In honour of breast cancer awareness month, SACHA STAPLES speaks to general surgeon and head of the Breast Clinic at Mater Dei Hospital, DR GORDON CARUANA DINGLI.

Dr Gordon Caruana Dingli has been a doctor for thirty years and has specialised in working with breast cancer patients. Since 2008, he has headed the Mater Dei Hospital Breast Clinic, a facility that takes a multidisciplinary approach to breast cancer prevention, detection and treatment.

October is internationally recognised as Breast Cancer Awareness Month - a time when special effort is made to increase awareness about the disease. Because of this, it is an important month for breast cancer patients, survivors and specialists, and FIRST is proud to acknowledge the campaign by sharing the knowledge and advice of Dr Gordon (as well as the experience of a survivor, on the following pages), in an effort to help our female readers educate themselves about the facts.

According to Gordon, "breast awareness" is the most important aspect of treating and fighting breast cancer. "Every woman should be aware of breast disease and should examine her breasts once a month," says Gordon. The best time for self-examination, he explains, is during the week after one's period or once a month after menopause. In addition, breast screening, in the form of regular mammograms, allows for early detection, an essential factor in prevention success rates. Gordon says that if the cancer is detected early, it is not only easier to cure, but the treatment is less aggressive and the outcome is better.

It is also important for women to understand the risk factors of breast cancer. Although breast cancer can affect men, the vast majority of patients are women. Besides gender, other risk factors include age as well as family history. Women of a certain age and those with a history of breast cancer in their family should be more vigilant about having regular screenings. In recent years, the importance of smoking, excess alcohol and especially obesity as risk factors for breast cancer are becoming increasingly recognised. Recent studies have shown that Maltese women are among the most obese in the Western World with 58% being overweight or obese.

Along with Dr David Pisani and Dr Etienne Mark Paris, Dr Gordon has recently published local data showing that hormone-dependent breast cancer is more common in obese women. In another international publication, the trio argued that the main cause of breast cancer is the production of Oestrogen by fat tissue. A UK study showed that breast cancer is more common in those who report an increase in skirt size since when they were young, with skirt size being used as a measure of central obesity. With findings such as these, an overweight individual can greatly minimise her risk of breast cancer by addressing weight issues, suggests Gordon. 

In stressing the importance of early prevention, it is pertinent to mention Angelina Jolie's article, "My Medical Choice", which was published in the New York Times last year. In the piece, she described her decision to undergo preemptive double mastectomy surgery after learning that she had nearly an 87 per cent change of developing breast cancer. Her mother died of breast cancer at the age of 56 and Ms Jolie knew that as a mother it was important for her to make this choice for her family. "I choose not to keep my story private," she writes, "because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options".

Since Ms Jolie's article, Gordon has noticed an increase in patients asking for risk reduction surgery. In Malta, women with relatives who had breast cancer at a young age can have their DNA analysed. Some women, such as Ms Jolie, have "a genetic mutation (an error in their DNA) that makes them highly susceptible to have breast cancer," explains Gordon, "and these women are offered mastectomy to decrease their risk of getting breast cancer. The breasts are reconstructed during the same operation, usually with silicone implants." Gordon notes that surgery such as this is intended for patients with gene mutation and is therefore not suitable for a woman with a normal risk of breast cancer.

With regard to statistics, Gordon suggests that in last twenty years, the incidence of breast cancer in Malta has increased from approximately 180 cases per year to about 350 cases every year; about one diagnosis every day. That being said, although the frequency of breast cancer diagnoses are increasing, more patients are surviving, because patients are presenting earlier but, more importantly, he explains, it is because the available treatment is more effective.

Based on Gordon's research and experience, the first and most important step is diagnosing the disease. Patients of the MDH Breast Clinic are discussed at a multidisciplinary meeting that combines the expertise of surgeons, radiologists, pathologists and oncologists. "Most women with breast cancer are operated on first, and this is what I do," explains Gordon. He continues that, "since the cure rates are so high, many women are living long lives and it is important to decrease their psychological burden by improving the aesthetic outcome of surgery."

Gordon emphasises the importance of minimising the negative emotional and psychological effects of surgery with the use of oncoplastic techniques that combine cancer surgery with plastic surgery, which may even involve surgery on the contralateral breast to symmetrise the size and shape of the breasts. Gordon emphasises the importance of taking time to explain to his patients, in detail, both the disease and the treatment options. This preliminary conversation often helps patients and their family to cope with the disease. Gordon is quick to note that the support of breast care nurses, psychologists and physiotherapists are also crucial for patients, before and after surgery.

 I ask Gordon if there is one message or piece of advice that he would like to impart to the reader; his response is this: "I appeal to all readers to consult their doctor if they notice any abnormality in their breasts. I appeal to the authorities to develop a nationwide strategy to address obesity, smoking and excess alcohol consumption. If successful, this would go a long way in improving the health of the nation".

 

FIRST Magazine thanks Dr Gordon Caruana Dingli for his keen attention to this project, as well as for his care, practice, research and commitment to combatting breast cancer in the local community