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Reports
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World Conference on Breast Cancer The first plenary session on "A Look at Breast Cancer in the 21st Century" included talks from the developed nations by Dr. Annie Sasco, WHO, France as well as a developing country, Dr. Papa Toure of Marie Curie Institute, Senegal. A comparison of conditions in developed and developing nations was to be the thread which ran throughout the conference. The second plenary session was on personal and political lifelong impact of the disease and touched upon fears all breast cancer patients harbour regarding recurrence. Helen Lynn, Health Coordinator, The Women's Environmental Network, UK presented the Global Action Plan (GAP) Report which explored the links between chemicals and breast cancer. In the UK, "hot spots" where there is a high incidence of a particular type of cancer have been mapped to try to identify possible environmental or industrial causes for such prevalence. The emphasis is on preventing breast cancer by assessing hidden hazards in, for example, cosmetics, waste management, crop cultivation. "Toxic tours" are held in homes, workplaces or local environment to gather evidence of a risk factor. The third plenary session dwelled on "Primary Prevention" covering identified risk factors, environmental impact and the effect of estrogen. The effects of genetic factors such as the BRCA gene mutations were discussed, but it was felt that they accounted for only 5-10% of the cases, while 90-95% of the cases were non-genetic and spontaneous. Health seems to depend on a combination of genes, cultural and spiritual environment. Hence it has been observed that cancer risk of adopted children is similar to that of adopted parents and migrants risk mimics that of the country of residence rather than the country of birth. Some possible risk factors were discussed such as genetically modified foods, environment, hormone replacement therapy, dietary fat, obesity, plastics, cell phones, power lines, stress, cytokines, fast foods, colours, preservatives and additives. Similarly, exposure to DDT, phthalates, nail polish and additives in cosmetics such as hormones and placenta, job related exposure to chemicals are suspect. While none of these factors have been proved to be a direct cause of breast cancer, speakers felt that there were benefits of protective foods such as broccoli, soy, fish and olive oil, fibres, chromium, selenium, Vitamins A, C and E, wine in moderation and regular exercise. The estrogen factor was discussed again and again during the conference. It was observed that compared to earlier times there is a much higher exposure to estrogen during a woman's lifetime. Estrogen has been recognised to be a weak carcinogen and is involved in uterine implantation, differentiation and proliferation signaling. Breast tissue has estrogen receptors and environmental estrogens are soluble in breast adipose tissue. A large scale study has been started wherein girls in the age group 9-14 will be asked to give their saliva for testing of estrogen at different times. These girls will then be tracked throughout their lives to study the effect of estrogen. The fourth plenary session was on the direction of future research. New treatment options being studied include monoclonal antibodies, antiangiogenesis products, matrix metalloproteinase inhibitors (MMPs), gene therapy, growth factor inhibitors and DNA profiling. The efficacy of mammography was the subject of a talk by Sharyl Nass, who also provided a CD, video and a book on the subject to all participants. While routine mammography has been shown to be effective in reducuing mortality, it still misses about 15% of tumours, cannot be used in younger women with dense breasts, it misses interval cancers, those that start between testing and there is a chance of overdiagnosis where detected lesions may not have become malignant. Other technologies are now being explored using the electrical, mechanical, physical and biological properties of breast tissue. Thus ultrasound, MRI, Scintomammography techniques are already being used. Film screen, full field digital, computer assisted mammography is under investigation. Since as many as 6 concurrent sessions were held simultaneously, it was necessary to choose the topics of most relevance. Some interesting medical talks were presented. A series on Sentinel Node therapy was especially illuminating. Lymph node dissection is done in almost all cases of breast cancer along with the lumpectomy or mastectomy, as a means of diagnosis, determination of further treatment and prediction of long-term prognosis. If nodes are found to have micrometastais, a more stringent treatment including chemotherapy is indicated. The larger the number of nodes involved, the worse the prognosis. If the tumour was small, as is the case in the majority of breast cancer cases in the west, removing lymph nodes, which usually turned out to be negative, had no benefit. Nerve damage can cause delayed return to normal function. Also, many patients experience problems of lymphedema due to impaired circulation or infections later. A study to explore a gentler technique was started in the early 90s by Dr. Juliano in California. The sentinel node (SN) is the primary lymphatic drainage point for the breast. It was felt that if it could be identified, removed, analysed by frozen section and was found to be negative for presence of metastasis, further nodes did not have to be removed. The study was conducted over 8 years from 1994-2002 to determine technical feasibility, accuracy and sensitivity and utility in improved staging. Between 1994 and 1996, SN dissection was followed by axillary lymph node dissection (ALND). Between 1997 and 2002, ALND was performed only if SN dissection was positive in frozen section for micrometastasis or if the SN could not be located. The technique consists of the injection of 5cc of a 1% solution of isosulphan blue dye peritumourally or into the wall of a previous biopsy. After massaging for 5-10 minutes depending on site of the tumour (more if it is in an inner quadrant), it is possible to identify the SN. 66 cases of women between 34 and 87 years were studied. Of these, 10 had T0 or tumour in situ, 32 had T1 (5 T1a, 4T1b and 23 T1c), 22 had T2 (tumour size greater than 2cm) and one each had T3 and T4 (tumour size greater than 5cm). Of these women, 47 had negative SN in Frozen Section analysis that was found to be true negative in 46 cases and only one was found to be positive in subsequent ALND. 15 patients had positive SN were all found to have micro or macrometastases. Typically a lumpectomy with SN requires local anesthesia and only 6 hours stay in the hospital. If the tumour is in the upper hemisphere, a single incision is required. In follow up, no paresthesia and no lymphedema was found. A similar study was reported from Egypt. In the first 120 patients studied, the procedure was followed by ALND to check for false negative rate and negative predictive value. In 52 patients, where the frozen section showed a negative result, no further nodes were removed. In 33 cases where the frozen section was positive for micrometastasis or where the SN could not be identified, ALND was completed. In the first 60 patients, the SN could be identified in only 60% cases, in the next 60 patients the number had gone up to 75% and in the last 52, 90% could be identified. Finding the SN is harder in older and obese patients, so 90% identification was considered the limit. Experience is extremely important in the detection. Out of 128 patients where sentinel node was identified, 51 were positive (+ves) and 77 negative (-ves) for micrometastasis. Out of the 51 +ves, remaining nodes were negative in 32 cases and positive in 19 cases. Out of the 77 -ves, the remaining nodes were negative in 72 cases who would have benefited from the SN technique and 5 were positive. There were therefore 6% false negative cases. There were no false positive cases in T0-T1 tumours, ie tumours less than 2cm in size. In subsequent follow up over 4 years, there were no cases of recurrence in patients with negative frozen section of SN. Thus the utility of Sentinel Node biopsy has been proved. A number of concurrent papers covered novel ways of meeting information needs of women regarding breast cancer. Some of these include websites, online support groups, telephonic helplines and the "Wildflower kit" a package given to newly diagnosed women in the eastern provinces of Canada. All the participants agreed that the conference was a great success. A remarkable feature was that, of the 800 participants, a large proportion were long time survivors. They could be recognised by their non-symmetric figures, elastic bandages on the arm, bald heads. Many confessed that every follow up at the doctor still evoked terror. But all of them showed grit and determination and the joy of being alive in the face of heavy odds. Their presence in such large numbers is a source of encouragement to everyone who is working in the field of cancer today.
CPAA's Alka Kapadia conducted numerous Awareness Lectures on the dangers of Tobacco addiction for the benefit of slum dwellers in Mahim; children of construction workers at Sunbeam, Phoenix Mills Compound; students of Swami Vivekanand International High School at Borivli, Christ Church School and at BJP College. A total of 1008 persons were covered. Mrunal Marathe conducted an Awareness Lecture for the Maharashtra Labour Welfare Centre on common cancers of women. 45 women attended the lecture. Prevention and Early Detection 29 camps and OPDs were held during the month of July. 2 camps each were held for David Sassoon (ENT only); Urivi Vikram Charitable Trust; Station Health Organisation, Mankhurd; MTNL, Prabhadevi; Upendra Niwas, Malad; St. Paul's Church, Dadar; M.D. Shah College and for the Giants Group, Byculla. A total of 678 people, 319 males and 359 females were screened in the camps. 242 people were advised follow up. 13 OPDs and clinics were held. 94 males and 147 females were screened. 71 people were advised follow up.
Smt. Lila Kishanchand Shahani Clinical Diagnostic Centre The Smt. Lila Kishanchand Shahani Clinical Diagnostic Centre screened 380 persons during July. 1068 tests were performed, out of which 898 were pathology tests. 99 sonography, 51 x-ray and 13 mammography investigations were carried out including 8 under the Voltas sponsored Well Woman Clinic Scheme. During July, 121 people were examined, of whom 27 had come for the first check-up and 94 for renewal check up. Rs 1.73 lakhs was disbursed towards the claims settled. During the month, two of our policyholders were diagnosed with breast cancer. A 39-year-old lady is undergoing treatment at Prince Aly Khan Hospital and a 66-year-old lady is undergoing treatment at Bombay Hospital. A 71-year-old lady who had enrolled in 1994 was diagnosed with cancer of the ovaries in 1997. She underwent prolonged treatment at Apollo Hospital, Hyderabad but relapsed and passed away on July 21st. Claims worth Rs. 5.92 lakhs were settled over the years. Her husband came to meet Ms. Anita Peter and remarked, "This is the last time I will be meeting you. I can never forget the help I received from CPAA. You were always there when I needed you." Anita told him that the bond between CPAA and a policyholder could never be broken and promised to call and keep in touch. All of us at CPAA pray that the bereaved family finds the strength to cope with the loss of a loved one.
At Smt. Panadevi Dalmia Cancer Management Centre 667 patients were aided, counseled and given guidance at our locations in Mumbai-Srimati Panadevi Dalmia Cancer Management Centre; at Nair Hospital Radiation Centre; Cama & Albless, Wadia and Tata Memorial Hospitals in July. 783 patients availed of ambulance facilities, including 23 patients who availed of the stretcher service for long distance travel. 100 persons were given clothes, 70 packets of biscuits and 50 boxes of Complan and Feredol were distributed CPAA would like to thank Madhu Abhay Shah for her generous donation of biscuits. 13 home and institutional visits were made. 2 of our patients expired during the month.
At Tata Memorial Hospital: Room No. 189, Golden Jubilee Block 288 patients were aided, guided and counseled by CPAA's Halima Aurangabadkar at Tata Memorial Hospital's Golden Jubilee Block Room No. 189 during July. 300 packets of biscuits were distributed. 66 patients were given clothes, 6 kgs of sweets were distributed. 8 referred cases were helped. 32 ward visits and 12 home visits were made. 12 patients were given medicines and toys were distributed to 20 children. 210 patients were given Complan and Horlicks. 757 patients utilized the ambulance facility, 701 who used the shuttle service between TMH and Dadar station and 56 for long distances. CPAA's Zakia Topiwala arranged for 4 cartons of Complan and one carton of Glucon D for distribution among patients. 60 umbrellas were also donated. Shubhra, an 18-year-old ALL patient was on our Adopt-a-Cancer Patient Scheme. She loved music, so CPAA arranged for a harmonium for her and she got a great deal of joy from playing the instrument. Everyone who came in contact with her grew to love this gentle girl and were glad that she seemed to be doing well on her treatment, so we were all shocked and saddened to hear of her sudden death. Halima conveyed the condolences of the entire CPAA team to her grief stricken mother. "Can I Help You?" CPAA’s Desk at Tata Memorial Hospital’s Private OPD Jennifer Quadros helped 1294 patients during July, providing literature on various kinds of cancers to 359 patients, helping 271 in filling up registration and other forms and answering questions about the hospital for 504 persons. 19 ward visits were made. 141 patients were counseled. Palliative Care Unit at Tata Memorial Hospital CPAA's Mrunal Marathe counseled 36 patients, 20 males and 16 females during the month of July. There were 14 cases each of head and neck, 5 cases of abdominal cancer; 6 cases of cervical cancer, 1 case of breast cancer and 8 other cases of cancer. A 10-year-old boy with a large tumour on his neck attended the clinic this month. His anger was evident from his body language and he refused to talk, so Mrunal gave him a piece of paper and a pen to allow him to express his feelings. The boy scribbled so hard on the paper that the sheet was torn from the book. He broke down and said he was tired of his treatment. He missed his sisters, his mother and her cooking. He wanted to go home and play with his friends and sisters. When Mrunal told him that he was indeed going home, he was full of joy, but asked, "How can we afford it? We don't have any money left after what we have spent on my treatment." Mrunal realized that the disease had taken away the boy's health, wealth and even his childhood. Counseling at Tata Memorial Hospital From July, CPAA volunteers counsel patients at Tata Memorial Hospital, covering the Radiation Departments in the Main Building and the Annexe; the Breast Cancer surgical wards (General, Semi-Private and Private) and the General OPD for Chemotherapy under the guidance of Dr. Reena Nair. Gouri Salvi, Katy Shapoorji, Susmita Mitra, Indu Nair and Rati Datta attend every morning from Monday to Friday, counseling patients regarding treatment, side effects, nutrition and precautions to be taken and answering any questions the patients may ask. Patients are counseled in English, Hindi, Marathi, Bengali and Gujarati. At Bai Jerbai Wadia Hospital for Children 17 new patients were registered during the month of July. 303 patients attended follow up of whom 77 patients are undergoing chemotherapy. 30 patients were counseled and given guidance and Vinaya Chacko visited 3 patients in their wards. 5 group meetings were held. 30 patients were given packets of Complan, 30 persons were given biscuits, 10 sets of clothes were distributed and 10 patients were given cooking oil. A new playgroup has been started for the children every Tuesday wherein children are encouraged to colour and story-telling sessions are held. This gives the children a chance to express their fears. Neel Sangal, an 8-year-old living in the US, donated two cartons of toys to help create a toy library at Wadia Hospital. The children look forward to playing with the toys. This eases the boredom while waiting for their treatment. Counseling at Cama & Albless Hospital Cancer Ward 25 patients were counseled and given guidance by Iva Athavia during July. 33 ward visits were made. 10 patients were given guidance regarding alternative therapy and 20 patients for hygiene. 12 patients were provided ambulance service. 4 terminally ill patients were referred to Shanti Avedana Ashram. Rs. 8,534 was donated towards medicines and radiation costs. 2 packets of chocolates were distributed among the patients. Nair Hospital (Radiation Department) 55 patients were counseled and given guidance at the Counseling Cell at Nair Hospital Radiation Department by Iva Athavia during July. 5 ward visits were made. 30 patients were given information about hygiene issues and 20 patients were given information about alternative forms of medicines. Rs. 18,113 was donated towards radiation treatment and medicines. 50 packets of biscuits and sweets, 22 packets of Complan and 3 packets of chocolates were distributed. 13 sets of clothes were distributed. The Rehabilitation Centre assisted 72 patients during the month of July. 11 cases of mastectomy were attended and breast prostheses were provided. 233 patients were given rations worth Rs. 31,155. Rs. 15,400 was spent on teachers' salaries, for patient education and vocational training. Rs. 98,985 was spent on patients' wages and Rs. 21,568 was spent on welfare activities, conveyance and diet supplements during the month. Cancer
Patients Aid Association Monthly Review is compiled by Dr. Shubha Maudgal
and printed by Mr. Suresh Mishra at Saraswati Printing Press Please
write in with your comments to: Smt. Panadevi Dalmia Cancer Management
Centre, Anand Niketan, King George V Memorial, |
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Shubha
Maudgal, Director, New Projects attended the World Conference on Breast
Cancer in Victoria, Canada from June 4-8. The first part of the report
on the conference proceedings appeared last month. Here is the second
part.
Khazana,
a festival of ghazals was held at Oberoi Towers, Mumbai on 27th and 28th
July. The programme, in aid of Cancer Patients Aid Association and Parents
Association Thallasemic Unit Trust was presented by Oberoi Towers; supported
by State Bank of India, Britannia, Bhavna Shah, District Governor Lions
District 323-A1, Prudential ICICI Mutual Funds, Gili Jewels and Stagecraft
Entertainment; coordinated by Just Cause. The Associate Sponsor was The
Famous Grouse. The broadcasting partner is Zee TV. An appreciative audience
was delighted with the performances of their favourite singers over the
course of the two days. 
A
wide spectrum of artistes sang ghazals for the cause of cancer patients
and thalasemic children. Nina and Rajinder Mehta, Mitalee and Bhupinder
Singh, Pankaj Udhas, Ahmed and Mohammed Hussain, Talat Aziz, Penaz Masani,
Anup Jalota are seen with Nana Chudasama and Y.K. Sapru, Founder Chairman
of CPAA. 
Mrs.
Poonam Sinha made her maiden speech after her husband Shatrughan Sinha
became Union Health Minister at the gathering. Here she is seen being
given a memento made at CPAA's Rehabilitation Centre by Rekha Sapru, Joint
Secretary, CPAA.