Close to the breast: Discussing breast cancer with Prof Dr Anisur Rahman

October is marked as Breast Cancer Awareness Month globally every year. Then what better time than now to talk to an expert in this field? We spoke to Prof Dr Anisur Rahman of United Hospital, to answer many questions which many of us would not ask otherwise. The respected doctor has more than three decades of experience in General and Laparoscopic surgery, and is a pioneer in breast cancer surgeries and treatment.  

The first issue that Dr Anis clarifies is that contrary to general notions, breast diseases and especially breast cancer is not a gynaecological problem, and rather fall under the General Surgeon's expertise. Also, as most women feel more comfortable seeking female/gynae doctors for anything related to discomfort in the breast, many things go undetected for longer because the issue takes time to reach the right kind of specialist. For this, he adds, people should consider consulting a doctor depending on their specialty, not just gender, as all doctors are supposed to treat their patients in the same respectful manner.

Moreover, he says that as a society, we need to break the taboo of talking about breast diseases. Women do not feel comfortable in talking about these, and men like the husbands, brothers and such are not comfortable listening either. And this issue is not related to any particular class or with lower education either.

"You will be surprised to know that I have had cases of university teachers with husbands equally educated, who came to me too late for this issue alone." This prevents timely detection and the success rate of treatments as well, he added, as early detection and intervention are key to successfully eliminating breast cancer.

To fix this problem, the surgeon suggests a two-prong approach, for a wholesome solution. First is to extensively train more female surgeons in breast cancer and surgery. The second is to teach people not to shy away from reaching a male surgeon for breast cancer, as a doctor is a doctor, regardless of their gender.

Another very important aspect is to create wider awareness on the methods and importance of checking for breast cancer. He suggests that women with family history of cancer be more vigilant, and everyone past the age of 30 should set a specific date to do self-examinations every month, for example the first or last Friday, to ensure regularity, and learn the process properly.

"We do not expect patients to detect cancer on their own, but regular check-ups will ensure that they can detect any abnormality/change at its earliest, for which they can then see a doctor," Dr Anis explained.

With early detection, complete recovery and cure is often achievable, he added. Another important factor to note is that the suspicious breast cancer lumps are rarely painful, for which many women ignore them. In this, women must remember that painful or not, any physical lumps or changes in the breast tissue or skin should immediately be checked by a surgeon, and even more so if it is not painful. It might become painful as it advances, however.

Further, he allayed some fears which are common in patients upon receiving a diagnosis of breast cancer. Any cancer diagnosis is feared like a death sentence, as the disease is truly scary. But Dr Anis explained that with better technology and skilful doctors, breast cancer is now very much a treatable disease.

The new technological developments allow surgeons to choose minimalist surgeries, combined with chemotherapy, radiotherapy or hormone therapy, depending on the size of the cancer, its type and even location in the breast. The surgeries can take the form of a lumpectomy, which only cuts out the cancer cells, and in most cases, can be treated without the dreaded mastectomy i.e. removal of the entire breast, which scares many women from even seeking treatment.

The decisions on how to proceed with the treatment wholly depends on the biopsy results of the cancerous cells. We try to design the treatment to ensure complete recovery of the patient in the best possible way, the surgeon added.

"For any surgery, I perform a "frozen section biopsy" of the excised tissue, which basically tells us whether all of the cancerous cells have been properly removed from the area. This can be done during the surgery and the results arrive in about fifteen minutes, and depending on the results we decide on the extent of surgery. In fact, I don't do any lumpectomy without a frozen section to ensure the removal of the entire cancerous mass. I must know that I got it all out. I would not recommend any lumpectomy in any hospital that does not have the option for frozen section."

Also, breast cancer is a very age-related disease, as young women rarely get it, though the risk also depends on family history of cancer. But for older women, any lumps in the breast are a bigger concern, and should always be seen by a specialist.

Another little-known fact is that breast cancer can also affect men. The fact that men do not expect to get breast cancer often delays detection, and although it is extremely rare, it is usually very advanced when detected.

So, apart from being aware and work towards early detection, what can we do for patients who receive a breast cancer diagnosis? Being supportive through being present with the patient, is paramount, the doctor said. "It is not that you hold the person and cry with them. Rather, just to be there to listen and help them come to terms with the situation through the psychological stages of disbelief, distress, frustration and acceptance, can be a great help. Being present with the patient to support them emotionally helps to boost a patient's capacity to fight the disease and the trauma to the body caused by surgery as well," Dr Anis added.

As no single phenomenon has been identified as a cause of breast cancer, Dr Anis warned time and again for women to learn and perform self-checks regularly, and to seek medical attention promptly whenever they detect any change in the breast area, which includes not just the breasts but also the surrounding regions in the armpit and chest. Remember, early detection can save lives!

Know your expert

Professor Doctor Anisur Rahman is a Senior Consultant Surgeon in United Hospital in Dhaka, and is a vastly experienced and learned Advanced Laparoscopic GI and Onco Surgeon.

 He completed his MBBS degree from Dhaka Medical College and obtained his MSc in Clinical Gastroenterology on a full scholarship from Memorial University of Newfoundland, Canada. Later, he obtained FCPS in Surgery, a fellowship from Bangladesh College of Physicians & Surgeons and FRCS, a fellowship from Royal College of Surgeons of United Kingdom. He also is trained in Laparoscopic surgery at Addenbrooke's Hospital, Cambridge, UK and Gartnavel Hospital, Glasgow, UK.

 Dr Rahman is renowned in the country for his expertise in managing all kinds of breast pathology including breast abscess, fibroadenoma, gynecomastia (male breast enlargement) and breast cancer; he has performed thousands of breast surgeries including breast conserving surgery (Lumpectomy) and surgical removal of all part of a breast (Mastectomy).

 On a personal note, he says he always makes sure to remain reachable to his patients, and to that end, is never too far from his phone. A great motivator to excel in his work is the palpable relief he witnesses after relaying news about a successful surgery to the patient and their dear ones. He loves technology and playing around with computers & gadgets and putting them together. Listening to old Hindi classics is a favourite leisure activity, though Dr Anis says his wife, who sings very well, is his favourite singer.