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Concerns of Elderly on Surgery for Breast Cancer

This article has been written by Dr D.K.Vijayakumar MS,M.Ch who is a Professor of Surgical Oncology at Amrita Institute of Medical Sciences
I still remember the day Sreedeviamma came to my OP. She had been brought to me by one of her granddaughters. The first thing she told me was,  Doctor, I am 92; I have lived a full life and am ready to go. I have this breast lump which has been reported as cancerous on scan a few months ago; however I did not want to trouble any of my children and was hoping I would pass away peacefully, but my grandchild insists on bringing me here. I do not want any surgery or radiotherapy. If you can give me some tablets, I’ll be happy. I had a long talk with her that day, and I’ll reproduce some of the salient points here. “This lump is cancerous. It is not going to kill you anytime soon, but it will grow in size and some time later it will break through the skin cause a wound there; there will be some bleeding daily which will need frequent dressings. It can then get infected causing a foul smell. Later as it grows deeper, it will cause pain also. If it spreads to other parts like the bone, it can cause severe pain and even fractures. In the lungs it can cause irritant cough and blood in sputum. The list of symptoms will keep growing and what is worse, the treatment will become more and more difficult the more you wait. It is not something that will cause a sudden death, but drags on for years before it kills. So if you really want to not trouble your children, then not taking treatment is going to cause much more trouble as they will be witness to all these sufferings and will have to spend more time on your care.”

But doctor, a surgery means lot of pain, hospitalisation and expenses!!

This again is a misconcept. Breast is a superficial organ and any surgery on the breast is not at all a major one. The pain is very minimal and can be managed with just a simple tablet of paracetamol. The hospitalisation is needed only for a day or two after surgery. You will be walking and taking normal food on the same day of surgery about 4-6 hours after the surgery.

What about the risk of anaesthesia?

Anaesthesia today is very safe and can be modified to suit any age and any other illness also. For very small lesions, the surgery can even be done under local anaesthesia.

But still doctor, can you not treat it with some tablets?

Tablets do work in some cases. Those people whose cancer are reported estrogen receptor (ER) positive on biopsy can be treated with tablets; but here again I must add that the results are much better if surgery is also done. In your particular case, the biopsy has been reported as ER negative, so the option of tablets is not suitable for you.

Does the whole breast have to be removed?

Not necessarily. This again is dependent on the size and location of the lump. As long as we can remove it with a margin of normal breast all around it is possible to conserve the breast. This also means that more you wait, more the size and less the chances of conserving the breast. However it must be remembered that breast conservation necessarily means radiation has to be given to the remaining breast.

But can I tolerate radiation at my age? Will I lose my hair?

Radiation is just like having an X-Ray taken. There is no pain or any significant side effects. Hair loss is a side effect of chemo, not radiotherapy. The only downside to radiation is that you have to come daily for about 3 weeks. Sreedeviamma went on to have her surgery,a total mastectomy the very next day and today almost 5 years later she is still fit and visits me once a year. Just a reminder that surgery for breast cancer is very safe and effective even in elderly and can give good results. Also the patient can be discharged on the same day after surgery and can recuperate at home. The fear of prolonged hospital stay is a real one and now this can be reduced with effective home based healthcare services as well.

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