28/09/2013

BIGOSA Conference

Last week we had our second BIGOSA conference in Johannesburg.  It was attended by about 45 breast specialists: the majority were from South Africa.  Our guest was Prof David Cameron from Edinburgh.  He gave 2 talks.  The first was on the controversial issue of breast cancer screening in the UK.   He was one of the contributors to the Marmot report and discussed the pros and cons of a mass screening programme.  The report is summarised in the Lancet.

I will highlight a couple of facts that illustrate the dilemma of whether mass screening is the way to go:
If 10 000 women, in the UK, between the age of 50-70 are screened for 20 years 43 cancer deaths will be prevented but 129 women will get treated for a cancer that would not have killed them: they would have died of something else first. Simply put, one cancer death will be prevented for every 3 women who are treated for a screen detected breast cancer.

His second talk looked at the cost of new cancer drugs.  He posed the question "Can we afford to use new (expensive) drugs to treat breast cancer?  Can we afford not to use them?"  His talk highlighted the cost to society of a women with breast cancer.  It is a cost that government forgets when they are deciding on health policy.

Both are difficult debates.

The conference is a mixture of invited speakers and specialists talking about their research.  There is a prize for the best paper and that was won by Dr Murugan from Chris Hani Baragwanath Hospital.  Her paper was entitled: "Can breast cancer in our public sector be downstaged in the pre screening era.  Experiences from CHB hospital"  Congratulations to the breast team at CHBH for their excellent presentations.







24/09/2013

THE NURSES COURSE: BARAGWANATH

10 days ago, we started our second breast course for nurses.  We went to Baragwanath Hospital in Soweto.  It was a fun day!  Dr Herbert Cubash is the head of breast surgery there and he made us feel very welcome.  He is ably assisted by Nelly and Maureen.  We were privileged to have 48 nurses and health care workers from 8 different hospitals and 2 NGOs (CANSA and Pink Drive).  Time was given to networking.
Although 4 of us went up as faculty, we all felt as though we learnt a tremendous amount. We heard from health providers about the different facilities they have.  It reinforced my belief that we need to share our experiences more if we are to improve breast care in this country.
Doing the course away from Cape Town made me very aware of the importance of sponsors.  We want this project to be sustainable and for that to happen, we need to be realistic about the costs incurred.  Care CrossAbbVieNetcare and Bluespier have been incredibly generous.  I have also been humbled by the kindness of individuals who have donated money.
The next course will be starting in Durban in January.  If you want any information about the breast courses, please contact me.  The web site will be up and running shortly.


14/09/2013

Can words heal?


Last weekend, Cape Town was treated to the Open Book Festival.  What a remarkable occasion.  The event has many sponsors but is largely organized by the Book Lounge.  I went to several sessions and, amongst others,  thoroughly enjoyed the engaging presentations of Ian Rankin, Marianne Tham, Damien Brown, Helen Zille, Mamphela Ramphele and her son.

The first event, chaired by Dawn Garrisch, had the title "Poetica: pen as a sword: can poetry be used to bring about social change".  On the panel was Malika Ndlovu, Adrian van Wyk and Clinton Osbourne.  Between them, they have been involved in many projects.

Malika's personal mantra is "healing through creativity".  She is a performanace poet and gave extraordinary renditions of some of her work. We are all Spirits having a bodily experience, not bodies having a spiritual one, she said. Adrian van Wyk is involved in the Stellenbosch University literary project.  I wished I had taken my boys to listen to his rap poetry.  Clinton Osbourne is involved with a project encouraging prisoners to express themselves through creative writing, and in the creative writing find some inner release.

Dawn Garrisch is a GP and based  in Cape Town.  She has published novels, books about the body and poetry.  She believes the power of writing can be used to restore/maintain mental health.

Many women are using creativity to come to terms with their diagnosis of breast cancer.  Some have painted (and given me lovely pictures), some have written blogs/diaries. Bev Rycroft, wrote a book of poems called "Missing" about her journey through the diagnosis and treatment of breast cancer.
Having had breast cancer, did you write creatively about your experience?  Did it help you with the healing process?  Please share your stories and poems with us, your metaphor as medicine.

07/09/2013

Personalised medicine for breast cancer treatment. A Reality?

Personalised medicine:a reality?


Once a year, I give a talk for the local branch of Reach for Recovery. It was my pleasure to be there last Thursday. Many of you will know that Cape Town hosted a very successful international Reach to Recovery Conference last year. I decided to give a talk based on the one I gave there. The title was 'New developments in the management of breast cancer'.  The essence of my talk was that we will go away from Evidence Based Medicine and start practising Personalised Medicine.

What does that mean?

Evidence based medicine is defined as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." The decisions we make are based on population studies. By this we mean research done on a number of people with a similar disease/disease state. For example, if we want to know if a medication works for breast cancer, we will give 1000 women with a particular disease profile the drug being tested and then give either standard therapy/no therapy to a matched group of women and see which is best. It is the principle behind all medical trials.

In reality, we tend to over treat a number of women with early breast cancer in the hope of not under treating the few that would benefit from extra treatment. (Conversely, we under treat a number of women as well.)

There has been a massive increase in the field of genetics. We can look at the individuals' genetic make up as well as the the genetics of the breast cancer.  (There is no doubt that more research will come out in this area.)  As a result, the cancer's behaviour will be more accurately predicted and so we should be able to individualise our recommendations for treatment.

What do you think? Do you believe we will be able to be so certain of a cancer's behaviour that we will be able to omit surgery/radiation/chemotherapy and guarantee that it is safe? Let me know.

01/09/2013

Every Wednesday morning the southern suburbs oncology group meet at Vincent Pallotti Hospital in Cape Town.  There are between 10-15 of us (surgeons, radiologists, pathologists, oncologists and radiotherapists). We discuss all the new breast cancer patients we have seen during the week and patients who are known to have breast cancer but need a new treatment plan.  It is a business meeting rather than an academic meeting.  However, the discussion often covers debatable issues and when we need to discuss them in more detail, we have a separate evening meeting to discuss specific topics.

10 days ago, we met at the Wild Fig Restaurant and discussed what staging investigations a woman should have when she has been diagnosed with breast cancer. (The stage of the disease is how far the cancer has spread).  Most women with early breast cancer are sent for a chest XRay (CXR) and liver ultrasound but is that more than we should be doing?  Are we just exposing women to unnecessary radiation or should everyone go for a CTScan of the chest, abdomen and pelvis? If the CTScan is normal, should they then have a bone scan?

We reviewed the current literature and the consensus was that women with very early breast cancer probably shouldn't have any staging investigations.  If the cancer has spread to the lymph nodes in the armpit then at least a CXR and liver US should be done.

Let me know what happens in your centre.  Did you find that having a CXR and liver sonar made you feel better?  Please share your thoughts.