Hair loss is a common side effect of most of the chemotherapeutic drugs used in the management of Breast Cancer and this period is quite traumatic for patients. It takes them some time to adjust to their new appearance, but their problem does not stop there.
After chemotherapy, majority of the breast cancer survivors start curly hair and no one exactly knows the reason behind this. This trend is universal and not restricted only to India. There is a lot of information about this on the net but no one exactly knows the scientific explanation behind this phenomenon. After reading a lot of survivor stories, I could infer that the texture of the hair after chemo is certainly different from a patient’s original hair and although some patients experience slight improvement in the quality and texture of their hair over time, for majority, this problem is life long.
For some patients, hair growth after chemo is a morale booster and they welcome this hair growth, without being concerned about the texture and the quality of hair. But for some patients, managing these curls can be quite a problem. It takes them a long time to get used to their new appearance and new hairstyle.
The following websites provide more information about chemo curls and how to manage them
Currently, one in 23 Indian women develop breast cancer, but a recently concluded study states that the numbers are going to double by 2030 –Breast cancer cases to double by 2030: Study – Times Of India.
India is on the brink of a breast cancer epidemic and the question is that is it really prepared to handle this epidemic?
This study highlights some important facts:
- 115,000 new cases of breast cancer are diagnosed each year and this number will double by 2030.
- Indian breast cancer presents a decade earlier than the Western world. This means Indian women in their thirties and forties will bear the brunt of this epidemic. As screening mammograms are not very useful in this age group, it cannot be used as an effective screening modality.
- Increasing longevity and lifestyle changes have been attributed to this sudden rise in the number of breast cancer cases.
There are some more shocking facts about Breast Cancer in India, which have been highlighted by other studies.
- Lack of awareness about this disease compounded by the lack of screening guidelines in the country, leads to majority of the patients presenting with locally advanced breast cancer. A study which I published in the Journal of Royal Society of Medicine, couple of years back, highlights this problem – Patient and provider delays in breast cancer patients attending a tertiary care centre: a prospective study.
- The above mentioned study also highlights the lack of preparedness of the medical system to tackle with this epidemic. There are very few centres in India, which are providing dedicated Breast Cancer Services. These facts should trigger a positive change in the medical system and more emphasis should be paid to develop dedicated breast cancer units across the country.
As it is extremely difficult to develop screening guidelines for breast cancer in our country, I feel increasing awareness about this disease is the first thing which we should focus on, in addition to developing a more comprehensive breast cancer service in our country.
Breast reconstruction following breast cancer is an acceptable modality and it can either be carried out at the same time as the mastectomy or as a delayed procedure. Immediate breast reconstruction is the standard of care these days, as it avoids a future surgery and also avoids the psychological trauma, which a patient faces after removal of the breast. Many studies have proven beyond doubt that it does not interfere with the oncological clearance of the cancer and that patients with breast reconstruction enjoy a better quality of life. Then why is it that Indian patients are not opting for breast reconstruction? The patients are not the only one to be blamed for this. Physician related factors are equally important in this regard.
The first and the foremost reason is lack of awareness. Many patients are unaware of these reconstructive modalities and don’t inquire about these options from the treating surgeon. Another important factor in India is the lack of awareness/ expertise about these reconstructive modalities among surgeons. There are only a handful of centres in India which offer breast reconstruction.
Breast Cancer is now the most common cancer among urban India women and the incidence is going up each year. Majority of our patients still present in an advanced stage and require mastectomies as a part of their treatment. With the improvement in the treatment modalities, many of these patients are cured of their disease and live a relatively normal life afterwards. As majority of these patients present in the advanced stage, they receive chemotherapy before surgery (neo-adjuvant chemotherapy). During this period, tackling with the side effects of chemotherapy shadows all other thoughts in their minds and they only think about surviving the onslaught of chemotherapy. By the time they get over with their chemo, they are mentally and physically so exhausted that they stop thinking about their quality of life after their treatment. This is another reason why they don’t opt for reconstruction at this stage.
Another important point is the lack of guidance/ counselling. We are fortunate to have a dedicated Breast Counsellor in our unit, who happens to be a breast cancer survivor as well. We have seen a more positive attitude towards the diagnosis and management in patients who have been counselled properly.
If more awareness is created among the patients and surgeons, more patients can benefit from these reconstructions and have a better quality of life.
Various Reconstructive Options after Mastectomy are:
- Microvascular free flap reconstruction: These flaps are the standard of care these days. It can either be a DIEP (deep inferior epgastric artery perforator) flap, in which fat is taken from the abdomen to reconstruct the breast or an ALT (antero-lateral thigh) flap, in which muscle and skin is taken from the thigh.
- Pedicle flaps: Latissmus dorsii flap – tissue take from the back or TRAM (transverse rectus abdominus myo-cutaenous flap) – tissue taken from the abdomen
- Implant based reconstructions using silicone implants.
I come across patients everyday complaining of terrible nausea & vomiting after chemotherapy and I try to console them by saying that it will get better with time. Sometimes, I feel that unless you have experienced something yourself, you cannot explain the feeling to some other person.
I have been fortunate enough not to encounter chemo myself, but my understanding of post chemotherapy nausea and the helplessness which one feels in that situation came during our recent whale watching trip in South Africa. Me, my wife and her sister were in a small boat along with 5 other people searching for whales off the coast of Knysna, South Africa. The three of us suffer from motion sickness but we never anticipated that this boat ride will give us a tough time. The initial 30-40 minutes of the boat ride were quite comfortable, as the water was calm. The problem started when the boat started getting rocked by huge waves in the middle of the ocean. My wife was the first one to get started, followed by her sister. I was sitting in the middle, passing the bucket around from one person to the other. They must have vomited at least 5-6 times during our two hours whale watching trip and there was very little we could do to help them out. In fact, towards the end of the boat ride, I also experienced a terrible pang of nausea, followed by a bout of vomiting. It is at that time I realised what cancer patients must be feeling every time they undergo chemotherapy. It is such a terrible feeling and no amount of medicines or consoling helps at that time.
The only saving grace for us was that we had an excellent whale sighting during our trip and every time someone on the boat vomited (5 out of the 8 members on the boat vomited), the whale used to come out to check on us 🙂 🙂 (attaching some pictures)
Concerned whale checking us out 🙂