 15;86(4):628-37. 8. Scarth H et al. Clinical practice guidelines for the careand treatment of breast cancer: Mastectomy or lumpectomy? The choice of operation for clinical stages I & II breast cancer. CMAJ 2002;167(2):154-5. Damn good article - What have we learnt from H1N1? by Bill Durodie Saturday, April 17, 2010 http://www.todayonline.com/Singapore/EDC100413-0000065/What-have-we-learnt-from-H1N1 What have we learnt from H1N1? by Bill Durodie Updated 05:19 PM Apr 13, 2010 Yesterday, health experts in Geneva began examining the controversial response to the first influenza pandemic of the 21st century, nearly a year after global alarm was raised over the new H1N1 strain. The World Health Organisation (WHO) is forming a panel of 29 external experts following accusations that the agency-led international reaction to the H1N1 influenza strain was overblown and may have been tainted by the commercial interests of the pharmaceutical industry. WHO Special Adviser on Pandemic Influenza Keiji Fukuda recently admitted that "we still have a lot of things to learn", including the way the risks posed by H1N1 are communicated to the public. Here, we examine the issues the panel will be weighing in the days to come. Outbreaks of infectious disease have a global impact. So, no matter how well prepared a country may be, it is still dependent on the actions of its neighbours. This provides a good reason for all to be well prepared and ready to cope - making international cooperation a critical factor. It is with this rationale in mind that some one hundred experts and officials from across Asia and beyond, including high-ranking representatives from the United Nations and WHO, met in Singapore recently to discuss measures to improve their systems. Central to their discussions were the responses - both health and non-health - to the worldwide outbreak of H1N1 influenza. Some key questions were debated: What did the pandemic alert last year accomplish? How much did the effort cost? Were health officials right to use the terminology they did? And, how much attention did the public pay to them anyway? Sars not a good model New public health measures emerged in Asia subsequent to the first outbreak of H5N1 avian influenza in Hong Kong in 1997. Then, after the anthrax incidents in the United States soon after the Sept 11, 2001 terrorist attacks there, governments worldwide started to pay more attention to the possibility of - and need to be able to cope with - biological threats. The outbreak of an unexpected virus, Sars, in 2003 then allowed countries to test these new procedures and look towards implementing better ones. But, as attendees at the conference organised by the Centre for Non-Traditional Security Studies of the S Rajaratnam School of International Studies at the Nanyang Technological University learnt, Sars may not have been a particularly useful model. Sars was unique. It had a different pathology to H1N1, as do other forms of influenza. Accordingly, the use of thermal scanners to detect cases at border entry points across the region yielded no detections this time around; it could only be justified by some officials as a supposed means to reassure the public that something was being done. Dr Margaret Chan, who heads the WHO and was previously Director of Health for Hong Kong, had been criticised then for not acting swiftly enough in relation to the outbreak of Sars there. So on raising the WHO's six-point alert-level for pandemics from Level 4 to Level 5 on April 29 last year, she announced: "It really is all of humanity that is under threat", moderating her language only somewhat the following month prior to announcing a full-blown pandemic in June. Accordingly, countries went into response overdrive. China, the country that probably faced the most international criticism in relation to Sars for failing to report suspected cases, did the most. It erected, in the words of one participant at the conference, "a great wall against the virus". Towards the end of May last year, all passengers on inbound flights were subjected to screening by technicians clad head-to-toe in biohazard suits. And if anyone was found with a higher-than-normal temperature, the entire flight was quarantined. Time: the critical dimension None of these measures, including social-distancing through the closure of schools and other public facilities, can be held to have "worked", given that H1N1 outbreaks occurred right across the globe regardless. Intriguingly, some countries with fewer measures of protection in place also noted significantly fewer cases - although this may have more to do with different reporting procedures, as well as the need to maintain various political and reputational agendas. The former Chief Scientific Adviser to the United Kingdom's Ministry of Defence, Professor Sir Roy Anderson, showed a computer model of viruses and the speed of their global spread. It seemed to suggest that, at best, what countries can do is buy time by delaying the full onset of an outbreak, thereby allowing scientists to develop a vaccine. The key was to switch from containment to mitigation, but also to take the time to explain this move carefully to the public, as happened in Singapore. It was the more apocalyptic pronouncements of some officials that could have done with being contained. As one delegate lamented, there is a growing tendency among public health professionals "to reach for the megaphone" and seek to conduct their affairs through the media at such times. In the long run, this could only damage the reputation and institutions of science. It could also demoralise the countless primary-care providers all countries rely on. The low uptake of vaccination for H1N1, particularly among the populations of Western countries that had stockpiled vast quantities of the antiviral drug Tamiflu, was also discussed as a cause for concern. Maybe, it was suggested, this had been the only active way in which people could register their opposition to the way the episode had been managed. Certainly, politicians in France and Germany, as well as elsewhere, are now expressing their concerns as to the huge expenditure poured in this direction. The French, in particular, according to some sources, spent nearly ?2 billion ($3.8 billion) in this exercise - or three times the amount allocated for cancer research in that country over a four-year period. Where do we go from here? How then, should officials manage such incidents, caught, as they are, between the equally unappealing poles of being accused of having done too little too late, or too much too soon, and thereby alarming the public either way? Certainly, all at the conference were in agreement that much more ought to be done in terms of improving laboratory capacity across the region. When a future infectious disease does become manifest, this is what will be the key - along with an adequate supply of trained and equipped doctors and nurses, and an infrastructure to match. Poverty remains the single clearest indicator of future health problems, both for individuals and countries. Accordingly, it might not be too much to hope more from those richer nations that are currently concerned by the lack of preparedness of their neighbours for dealing with such a situation. But what they could do is put more effort into ensuring growth and economic development, rather than try to anticipate the unknown elements of pandemics that have yet to emerge. The writer is Senior Fellow in the S Rajaratnam School of International Studies at the Nanyang Technological University. He coordinates the Health and Human Security programme within the school's Centre for Non-Traditional Security Studies. Mary Frye Sunday, April 4, 2010 Do not stand at my grave and weep, I am not there, I do not sleep. I am in a thousand winds that blow, I am the softly falling snow. I am the gentle showers of rain, I am the fields of ripening grain. I am in the morning hush, I am in the graceful rush Of beautiful birds in circling flight, I am the starshine of the night. I am in the flowers that bloom, I am in a quiet room. I am in the birds that sing, I am in each lovely thing. Do not stand at my grave and cry, I am not there. I do not die. Defy. Saturday, March 20, 2010 Troy was right. Or rather, he just laid it out for us in the strips. I just didn't connect the dots till almost 4 months later. Now, what do I do with this revelation? The man I wanna marry Monday, March 15, 2010 CHUA EN LAI!!!!!!!!!!!!!! La Pause Wednesday, March 10, 2010 Bye for now! The rest Tuesday, March 9, 2010 Sigh... bored. Watching Girls Out Loud again LOL!!! and doing Quizilla hahahha Stolen off someone's FB - not saying who If you are a guy - post this as 'my kind of girl' If you are a girl - post this as 'my kind of boy' Tag as many people as you want. 1. Do you need him/her to be good looking? - Nope. As long as i think he's cute! 2. Smart? - Brains and wit 3. Preferred age? - Hmmm no preference really 4. Preferred height? - Slightly taller than me but not more than 1.8m 5. How about sense of humor? - YES YES. 6. How about piercings? - As long not on private parts 7. Accepts you for who you are? - Please, yes, please 8. Pink hair? - Nah... 9. Mushy? - Not really, I'm the mushy one 10. Thin or fat? - Don't like thin guys and I will make the fat ones slim down 11. Black, Brown or White (skin color)? - I like tanned but these things don't matter, what's inside counts! 12. Long hair or short hair? - I like short hair, spikey hair 13. Plastic or metal? - erm... what? 14. Smells good? - no BO can liao 15. Smoker? - no thanks 16. Drinker? - Social drinker is ok and I don't like drunk people 17. Girl/Boy-next-door type? - Yeah, I like boy next door 18. Muscular? - NOOO I don't like body builders type of guys... a bit is ok 19. Plays piano? - Have sensitive side can liao 20. Plays bass and/or acoustic guitar? - Sure 21. Plays violin? - Sure 22. Sings very good? - Sings for me 23. Vain? - Vain guys? 24. With glasses? - Yeah 25. With braces? - Ok too 26. Shy type? - As long not shy around me, I would think he doesn't like me 27. Rebel or good boy/girl? - Both! 28. Active or passive? - Hmmm don't know 29. Tight or bomb? - HUH 30. Singer or dancer? - singer 31. Stunner? - Ok.... not really 32. Hiphop? - Sorry no thanks 33. Earrings? - Ok 34. Mr/Ms. count-my-ex-girlfriends-until-you-drop? - Long term relationships is fine but not flings type 35. Dimples? - I don't see dimples on guys much 36. Bookworm? - Cute 37. Mr/Ms. love letter? - That'll be me 39. Flirt? - Only allowed to flirt with me haha 40. Poem writer? - I'm not fond of poems but if he writes some, that's nice 41. Serious? - not all the time 43. Painter? - ok lah 44. Religious? - Open-minded religious people is ok 45. Someone who likes to tease people? - as long as knows the limit 46. Computer games geek? Or internet freak? - typical lah 47. Speaks 20 languages? - Not necessary 48. Loyal or faithful? - Both 49. Good kisser? - We can teach each other. 50. Loves children?? - For sure, loves animals too YES SHE LOVES ME, SHE REALLY LOVES ME!! (not my mom) Monday, March 8, 2010 So I didn't end up calling someone to bitch because, well, I decided to spare them. But I ended up texting R and this morning, I saw her reply. Opened my MSN and saw...... Friend no. 2 who is making bad decisions in her life asking me if I would be able to visit her in Spain this Summer. Hello!? Where is my paper invitation?? Secondly, I do no support your marriage, the dude is old, has kids and was a waiter when he picked you up (ever-so-gallantly in shiny white apron?). No, you do not marry someone out of gratitude, we're not the middle ages here. Thirdly, she didn't dare tell her family so I'm not sure if any of them knows yet. Fourthly, I do want to go for her wedding, she's my BFF! And obviously mission is to give the in-laws multiple evil eyes in case they even think about mistreating my lovely. Fifth, he could be marrying her for citizenship!!?? Ok, I need my coffee. Sunday, March 7, 2010 Hmmm maybe I shouldn't blog my troubles, re-reading my old posts was quite upsetting. But if I don't blog about them and take care of them, these problems re-surface. Ah headache. Shall call a friend to bitch. | |