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Breast Cancer

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focus on early detection

Breast is an organ paramount for the nourishment of offspring as well as it denotes female identity and beauty.

The month of October is named as Breast Cancer awareness month by the World Health organization (WHO) to make people aware of the burden of the Breast Cancer and motivate them for early detection which is the corner stone for cure of this, otherwise dreaded disease.

Annually around 4,000 women in Sri Lanka diagnosed to have Breast Cancer and unfortunately a third of them succumb in a year, mainly because of the advance of the disease at the time of seeking medical advice.

The main reasons behind the reluctance of seeking medical advice are fear of losing the breast, side effects of Radiotherapy & Chemotherapy, stigma associated with breast cancer and cultural backwardness to reveal private parts of the body for edical examination.

This article focuses on the following main areas,

1. The importance of early detection

2. Diagnosis of Breast Cancer

3. Novel modalities of treatment available in Sri Lanka

Importance of early detection of Breast Cancer

A Cancer cell must divide on average 30 times before it forms a mass that can be felt in the breast. Since tumor cells multiply and divide exponentially – one cell become two, two cells become four and so on- a tumor will increase more rapidly in size the larger it is.

Longer one waits larger it gets and further away spreads from the place of origin (metastasis) leading to incurable systemic disease.

How do we detect a Breast Cancer early?

1. Self-Breast Examination

2. Screening Mammogram

3. Medical Breast Examination

Self-Breast Examination (SBE)

SBE is a simple technique to master by all females over the age of 20 to check their own breasts monthly.

Salient features of SBE are;

Regular Examination,

Fix a date convenient to remember; usually a menstruating female can perform these 7-10 days after each menstruation. Others can fix an easy date to remember, e.g. 1st of the month etc.

Repeated practice makes you master the technique, initially you may not feel much but when it is repeated monthly one become aware of the normal consistency, shape & contour of the breast so when there’s slightest change, can be discovered easily.

Privacy & Place

SBE takes 5-10 minutes, and must be done in a properly covered & secure place with a mirror.

Inspection

Undress the upper body and stand in front of a mirror and observe any changes of color, shape, size of breasts; inspecting by keeping arms by the side of the body, pressed at hip and raised above the head.

Palpation

This can be done standing or lying down, the left breast is examined by the right hand and vice versa. Start at the periphery of the breast and proceed in a circular manner, like a mosquito coil; at the end squeeze the nipple to see whether any discharges occur.

Once you finish with the breast feel under the armpit for any lumps.

I hope you will surf the internet to find out many educative videos on SBE to master the technique today itself.

Screening Mammogram

Mammogram is similar to a X-ray film but with very low radiation. It can detect cancers very early which are not felt by the hand.

‘Screening’ means it performs in healthy individuals who have a higher risk of the disease; some western countries screen their entire female population at the age of 45-years and every 3-5 yrs thereafter. In Sri Lanka there are no such guidelines but if you fall in the high risk category (Table 1) it is advisable to undergo screening mammogram periodically .Your first mammogram is considered a baseline mammogram against which all future tests will be compared to look for changes in your breast tissue.

Mammograms are not performed below the age of 35 yrs due to difficulties in interpreting when the breast tissues are dense.

Table No 1

Risk factors for Breast Cancer

Non-Modifiable risk factors

1. Advanced age

2. Family history of Breast Cancer

3. Radiation exposure

4. Family History of early Ovarian Cancer, Uterine Cancer, Colon Cancer

5. Certain inherited genes (BRCA 1, BRCA2, TP53, Atm, CDH1)

6. First pregnancy after 35yrs of Age

7. Early Menopause

8. Late Menopause

9. Nulliparity

10. Never breast fed a child

Modified Risk Factors

1. Hormone replacement therapy

2. Obesity

3. Alcohol consumption

4. Type 2 Diabetes Mellitus

5. Tobacco Use

6. Sedentary lifestyle

Even though many are not aware, risk of Breast Cancer development can be reduced on your own, see modifiable risk factors

Medical Breast Examination

This will be done by a consultant or a medical doctor to detect any abnormality or problems as well as to address any concerns arisen from the SBE.

This is more advanced than SBE as it will be performed by a trained and experienced professional who can determine features suggestive of Cancer in order to proceed with further investigations.

Diagnosis of Breast Cancer

Early detection and confirmation pave the way for early treatment. Diagnosis of Breast Cancer is achieved through three stages referred as Triple assessment.

1. Clinical Assessment

2. Radiological Assessment

3. Pathological Assessment

Clinical Assessment

This is done by a Consultant doctor. Breast examination & thorough systemic examination will be performed and findings will be graded in a scale from 1-5 (5 bears most probability of Breast Cancer)

Radiological Assessment

Mainstay of radiological assessment is by ultrasound scan (USS) and diagnostic mammogram.

Diagnostic mammogram differs by screening mammogram as it is performed in patients where breast cancer is suspected. and may take more pictures in different angles than screening mammogram.

Ultrasound scan is an outpatient procedure. Below the age of 35 yrs. when the breasts are denser, it is a safer and reliable mode. It can detect lumps, cysts (water bubbles), infections etc.

USS can reveal valuable information as an adjunct to mammogram where sensitivity of picking a lesion can be as high as 98% when both are combined.

There are other advanced tools such as CT scan and MRI which are reserved for more complex and advanced cases.

After the radiological diagnosis radiologist will scale the findings in a scale of 1-5 (5 being the most probable of cancer)

Pathological Assessment

This is the most important step of confirmation of a breast cancer, where a small piece or few cells from the lump is taken out to be examined under the microscope.

Commonly known as fine needle aspiration cytology (FNAC) is performed on an outpatient basis by inserting a small needle to the mass and taking out few cells. If the lump is not readily probable this could be done under the USS guidance.

In case a larger sample of tissues are needed for confirmation a core of tissue or part of the lump is taken out and examined under the microscope.

Again, the results of pathological assessment will be graded in a scale of 1-5 (5 being the most probable of Cancer) by the Pathologist.

Once the results of above are available another set of tests will be performed to assess the spread of the disease outside the breast. These are chest X-ray, USS Abdomen, Bone scan, CT scan, MRI Scan, PET Scan and the most appropriate of these will be selected by the clinician according to the disease & the patient.

When the results of above tests are available he/she will summon a multidisciplinary team meeting (MDTM) to decide the best treatment option for a particular patient. This will enable to tailor made the treatment for each and every individual rather to impose a set guideline for everyone. Information which needs at the MDTM are,

1. Confirmation of Cancer, its type & behavior

2. Spread to the arm pit

3. Spread to the other areas of the body

4. Proportion of cancer size compared to the breast size

5. Patient wishes and compliance

Novel modalities of treatment available in Sri Lanka

In 1894 Dr. William Stewart Halsted performed the first series of mastectomies to remove the whole diseased breast and this technique was the gold standard for the treatment of breast cancer with slight modifications until recently.

But in recent past there has been a paradigm shift of treatment modalities for the disease mainly due to the way we analyze it now.

Treatment options for Breast Cancer are subdivided as follows,

1. Treatment of Breast

2. Treatment of Armpit

3. Systemic Treatment

Treatment of the Breast

There has been a drastic change of the way we treat breast nowadays with mastectomy seldom required. Following are some approaches,

1. Wide local excision (WLE)

If the cancer is small compared to the size of the breast, it can be taken out with a clear margin of normal tissues carefully through a small incision. This will be assessed under the microscope to determine complete removal.

2. Quadrantectomy

Breast is divided arbitrarily in to four quadrants; Upper medial, Upper lateral, Lower medial & Lower lateral.

In case of a relatively large cancer which is in a quadrant can be taken out along with this entire quadrant. And the resulted defect can be filled with fat from under the armpit. (Li cap)

In some cases, it is necessary to remove more than one quadrant, in these cases resultant defect can be filled with fat & muscles taken out from the arm pit and back.

3. Skin and nipple sparing mastectomy

When the tumor is much bigger or it is in several different places, whole breast tissue is taken out leaving the skin & nipple. Obviously large defects created by this surgery can be filled with silicon prosthesis which are commercially available to restore the size & context of the breast.

4. Mastectomy and reconstruction

Still mastectomy has its ground for advanced cancer when the patients presents herself late for examination. It can now be combined with immediate, early or late breast reconstruction to restore the beauty.

Treatment of the Armpit

It was customy to remove all lymph nodes under the armpit along with Mastectomy as described by the Halsted, but now mainly due to the knowledge of lymph draining pathways, we perform sentinel lymph node biopsy.

When cancer cells travel from breast to armpit it goes along the lymph channel to one lymph node first, which we call as sentry or sentinel lymph node.

When we inject a dye or radioactive particle around the cancer and nipple it drains first to the sentinel lymph node which will be identified using a gamma camera and removed through a small incision to be examined under the microscope for cancer cells. If there are no Cancer cells detected rest of the lymph nodes will not be removed. Only when there is cancer present at the sentinel node rest of the lymph nodes are cleared away.

This will greatly reduce the complications and side effects associated with arm pit clearance.

Systemic Treatment

Usually, systemic treatment is advocated for patients with advanced breast cancer. There are several modalities,

1. Radiotherapy

2. Chemotherapy

3. Hormone Therapy

4. Immune Therapy

These can be given prior to the surgery, after the surgery or both to achieve maximum effect.

Take home message

Breast Cancer is completely curable without removing the breast if treated early. SBE and Screening Mammogram are crucial in picking up early cancer.



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From 1906 to today: Nestle’s 120-year journey in Sri Lanka

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Bernie Stefan - proud of Nestle’s 120 years jouney

Bernie Stefan is the Chairman and Managing Director of Nestlé Lanka Limited, overseeing Nestlé’s operations in Sri Lanka and the Maldives. He assumed this role in March 2023. Under his leadership, Nestlé has strengthened its footprint in Sri Lanka, touching individuals and families, communities and spearheading sustainable development.

Since taking charge in 2023, Stefan has brought with him over two decades of international experiences, steering the company with a clear focus on sustainability, innovation and long term growth.

Bernie describes the anniversary as a moment of pride and reflection on over a century of commitment to Sri Lanka and its people.

Under his leadership, Nestle has expanded its footprint while staying true to its mission: to improve lives by providing nutrition and wellness for all Sri Lankans. Beyond the commercial success, the company has focused on community impact – supporting local farmers. promoting sustainable practices and contributing to public health initiatives.

(Q) Nestlé has been part of Sri Lankan homes for 120 years. How has the brand evolved alongside the changing lifestyles of Sri Lankan families?

(A) We at Nestlé are extremely proud of our 120 year journey of enriching Sri Lankan lives. It has been a journey guided by purpose and working together for good – touching individuals and families, the community, and the planet. As lifestyles and needs have evolved, so, too, have our products – offering convenient, tasty and nutritious solutions that meet everyday moments, whether it’s energy on the go or a quick and tasty meal. A true symbol of this legacy is our flagship brand, Nestomalt – synonymous with power, strength and energy – which today is enjoyed as the first cup of the day by a majority of Sri Lankan households.

(Q) Many Sri Lankans have grown up with Nestlé products at their breakfast table or during tea time. How does the company stay emotionally connected with generations of consumers?

(A) Our product range caters to the nutritional needs of consumers from birth to old age. We always ensure that the consumer is at the centre of everything we do. This deep understanding of consumer preferences, ensures not only that our products deliver taste and nutrition but also our communication is in tune to the local context. Our brands have been deeply rooted in the lives of the Sri Lankan community over many decades – be it through Milo school sports programmes or Nestomalt marathons. Being an organisation that has been present in Sri Lanka for such a long time, it also means that consumers hold many nostalgic memories from their childhood with our products.

(Q) From childhood treats to everyday beverages, Nestlé products often carry nostalgic memories. How important is this sense of nostalgia to the brand’s identity?

(A) Brands need to evolve with time and remain relevant. Nostalgia does bring a deep bond and connect with consumers. However, through product and packaging renovations, we have successfully ensured that our brands remain relevant to consumers. One of our oldest Nestlé brands in Sri Lanka, Milkmaid , today, has an online recipe platform with over 300 recipes. This is another example where we have ensured that our brands are able to connect with today’s consumers.

(Q) Has Nestlé adapted its products to suit modern lifestyles while still respecting local tastes?

(A) Our ability to cater to local taste preferences has been a crucial factor to the success of our brands. With the setting up of our local manufacturing operations in 1984, we now manufacture over 90% of Nestlé products sold locally. The deep consumer understanding our teams possess, combined with our global R&D expertise in the food and beverage sector, have given us the ability to tailor make our products to cater to the Sri Lankan taste palette while offering convenience. This is evident in the success of our Nescafe and Nestea 3-in-1 variants and the Ready-to-drink beverage range of Milo and Nescafe, that deliver convenience and great taste.

(Q) How is Nestlé aligning its practices to sustainability and mindful living?

(A) We are committed to reaching net zero carbon emissions by 2050. Promoting circularity is also a focus area in this journey. We have plans to be 100% plastic neutral this year. Our sustainability initiatives cover the entire value chain, from farm to fork. In Sri Lanka, we are focusing a lot on increasing yield and promoting regenerative agricultural practices across our dairy and coconut value chains. In our manufacturing operations, we have continuously striving towards reducing water and energy usage. We have also implemented numerous initiatives to reduce our carbon footprint in logistics, such as the adoption of rail transportation. We also focus on fostering behavioural change on responsible waste disposal amongst the youth through our School Waste Management Programme.

(Q) What moments or milestones best reflect its connection with everyday life in the country?

(A) Our ability to provide consumers with good food moments each and every day is something that I and the team are extremely passionate about. Also, the deep connect we have with the community, be it our dairy and coconut farmers, the numerous suppliers and trade partners, has been built on trust over the years. Today, we have farmers, suppliers and even employees from across generations and this speaks volumes about our business practices and the trust we have built in Sri Lanka for over a century.

(Q) Nestlé is known globally for innovation. How do you balance global expertise with the unique lifestyle and culinary culture of Sri Lanka?

(A) As I mentioned, understanding the taste palette, nutritional needs and the lifestyles of Sri Lankan consumers and ensuring our products fulfill these needs is key. Having access to one of the world’s leading R&D facilities gives us the unique ability to ensure our products deliver to these consumer needs and preferences. Further, it enhances our ability to ensure the freshness and bio-availability of certain nutrients contained in our products. We’ve also made significant strides in packaging innovation, where we use less plastic and materials that are better suited for recycling. The introduction of Coconut Milk Powder in 1986 was a first for Sri Lanka, and this is another great example of the deep understanding we have of local culinary culture.

(Q) How is the younger generation engaged with the brand today?

(A) Appealing to the discerning youth population will be key to ensuring the future success of our brands. Understanding the nuances of each generation is important. It is also evident that consumption patterns and lifestyles across generations are evolving rapidly. Staying abreast of these changes is something we are deeply committed to. In addition to delivering on taste and nutrition, being trendy and youthful – the purpose for which our brands stand for – is equally important. NESCAFÉ and MAGGI PAPARE BLAST are two brands that have developed a strong connect with Sri Lankan youth.

(Q) What vision do you have for the next chapter in Sri Lanka, especially in shaping lifestyle trends?

(A) Looking ahead, our vision is to continue enriching Sri Lankan lives by providing tasty and nutritious products and promoting healthier and active lifestyles. We will keep innovating to meet evolving consumer needs, while strengthening local sourcing and reducing our environmental impact. The next chapter is about deepening our positive impact – supporting communities, empowering youth and contributing to a resilient food system.

(Q) As the head of Nestlé Sri Lanka, what does celebrating 120 years personally mean to you?

(A) Celebrating 120 years in Sri Lanka is deeply meaningful to us, as it reflects the trust generations of Sri Lankan families have placed in Nestlé. This milestone is a testament to the dedication of our people and the strong partnerships we have built across the country. For me personally, it is both a moment of pride and a responsibility – to honour this legacy while continuing to work together for good, doing what is right for our consumers, our communities, and Sri Lanka.

By Zanita Careem

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A hat-trick for knowledge: Saranga’s triple triumph at Raigam Tele’es

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K.C. Saranga

At a time when entertainment often overshadows education on television, K.C. Saranga has rewritten the script—securing a remarkable third consecutive win for Best Educational Programme at the Raigam Tele’es 2025.

His flagship programme, Jeevithayata Vidyawa (Science for Life), aired on Ada Derana, has not only dominated its category but also elevated the standards of educational broadcasting in Sri Lanka.

Reflecting on the milestone, Saranga described the win as more than a personal achievement. “Maintaining an award ceremony of this magnitude for 22 years is no small feat. Raigam Tele’es plays a pivotal role in uplifting the industry. By consistently recognising and rewarding Sri Lankan creators, it provides the necessary oxygen for television to evolve as a professional craft,” he said.

A veteran with over 25 years in the industry, Saranga—currently General Manager (News and Current Affairs) at TV Derana and Head of the Ada Derana News Channel—has seamlessly transitioned from hard news to impactful educational programming. His success underscores a broader vision: to harness television’s full potential as an audio-visual learning tool.

“There is a significant void in Sri Lankan television when it comes to high-quality educational productions,” he noted. “Television is an audio-visual medium; its true power lies in its ability to show, not just tell. We use multimedia elements—graphics, animation, and dynamic presentation—to grip the viewer’s attention.”

Saranga emphasised that his goal was to match global benchmarks. “If world-class science documentaries are available in English, our mission was to bring that same global standard to the Sinhala-speaking audience,” he said.

Through Jeevithayata Vidyawa, complex scientific concepts—from aerodynamics to cyclones—are presented in a manner that is both accessible and engaging, redefining the notion of “edutainment” in local television.

Expressing gratitude, Saranga credited his team and network for the continued success.

“This achievement is a result of a shared vision. My deepest gratitude goes to the management of Ada Derana. In an industry often driven by conventional ratings, they have consistently provided a sanctuary for creative freedom, allowing ‘out-of-the-box’ ideas to flourish,” he said.

He added: “To my incredible production team—this trophy belongs to you. Your technical skill and commitment have transformed simple ideas into a national standard. Finally, thank you to our viewers; your curiosity is our ultimate motivation. We will continue to prove that learning is an inspiring journey.”

Saranga’s hat-trick stands as a testament to the power of innovation in educational broadcasting—proving that knowledge, when presented with creativity and purpose, can captivate audiences just as effectively as mainstream entertainment.

By Ifham Nizam

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‘Style Surge’ blends glamour with a cause

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Lighting up the evening with effortless charm

The event “Style Surge,” organised by the Lions Club Elevate, was an evening filled with glamour, leadership and purpose collided in a spectacular fusion. The grand Ballroom at Galle Face Hotel became a canvas of fashion; every detail, from the floral centrepiece to the curated lighting, whispered elegance, while glamour set the stage, purpose was the back bone.

The show featured a curated selection of Sri Lankan designers, each bringing their signature styles to the stage.

The designers captivated the audience with bold, contemporary silhouettes that fused modern trends with traditional influence, creating pieces that were both sophisticated and wearable.

The batik ensembles by doyen of Batiks, Eric Suriyasena, were masterpieces, demonstrating the designer’s mastery in balancing artistry and practicality. Each piece told a story, highlighting the cultural nuances of Sri Lanka, while contributing to the glamour of the event.

The hair and make up for the models were curated by Salon Avra by Thushari de Silva and was nothing short of perfection,

From sleek, modern looks to elegant textured styles, Salon Avra ensured every model complemented the designer’s vision, highlighting the intricate details of each ensemble. The artistry on stage reflected a seamless collaboration between fashion beauty and presentation.

Style Surge unfolded an evening of elegance, creativity and purpose. It brought together Colombo style conscious crowd, social leaders and fashion enthusiasts and transformed the venue into a vibrant celebration of couture and compassion.

As the lights dimmed,the runaway came alive with a striking showcase of designs, ranging from contemporary chic to timeless sophistication, by designers like Eric Suriyasena, Anushko, Azeena Sulaiman and Jaywanthi Panibharatha. Leading fashion brands showcased were Aluminium, Disala, Eriq and Elegant Closet, and they presented a blend of contemporary and traditional fashion. Jewellery for the show was designed and sponsored by Blue Majestara Ceylon, . The Chief Guest was District Governor Lion Mahesh Borolugoda and his wife Lion Lady Sunethra Borolugoda.

Beyond glamour, this event, Style Surge, carried a meaningful mission to help rennovate two schools and improve educational facilities for future students

Lions Club of Colombo Elevate district 306D6, the organisers of this event, have been long synonymous with community development .The event underscores the power of fashion as a force of good.

Proceeds and awareness generated though the evening will be directed towards the clubs ongoing humanitarian initiatives, reinforcing its commitment to uplifting communities while engaging the public in an inspiring way.

In every sense, the event was more than a fashion show, it was a statement. This event reaffirms that glamour can also carry a purpose, creativity can spark compassion, and a runaway that can become a powerful platform for social change. This fashion show was graced by distinguished guests of honour , including designers Aseka Wijewardena, Michael Wijesuriya, Yolande Aluwihare, and Shyara Mendis

This event was organised by Lion Diana Nilanthi, Shen, Lion Thushari de Silva and Lion Shashika Hettiarachchi, whose commitment to creativity and attention to detail transformed the event into a truly memorable evening. They were the driving force that brought the vision of the show to life. Their meticulous planning, conceptualising the theme, coordinating the designers ensured the show ran seamlessly, from start to finish Pix by Thushara Attapathu

By Zanita Careem

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