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Dr. Shama inspires hope in battle against breast cancer

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Dr. Sharma Goonatillake Consultant Clinical Oncologist

Breast cancer is the most common cancer among women in Sri Lanka. Annually, out of approximately 37,000 newly diagnosed cancer patients nearly 27% are attributed to female breast cancer. In contrast male breast cancer is significantly rarer, observed at a ratio of about 1:100 compared to female cases.

On a daily basis, the statistics translate to approximately 15 new female breast cancer patients being detected with sadly three fatalities due to this disease. An excerpt from an interview with Dr Shama

Goonatilleke, Consultant Oncologist at Asiri Surgical Hospital

Breast cancer remains one of the most common cancers among women. What trends are you seeing locally in terms of age, risk and incidence?

Breast cancer is the most common cancer among women in Sri Lanka. Annually, out of approximately 37 000 newly diagnosed cancer patients, nearly 27% are attributed to female breast cancer. In contrast, male breast cancer is significantly rarer, observed at a ratio of about 1:100 compared to female cases.

On a daily basis, the statistics translate to approximately 15 new breast cancer patients being detected, with sadly, three fatalities due to this disease.

In Sri Lanka, the key trends for breast cancer show a significant increase in incidence, particularly affecting older, post-menopausal women, and a growing prevalence of lifestyle-related risk factors.

The age-standardized incidence rate for female breast cancer in Sri Lanka has shown a steady and significant increase over the years, rising from 18.4 per 100,000 in 2005 to 34.4 per 100,000 in 2019. A gradual increase of approximately 4% per year was observed between 2001 and 2010, with the trend expected to continue.

The highest incidence of breast cancer is observed in women aged 50 to 59 years, with the mean age of diagnosis around 56 years. The increase in incidence has been substantially greater among women older than 50 years compared to younger women. While the incidence is lower in younger age groups, cases are reported from the 20-24 age group onwards, and nearly one-third of cases are reported before the age of 50. A significant proportion of patients are diagnosed at advanced stages (Stage III and IV), which contributes to lower survival rates compared to developed countries.

Why are we witnessing more breast cancer cases in younger women today?

Unfortunately, breast cancer is not a preventable cancer. The rise in breast cancer cases among younger women today is attributed to a complex interplay of lifestyle changes, environmental exposures, hormonal/reproductive shifts, and genetic factors. No single cause fully explains the trend, and research is ongoing.

Lifestyle and Hormonal Factors: Reproductive Changes:

Women are having their first child later in life or not having children at all, and are less likely to breastfeed. Pregnancy and breastfeeding, especially at a younger age, have a protective effect against breast cancer later in life, and the loss of this protection increases risk.

Increased Lifetime Estrogen Exposure:

Girls are starting menstruation earlier and women are entering menopause later, increasing the number of menstrual cycles and the body’s lifetime exposure to estrogen and progesterone, which can fuel the growth of hormone-receptor-positive breast cancers.

Obesity and Weight Gain:

Higher rates of obesity and weight gain during childhood and adulthood are associated with increased inflammation and hormonal imbalances, raising the risk of breast cancer in premenopausal young women.

Alcohol Consumption:

Alcohol intake is clearly linked to an increased risk of breast cancer, and the risk increases with the amount consumed. Alcohol consumption among young Sri Lankan females have increased during recent past.

Physical Inactivity and Diet:

A lack of physical activity and diets high in red meat and processed foods, which are common in “Western-style” diets, are linked to an increased cancer risk.

Environmental Exposures:

Endocrine-Disrupting Chemicals:

The current generation of young women has grown up exposed to a wider array of chemicals than ever before, including endocrine disruptors in plastics (like BPA and phthalates), cosmetics, pesticides, and food packaging. These chemicals can mimic hormones and interfere with hormonal regulation, increasing susceptibility to cancer.

Air Pollution:

Exposure to air pollutants can be absorbed into breast tissue and contribute to cancer development.

Other Potential Factors:

Genetics: Younger women getting breast cancer are more likely to have a genetic predisposition, such as BRCA1 and BRCA2 gene mutations, some may be direcDr. Shama inspires hope in

battle against breast cancertly getting from their parents,are associated with higher cancer risk and more aggressive forms of the disease.

Increased Awareness and Screening:

While not a cause of the disease itself, recent changes to screening guidelines (such as the recommendation to start mammograms at age 40) lead to earlier detection of existing cancers, which may contribute to the uptick in reported cases in this age group.

Researchers emphasize that these factors likely interact with one another, and exposures during critical windows of susceptibility, such as puberty and pregnancy, may be particularly impactful.

What early warning signs should women be paying attention to?

Women should pay attention to any new or unusual changes in the look or feel of their breasts, chest, or armpit areas. The most common early warning sign of breast cancer is a new lump or thickening, but other symptoms can occur even without a lump.

A new lump or thickening in the breast or armpit area, which may be painless and have irregular edges (though some can be soft, round, or tender).

Changes in the size or shape of one or both breasts.

Skin changes on the breast, such as dimpling, puckering, redness, scaling, or irritation (sometimes described as resembling an orange peel texture).

Nipple changes, including a nipple that pulls inward (inverts), changes direction, or has a rash or scaling.

Nipple discharge (other than breast milk), especially if it is clear or bloody and happens spontaneously (without squeezing).

Persistent pain in the breast or nipple area that is new and does not go away after a menstrual cycle.

Swelling or a lump in the armpit or around the collarbone, as cancer can spread to nearby lymph nodes.

It is important to become familiar with the normal look and feel of your breasts through regular self-exams so that any changes can be spotted promptly. While many of these symptoms can be caused by benign (non-cancerous) conditions, any new and persistent changes should be evaluated by a healthcare professional as soon as possible for an accurate diagnosis. Early detection significantly improves the chances for effective treatment and positive outcomes.

Many women are still hesitant about breast screening. What misconceptions prevent early detection?

Misconceptions and fears that prevent women from attending breast screening and receiving an early diagnosis include false beliefs about personal risk, the screening procedure’s safety and comfort, and the outcomes of a cancer diagnosis

Key misconceptions preventing early detection are:

“I am not at risk because I am healthy/have no family history.” This is a very common myth. The truth is that most breast cancers occur in women with no family history, and healthy habits only reduce the risk, not eliminate it. A woman’s primary risk factors are simply being a woman and getting older.

“Mammograms are painful or dangerous.” Many women avoid screening due to fear of pain or concerns about radiation exposure. In reality, the procedure may cause brief, manageable discomfort, and the radiation dose is very low and considered safe by medical guidelines. The benefits of early detection far outweigh the minimal risks.

“Only women with symptoms or lumps need screening.” Mammograms are designed to find cancer years before physical symptoms, such as a lump, can be felt. Waiting for symptoms often means the cancer is more advanced and potentially less treatable.

“A painless lump is harmless.” Most breast cancers do not cause pain. Any new lump or unusual change should be checked by a healthcare provider regardless of whether it is painful.

“Breast cancer is a death sentence.” This fatalistic view can lead women to avoid screening or delay treatment. With early detection, the 5-year relative survival rate for localized breast cancer is an impressive 99%.

“Breast self-exams are enough.” While self-awareness of breast changes is important, self-exams alone are not a substitute for regular professional screenings like mammograms, which can detect much smaller cancers.

“Newer tests make mammograms obsolete.” While other tools like ultrasound and MRI are used for high-risk cases, mammography remains the gold standard and most effective tool for average-risk screening and early detection.

Other Barriers:

Fear and Anxiety:

Many women avoid screening due to fear of the results (receiving a cancer diagnosis) or the procedure itself.

Socio-cultural factors:

Taboos, stigma, or a preference for traditional medicine can lead to significant delays in seeking conventional care.

Logistical and financial issues

: Cost, lack of health insurance, difficulty accessing healthcare facilities (e.g., transportation issues), or an inability to take time off work or find childcare can all prevent women from attending appointments.

Lack of knowledge:

Low awareness of the benefits of screening, the risk factors, and the signs and symptoms of breast cancer contributes to hesitation and delay

Addressing these misconceptions through better education and communication from healthcare providers is essential to encouraging regular screening and improving outcomes.

How has modern technology improved breast cancer treatment outcome at Asiri AOI (American Oncology Centre) cancer centre?

Modern technology has improved breast cancer treatment outcomes at Asiri AOI Cancer Centre by enabling more accurate, personalized, and less invasive care, which enhances efficacy while minimizing side effects and recovery times.

Key technological advancements and their impact include:

Diagnosis and Staging

Advanced Imaging (PET-CT, MRI, 3D Mammography): These technologies allow for the detection of tumors at earlier stages and provide detailed information on their location, size, and extent. This precision in staging is crucial for developing the most effective treatment plans, which directly improves survival rates.

Genetic and Histopathology Labs: Asiri AOI uses advanced labs for genetic testing and biomarker analysis to understand cancer at a molecular level. This allows for the classification of breast cancer into specific subtypes (e.g., hormone receptor-positive, HER2-positive) and the development of personalized treatment plans tailored to the patient’s unique cancer profile, improving treatment efficacy and reducing unnecessary therapies.

Treatment Modalities Surgical Techniques

Sentinel Lymph Node Biopsy (SLNB): This minimally invasive procedure has largely replaced the traditional, more extensive axillary lymph node dissection. SLNB accurately stages the cancer while significantly reducing the risk of lymphedema and other post-surgical complications, leading to better recovery and quality of life.

Intraoperative Guidance:

Techniques such as image-guided surgery and the potential future use of cancer-targeted dyes or molecular probes during operations help surgeons ensure complete tumor removal while preserving maximum normal breast tissue, reducing the need for re-operations and improving cosmetic results.

Systemic Therapies

Targeted Therapy and Immunotherapy:

By using insights from advanced diagnostics, in addition to traditional chemotherapy clinicians can employ targeted therapies and immunotherapies that focus on specific cancer-driving molecules or leverage the body’s own immune system to fight cancer. These treatments are often more effective and have fewer side effects than traditional chemotherapy.

Precision Radiotherapy (TrueBeam STx)

Asiri AOI utilizes the TrueBeam STx radiotherapy system, which delivers high doses of radiation with sub-millimeter accuracy.

Improved outcomes:

This system targets cancer cells while sparing healthy surrounding tissues and organs (like the heart and lungs), which reduces side effects and long-term complications.

Efficiency:

It allows for faster treatment sessions and fewer visits (e.g., reducing multi-week radiation courses to a few sessions or even intraoperative radiotherapy options), which improves patient comfort and quality of life.

Overall, the integration of these modern technologies, combined with a multidisciplinary approach and adherence to international protocols (via collaboration with UPMC), enables Asiri AOI Cancer Centre to provide world-class, individualized care that has significantly improved breast cancer treatment outcomes.

Is radiotherapy recommended for every breast cancer patient? When is it more beneficial?

No, radiotherapy is not recommended for every breast cancer patient. The decision to use radiotherapy is personalized and based on a variety of factors related to the cancer’s characteristics, the type of surgery performed, and the patient’s overall health.

Radiotherapy is primarily used to destroy any remaining cancer cells after surgery and reduce the risk of the cancer coming back in the breast area or nearby lymph nodes. It is generally more beneficial, and often standard, in the following situations:

After Breast-Conserving Surgery (Lumpectomy): Radiotherapy to the remaining breast tissue is a standard part of treatment to lower the risk of local recurrence. Some very low-risk, older patients (e.g., age 70 or older with a small, hormone receptor-positive tumor) who are receiving hormone therapy may be able to skip it, but this is an exception.

After a Mastectomy:

It is often recommended if there is a high risk of the cancer returning to the chest wall or nearby lymph nodes. This includes cases where:

The tumor was large (larger than 5 cm).

Cancer has spread to the lymph nodes (especially four or more, but potentially even one to three).

Surgical margins have cancer cells (positive or very close margins).

The cancer has grown into the skin or muscles.

For Certain Aggressive Cancers: Radiotherapy is a key part of the treatment plan for inflammatory breast cancer.

For Advanced or Metastatic Cancer: It can be used as a palliative treatment to shrink tumors, relieve pain, and control symptoms when cancer has spread to other parts of the body, such as the bones or brain.

Before Surgery (Neoadjuvant therapy): In some cases, it can be used to shrink a large tumor to make it easier to remove with surgery.

A patient may not be an ideal candidate for radiotherapy in certain situations:

Very Early Stage, Low-Risk Breast Cancer: Some patients with early-stage, small, hormone receptor-positive tumors that have not spread to the lymph nodes may not require radiotherapy, especially if they are older and receiving hormone therapy.

Prior Radiation Exposure: Patients who have previously had radiation therapy to the same area (chest/breast) cannot typically receive a second course due to the risk of damage to healthy tissues.

Certain Medical Conditions:

Individuals with connective tissue diseases (like lupus or scleroderma) or severe heart/lung problems may face higher risks of complications.

Genetic Predisposition:

Patients with certain genetic mutations, such as Li-Fraumeni syndrome or some ATM mutations, may be advised against radiotherapy due to a higher risk of developing a second cancer later.

Pregnancy:

Radiotherapy is generally avoided during pregnancy.

Ultimately, the decision to use radiotherapy is made through a discussion between the patient and their healthcare team (including a radiation oncologist), weighing the benefits of reducing recurrence risk against potential side effects and the individual’s specific health factors.

Many patients initially fear diagnosis more than the disease. How do you help them cope emotionally?

Helping patients cope with the fear of a potential diagnosis involves compassionate communication, providing clear information, offering emotional support, and empowering them with a sense of control.

Compassionate and Empathetic Communication

Active Listening: Give the patient your undivided attention and allow them to express their fears, worries, and anxieties without interruption. Acknowledging their feelings with phrases like, “I understand why you’re feeling this way” or “It’s okay to feel scared,” helps them feel heard and validated.

Acknowledge and Normalize Feelings: Reassure patients that denial, fear, anxiety, and anger are normal responses to the stress and uncertainty of a potential serious diagnosis.

Be Aware of Non-Verbal Cues:

Use calm body language, maintain appropriate eye contact, and use a warm, comforting tone of voice to convey support and sincerity. A reassuring touch on the arm, when appropriate and consensual, can also make a difference.

Honesty and Transparency:

Be honest about what is known and what is unknown, as this builds trust. Avoid giving false reassurance or minimizing their concerns, as this can break trust and make them feel misunderstood.

Information and Education

Provide Clear, Simple Information: Explain medical conditions, tests, and procedures in clear, non-medical language to reduce the “fear of the unknown”. Use visual aids if helpful.

Encourage Questions: Create an open, non-judgmental environment where patients feel comfortable asking questions. Offer your contact details or a specific point of contact for follow-up questions they may have later.

Guide Information Seeking: Advise patients on reliable sources for information and gently discourage unhelpful internet searches, which can increase anxiety with misinformation.

Empowerment and Control

Involve Patients in Decision-Making: Discuss options and allow patients to be active participants in their care plans. This gives them a sense of control, which is often lost during a health crisis.

Focus on the Next Steps: Collaboratively formulate a plan for immediate next steps and contingencies. A clear action plan helps shift focus from worry to proactive management.

Set Realistic Goals: Help patients focus on manageable, day-to-day goals and activities, rather than overwhelming long-term expectations, to prevent feelings of frustration and failure.

Support Networks and Coping Strategies

Involve Family and Friends: With patient consent, involve loved ones in the conversation. They can offer emotional support and help remember information and instructions.

Suggest Coping Techniques: Introduce relaxation strategies such as deep breathing exercises, mindfulness, meditation, music therapy, art therapy, aroma therapy, or guided imagery.

Recommend Support Groups: Connect patients with peer support groups or online communities where they can talk to others who have similar diagnoses and experiences. Hearing personal stories can provide valuable perspective and coping strategies.

Refer to Mental Health Professionals: Encourage patients to seek professional help from a counselor or psychologist who specializes in health anxiety if their feelings become overwhelming or interfere with daily life and treatment adherence.

What lifestyle factors contribute to increased breast cancer risk – especially in urban areas?

Can diet exercise or hormone regulation reduce risk?

How can survivors, ensure long term health and reduce recurrence risk?

Breast cancer survivors can ensure long-term health and reduce recurrence risk through a combination of consistent medical follow-up, healthy lifestyle choices (diet, exercise, weight management), avoiding harmful habits, and managing emotional well-being.

Medical Follow-Up and Adherence to Treatment

Regular Check-ups and Screenings: Adhere strictly to your follow-up schedule with your oncology team or primary care physician. These visits, typically every few months initially and then annually after five years, are crucial for monitoring signs of recurrence or new cancers.

Annual Mammograms: Continue annual mammograms on the remaining breast tissue (or both if you had breast-conserving surgery).

Adherence to Therapies: If prescribed, complete the full course of hormone therapy (e.g., tamoxifen, aromatase inhibitors) or other maintenance therapies, as early discontinuation increases the risk of recurrence.

Discuss Advanced Therapies: Talk to your doctor about advanced therapy options, as modern targeted treatments can significantly reduce long-term risk for specific cancer types.

Know Your Body and Report Changes: Be vigilant for new or persistent symptoms, such as new lumps, unexplained pain, chronic cough, or sudden weight loss, and report them to your doctor immediately.

Healthy Lifestyle Choices

Maintain a Healthy Weight: Obesity is a significant risk factor for recurrence. Aim to achieve and maintain a healthy weight through diet and exercise.

Be Physically Active: Regular physical activity can reduce breast cancer mortality and recurrence risk by a significant percentage (up to 40%). Aim for at least 150-300 minutes of moderate-intensity aerobic exercise (like brisk walking) or 75-150 minutes of vigorous activity per week, plus two strength-training sessions per week.

Eat a Balanced Diet: Focus on a diet rich in a variety of colorful fruits, vegetables, whole grains, and lean proteins (fish, chicken, legumes). Limit red and processed meats, highly processed foods, and sugary drinks.

Avoid Alcohol: Avoid alcohol, as alcohol intake is linked to an increased risk of a second primary breast cancer.

Quit Smoking: Smoking increases the risk of recurrence and overall mortality. Seek support to quit immediately.

Consider Vitamin D: Low levels of vitamin D may be associated with a higher risk of recurrence. Discuss monitoring your levels and appropriate supplementation with your healthcare team, especially for bone health.

Emotional and Mental Well-Being

Manage Stress: Chronic stress can impact immune function. Utilize stress-reduction activities like yoga, meditation, gardening, or counseling to manage anxiety and the fear of recurrence.

Seek Support: Connect with friends, family, or support groups of other survivors. Sharing experiences and building a strong support network can improve quality of life and emotional health.

Prioritize Sleep: Aim for at least seven hours of quality sleep per night to aid physical and mental recovery.

By Zanita Careem



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Life style

From Colombo to Canada and Back: How Thevin Gamage found his voice through cinema

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Thevin with Gautham Manoj, his director of photography, behind the camera

For most Sri Lankan parents, success is often measured in familiar terms: a doctor, a lawyer, an engineer, or a businessman. Creative pursuits, while admired, are rarely viewed as dependable career paths.

Young filmmaker Thevin Gamage knows that reality is all too well.

Ironically, he grew up in a household immersed in the arts. His mother, celebrated actress Kumudumali De Silva, entered the film industry as a teenager and went on to win acclaim for her performances on television.

His father, veteran actor Nihal Gamage, also established himself as a respected figure in Sri Lanka’s film and television landscape.

Yet even within a family of artists, there remained a strong expectation that their only son would pursue a more conventional profession.

“I grew up in a very strict and conservative household,” Gamage recalls. “Like many Sri Lankan families, education was everything. The expectation was that I would become a businessman, lawyer, or something considered stable and respectable.”

Today, sitting thousands of miles and many life lessons away from that childhood, Gamage reflects on a journey that has taken him from the classrooms of Colombo to the film schools of Toronto, in Canada, and eventually to the director’s chair of his own feature film.

His story is not merely about filmmaking. It is about identity, perseverance, self-discovery, and the courage to pursue a passion that remained hidden beneath years of expectations.

“I think I was always creative,” he says. “The problem was that nobody around me really understood that creativity and academic intelligence are two very different things.”

Directing a scene

Thevin and Gautham

Educated at Colombo International School, Gamage admits he was never among the highest-performing students, academically.

“I wasn’t the student teachers pointed to as an example,” he laughs. “But looking back now, I think I simply processed the world differently.”

Like many Sri Lankan students pursuing London examinations, he spent countless hours attending tuition classes.

“My days would begin before sunrise. There would be mathematics classes at four in the morning, before school. Then another class, after school, and another in the evening. That was the routine.”

The hard work eventually paid off. He secured admission to the prestigious University of Toronto, a move that opened the door to a world far removed from the sheltered upbringing he had known.

More importantly, it offered him the independence he had long desired.

“To be honest, one of the biggest motivations for going overseas was that I wanted to experience life beyond the boundaries I had grown up with.”

Initially, he enrolled in a Bachelor of Business Administration programme, with a focus on economics. However, it quickly became apparent that the world of finance and accounting did not inspire him.

“I knew very early that I wasn’t built for accounting. Finance wasn’t something that excited me either.”

After considerable soul-searching, he switched his academic focus to political science, while pursuing minors in economics and psychology.

THE ONSET

The decision proved to be the right one.

He graduated with honours, much to the relief and pride of his parents.

“That was important to them. Like many parents, they wanted to know their sacrifices had meant something.”

Yet, despite earning a respected university degree, Gamage remained uncertain about his future.

Upon returning to Sri Lanka, for a period, he became involved in his family’s restaurant business. At the time, it seemed the closest thing to a creative profession that he could realistically pursue.

“I loved the idea of hospitality because there is artistry involved in food, presentation, and customer experience. But something still felt missing.”

The answer would emerge unexpectedly during one of the most disruptive periods in modern history.

The COVID-19 pandemic.

At the time, Gamage was back in Canada, working toward permanent residency, while also exploring possibilities for introducing Sri Lankan restaurant concepts to the Canadian market.

To support himself, he worked as a bartender in one of Toronto’s leading restaurants.

Then, the world shut down.

For many people, lockdowns created uncertainty. For Gamage, they created clarity.

“I suddenly had time to think. For the first time in years, I wasn’t running from one responsibility to another.”

That period of reflection led him back to a childhood obsession that had never truly disappeared – Cinema.

Growing up, movies had been far more than entertainment.

“Because I wasn’t allowed to socialise much, films became my escape. They allowed me to experience different cultures, different lives, and different ways of thinking.”

While other teenagers spent weekends attending parties, Gamage spent his watching films.

“I could sit for hours studying how stories were told. I didn’t realise it then, but storytelling was already becoming a huge part of who I was.”

One day, driven by curiosity rather than any grand ambition, he requested information from Toronto Film School.

What followed would alter the course of his life.

A lengthy conversation with a school representative encouraged him to take a chance on himself.

“She simply asked me why I wasn’t applying. I honestly didn’t have an answer.”

Using money he had painstakingly saved from bartending, Gamage enrolled.

The experience was transformative.

“For the first time in my life, I felt like I belonged somewhere.”

Surrounded by fellow storytellers, writers, directors, and aspiring artists, he discovered a community that understood the language of creativity.

“It felt like home. These were people who saw the world the way I did.”

His instructors quickly recognised both his passion and his work ethic.

“They kept telling me that I had something worth pursuing.”

Among hundreds of students, Gamage was selected to direct a student short film — an achievement that boosted his confidence enormously.

Thevin with his DoP camera With his parents and lighting crew

Yet his education was not confined to the classroom.

A chance opportunity on a Discovery Network production opened the door to the professional industry.

In a story he still recounts with amusement, his first break came, thanks to a dog.

“The showrunner, Mary Bissel, who, in due course, became Thevin’s first mentors, needed somebody to help take care of her puppy, while she was working. I always joke that my career began because of a dog.”

What began as a production assistant role quickly evolved.

Gamage volunteered for every task available.

“I wasn’t interested in staying inside one department. I wanted to understand how every part of a production worked.”

His enthusiasm and dedication did not go unnoticed.

Within a remarkably short period, he moved from production assistant to wardrobe assistant, then unit production manager and eventually assistant director.

By the time he completed film school, he was already serving as an assistant director on a major production.

“I actually missed my graduation because I was working on set. That was a pretty special feeling.”

Working alongside experienced professionals further strengthened his belief that filmmaking was where he belonged.

But he wanted more than a career.

He wanted to tell stories.

Determined to prove himself, Gamage embarked on creating his first short film, despite having limited resources.

Without substantial financing, or an established reputation, he improvised.

Friends and relatives became producers. Multiple crew positions were consolidated. Administrative responsibilities were shared.

“There were moments when I was essentially doing several jobs at once.”

The experience taught him one of the most valuable lessons of his career.

“You don’t wait for permission. If you believe in something strongly enough, you find a way.”

While the short film was travelling through international festival circuits, Gamage began work on an even more ambitious project — his first feature film.

Rather than play it safe, he chose to create a Sinhala-language film, influenced by the storytelling rhythms and cinematic sensibilities he had absorbed in North America.

“I wanted to bring something different to Sri Lankan cinema. Not because local films are lacking, but because every generation deserves to contribute its own voice.”

The feature called, “Aragalyak Mada- In The Middle Of A Struggle,” stars respected Sri Lankan actor Buddika Jayarathna and represent years of learning, experimentation,and persistence.

Directing the lead with Buddika Jayarathna in one scene

Remarkably, Gamage also undertook much of the editing process himself.

“Editing is where the story truly comes alive. It allows me to stay connected to every stage of the creative journey.”

Today, with his debut feature film completed and awaiting release, Gamage remains focused not on fame or recognition but on impact.

He hopes his journey will encourage other young Sri Lankans who feel trapped between societal expectations and personal aspirations.

“There are many talented young people in this country who don’t realise their potential because they are afraid of pursuing creative careers.”

His own story stands as evidence that unconventional paths can lead to extraordinary destinations.

Looking back, he does not regret the years spent navigating expectations, academic pressures, and uncertainty.

Every experience contributed to the filmmaker he has become.

“If there’s one thing I’ve learned, it’s that passion matters. Obsession matters. Sometimes, talent helps, but determination is what carries you forward.”

For Thevin Gamage, the boy who once sought refuge in movies, has now become a storyteller himself — crafting worlds, exploring emotions, and giving voice to dreams that often go unspoken.

And if his ambitions are realised, this may only be the opening scene of a much larger story yet to unfold.

By Ifham Nizam

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Healing bones restoring confidence

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Dr. Melanie Amarasuriya Consultant Orthopaedic surgeon hands and upper Limb

Advancing Orthopaedics through care and education

Dr Melanie Amarasuriya is a distinguished Consultant othopaedic surgeon,academic and educator whose career bridges the world of medicine and higher education. As a senior lecturer at the University of Moratuwa, she combines clinical expertise with a passion for teaching and mentoring the next generation of professionals. Renowned for her commitment to patient care and advancing orthopaedic practice, Dr. Amarasuriya has earned respect both within the medical fraternity and academia. In this interview, Dr. Melanie shares insights into her professional journey,the evoving landscape of orthopaedic surgery,and the challeges and opportunities facing health care in Sri Lanka

(Q) Can you tell us about your professional journey and key milestones?

(A) I qualified from the University of Colombo and completed my specialist training in Orthopaedic Surgery in Sri Lanka. I then pursued advanced training in hand and upper limb surgery in the United Kingdom and Australia, followed by a PhD in Wrist Biomechanics at Flinders University, Australia.

My career has combined clinical practice, research, and education, with a particular focus on complex hand, wrist, and upper limb conditions. Some key milestones include becoming the first and the only woman to qualify as Consultant Orthopaedic Surgeon in the country, completing further fellowship training in hand and upper limb surgery under internationally renowned hand and upper limb surgeons all over the world, earning a PhD, publishing internationally recognised research on wrist biomechanics, being awarded international awards and fellowships by other hand / upper limb organisations, like IFSSH, APWA, and representing Sri Lanka in international orthopaedic and hand surgery organisations.

Today, I divide my time between clinical practice, teaching, research, and contributing to the development of orthopaedic care in Sri Lanka.

(Q) What are the most common orthopaedic conditions you encounter in Sri Lanka?

(A) In Sri Lanka, the most common orthopaedic conditions we encounter are fractures, resulting from road traffic accidents, falls, and sports injuries. We also see a large number of patients with arthritis affecting the knees, hips, and hands, particularly as the population ages. Back and neck pain, tendon injuries, nerve compression syndromes such as carpal tunnel syndrome, and work-related musculoskeletal disorders are also very common.

I frequently manage complex injuries of the hand, wrist, and elbow, as well as conditions that affect function and quality of life, such as ligament injuries, nerve compressions, and degenerative disorders.

(Q) Are there any emerging trends in bone and joint health that people should be aware of?

(A) One of the most important trends is the growing recognition that bone and joint health is closely linked to overall health and lifestyle. We are seeing increasing rates of obesity, sedentary behaviour, and Vitamin D deficiency, all of which can negatively affect the musculoskeletal system.

At the same time, more people are remaining physically active well into older age, creating greater demand for treatments that preserve mobility and independence. So it’s really important looking at the patient as a whole and not only focus on bones and joints. It is also important to prevent injuries, intervene early before they need complex surgery, and rehabilitation, rather than simply treating problems after they occur. The goal is not only to help people live longer, but to help them remain active, independent, and pain-free throughout their lives.

Another emerging trend is the use of advanced technologies, such as artificial intelligence, three-dimensional imaging, computer-assisted surgery, and patient-specific treatment planning. These innovations are helping surgeons diagnose conditions more accurately and tailor treatments to individual patients. While Sri Lanka still is a middle-income country, according to WHO, we do have the capacity to utilise most of these advanced technology.

(Q) What steps can people take to maintain healthy bones and joints throughout their lives?

(A) Maintaining healthy bones and joints starts with regular physical activity. Weight-bearing exercise, strength training, and activities that improve balance and flexibility help maintain bone density, muscle strength, and joint function.

A balanced diet, rich in calcium, protein, and Vitamin D, is also important. Avoiding smoking, limiting excessive alcohol consumption, and maintaining a healthy body weight can significantly reduce the risk of osteoporosis and arthritis.

Equally important is listening to your body. Persistent pain, swelling, weakness, or loss of function should not be ignored. Early assessment and treatment often prevent minor problems from becoming major ones.

Ultimately, bone and joint health is an investment that begins in childhood and continues throughout life. The choices we make every day have a significant impact on our mobility, independence, and quality of life as we age.

(Q) How important are exercise and nutrition in preventing orthopaedic problems?

(A) Exercise and nutrition are fundamental to preventing many orthopaedic problems. Regular physical activity helps maintain strong bones, healthy joints, muscle strength, balance, and coordination. It also reduces the risk of falls, fractures, obesity, and many chronic conditions that can affect the musculoskeletal system.

Nutrition is equally important. Adequate intake of calcium, Vitamin D, and protein is essential for bone health, muscle maintenance, and recovery from injury. Poor nutrition can contribute to osteoporosis, frailty, delayed healing, and reduced physical function. When I mention poor nutrition, being overweight is also included in the spectrum. A large number of patients, with long standing back pain and knee pain, would get a better quality of life if they simply manage their body weight. The good news is that prevention does not require extreme measures. Consistent exercise, a balanced diet, maintaining a healthy weight, and avoiding smoking can significantly reduce the risk of many bone and joint problems. In orthopaedics, prevention is often far more effective than treatment.

(Q) What are some of the common misconceptions about bone and joint health are women at greater risk of certain orthopaedic conditions?

(A) There are several common misconceptions about bone and joint health. One is that joint pain is simply a normal part of ageing that must be accepted. While age-related changes do occur, many conditions can be prevented, treated, or managed effectively if identified early. Another misconception is that osteoporosis only affects very elderly people, when in fact bone health is influenced throughout life by factors such as nutrition, physical activity, and hormonal health.

Women are indeed at greater risk of certain orthopaedic conditions. Osteoporosis is particularly common in women, after menopause, due to the decline in oestrogen levels, which accelerates bone loss. Women are also more prone to conditions such as osteoarthritis of the hand and knee, certain ligament injuries, and some nerve compression syndromes, including carpal tunnel syndrome.

However, many of these risks can be reduced through regular exercise, good nutrition, maintaining a healthy weight, and seeking medical advice when symptoms first appear. Awareness and early intervention are often the key to preserving long-term mobility and independence.

(Q) As women age how can women protect their bone health?

(A) As women age, protecting bone health becomes increasingly important, particularly after menopause when bone loss accelerates due to declining oestrogen levels. The most effective strategies include regular weight-bearing and resistance exercises, such as walking, jogging, dancing, or strength training, which help maintain bone density and muscle strength.

Good nutrition is equally important. Women should ensure adequate intake of calcium, Vitamin D, and protein, either through diet or supplementation when necessary. Maintaining a healthy body weight, avoiding smoking, and limiting excessive alcohol consumption also play a significant role in preserving bone health.

Regular health check-ups are important, especially for women with risk factors for osteoporosis, such as a family history, early menopause, or previous fractures. Early screening and intervention can identify bone loss before fractures occur.

The key message is that it is never too early—or too late—to invest in bone health. Small lifestyle choices made consistently over time can have a significant impact on mobility, independence, and quality of life in later years.

(Q) What should women know about osteoporosis and fracture prevention?

(A) Osteoporosis is often called a “silent disease” because bone loss occurs gradually and usually causes no symptoms until a fracture happens. Many people only discover they have osteoporosis after sustaining a fracture from a minor fall or injury.

Women, particularly after menopause, are at increased risk because of hormonal changes that accelerate bone loss. However, osteoporosis is not an inevitable part of ageing. Regular exercise, especially weight-bearing and strength-training activities, adequate calcium and Vitamin D intake, maintaining a healthy weight, and avoiding smoking are all important preventive measures.

Fracture prevention is equally important. Falls are a major cause of fractures in older adults, so maintaining muscle strength, balance, good vision, and a safe home environment can significantly reduce risk. Women with risk factors, such as a family history of osteoporosis, previous fractures, or early menopause, should discuss bone density screening with their doctor.

The good news is that osteoporosis can be detected early and effective treatments are available. With appropriate lifestyle measures, screening, and medical care when needed, many fractures can be prevented, and people can maintain an active and independent lifestyle.

(Q) What advice would you give to young people involved in competitive sports?

(A) My advice to young people involved in competitive sports is to view their bodies as their most valuable piece of equipment. Talent and hard work are important, but long-term success depends on staying healthy and injury-free.

Good training habits, proper technique, adequate rest, nutrition, and recovery are just as important as performance. Young athletes should avoid the temptation to play through significant pain or return to sport too quickly after an injury, as this can lead to long-term problems.

It is also important to remember that sport should promote lifelong health and enjoyment. While competition is important, developing good habits, resilience, teamwork, and a love for physical activity are equally valuable outcomes.

Finally, if an injury does occur, seek expert advice early. Early diagnosis and appropriate treatment often allow athletes to return to sport safely and perform at their best for many years to come.

(Q) What development do you expect to see you in the next decade?

(A) The next decade is likely to bring major advances in orthopaedics, driven by technology, data science, and a deeper understanding of how the musculoskeletal system functions. I expect to see greater use of artificial intelligence, advanced imaging, computer-assisted surgery, and personalised treatment plans tailored to each patient.

We are also moving towards earlier diagnosis and more precise interventions. Technologies such as dynamic imaging and motion analysis are helping us understand joint disorders in ways that were not possible before, allowing treatments to be targeted more effectively.

In addition, biologic therapies and regenerative medicine may play an increasing role in treating cartilage injuries, tendon disorders, and early arthritis. While joint replacement surgery will continue to be important, there will be a stronger focus on preserving native joints and maintaining function for as long as possible.

Ultimately, the future of orthopaedics is not just about treating injuries and disease—it is about helping people remain active, independent, and able to enjoy a high quality of life throughout their lifespan.

By Zanita Careem

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Life style

Behind close doors: Hidden trauma of child abuse?

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Dr Anita Sharma: Dedicated mental health professional whose work focuses on helping individuals navigate emotional challenges, relationship issues, anxiety and depression

Child abuse remains one of the most disturbing yet under-reported issues affecting children worldwide. Beyond the visible scars, abuse often leaves deep emotional and psychological wounds that can shape a child’s development, relationship, and mental well being for years to come. Despite increasing awareness, child abuse remain a serious concern in Sri Lanka. Recent events in Sri Lanka have once again highlighted the urgent need to address child abuse in all its forms. From allegations involving influential figures to heartbreaking cases that have shaken the nation, these incidents have exposed the devastating consequences of abuse and challenges faced by young victims seeking protection and justice. In an interview with the ‘Sunday Island,’ a leading Singaporean psychologist, living in Sri Lanka, Anita Sharma, says many children suffer in silence, carrying trauma that can affect their emotional well being, education, relationships and their future lives. She also discusses the warning signs that parents and teachers should recognise, the barriers to reporting and the support systems needed to help children heal and rebuild their lives. With experience in leading medical institutions, she has a patient centred approach, to empower children and individuals to lead healthier and more fulfilling lives.

(Q) How would you define sexual abuse of children and what forms can it take?

(A) Child sexual abuse occurs when an adult, older adolescent, or another person in a position of power involves a child in sexual activities that the child cannot understand, consent to, or is not developmentally ready for. It is a serious violation of a child’s rights, safety, and trust. Sexual abuse can take many forms, including inappropriate touching, forcing or persuading a child to engage in sexual acts, exposing a child to sexual content, taking sexual images of a child, online grooming, or exploiting a child for sexual purposes.

(Q) What are the common psychological effects of sexual abuse on children?

(A) The effects vary from child to child, but common psychological consequences include anxiety, depression, fear, shame, guilt, low self-esteem, sleep disturbances, nightmares, emotional withdrawal, and difficulties trusting others. Some children may also develop symptoms of post-traumatic stress, struggle academically, or engage in risky behaviours later in life.

(Q) What signs should parents, teachers, and caregivers look for that may indicate a child is being abused?

(A) Warning signs may include sudden changes in behaviour, withdrawal from family and friends, unexplained fear of certain people or places, regression to younger behaviours such as bedwetting, sleep problems, declining school performance, self-harm, age-inappropriate sexual knowledge or behaviour, and unexplained physical injuries. While these signs do not automatically mean abuse has occurred, they should never be ignored.

(Q) Why do many child victims find it difficult to disclose abuse? Is it social stigma or fear?

(A) Many children do not disclose abuse because they are frightened, confused, ashamed, or worried they will not be believed. In many cases, the abuser may be someone the child knows and trusts, making disclosure even more difficult. Children may also fear punishment, family conflict, social stigma, or threats made by the perpetrator. The silence surrounding sexual abuse often creates additional barriers to seeking help.

(Q) How does sexual abuse affect a child’s emotional and social development?

(A) Sexual abuse can interfere with a child’s ability to develop healthy relationships, trust others, and feel safe in the world. Emotionally, children may struggle with feelings of fear, anger, sadness, or worthlessness. Socially, they may become isolated, have difficulty making friends, or experience challenges in forming healthy relationships later in life. Without support, the impact can extend into adulthood.

(Q) What role do counselling and therapy play in a child’s recovery?

(A) Counselling and therapy provide children with a safe and supportive environment to process their experiences, express their emotions, and learn healthy coping strategies. Therapy can help reduce symptoms of trauma, rebuild self-esteem, strengthen resilience, and support healthy emotional development. Early intervention often improves long-term outcomes and helps children regain a sense of safety and control.

(Q) How can society create a safer environment for children?

(A) Creating a safer environment requires a collective effort. Parents, schools, communities, religious institutions, and authorities must work together to educate children about personal safety and boundaries, encourage open communication, take disclosures seriously, strengthen child protection systems, and hold perpetrators accountable. Equally important is fostering a culture where children feel heard, respected, and protected.

(Q) Are boys and girls affected differently by sexual abuse?

(A) Both boys and girls can experience severe emotional and psychological harm from sexual abuse. While the core effects are often similar, boys may be less likely to disclose abuse due to societal expectations around masculinity and fears of being judged or misunderstood. Girls may face different social pressures and stigmas. Regardless of gender, every child deserves support, protection, and access to appropriate care.

(Q) What is the emotional journey of a child survivor from disclosure to recovery?

(A) Every child’s journey is unique, but recovery is often a gradual process rather than a single event. Following disclosure, many children experience a mix of emotions, including relief, fear, confusion, shame, anger, sadness, and anxiety. While some may feel relieved that the secret is no longer being carried alone, others may worry about the consequences of speaking out. As the child begins receiving support from trusted adults and mental health professionals, they can gradually develop a sense of safety and stability. Over time, therapy and a supportive environment can help them process the trauma, rebuild trust, strengthen self-esteem, and develop healthy coping skills. Recovery does not mean forgetting what happened; rather, it means learning to move forward without the trauma defining their life. With appropriate intervention, many survivors go on to lead healthy, fulfilling, and meaningful lives.

(Q) How prevalent is child sexual abuse?

(A) Child sexual abuse is unfortunately a global public health concern affecting children across all cultures, communities, religions, and socioeconomic backgrounds. Research consistently shows that many cases go unreported, meaning the true prevalence is likely higher than official figures suggest. According to international estimates, approximately 1 in 5 girls and 1 in 13 boys experience some form of sexual abuse before the age of 18. However, experts believe these numbers may underestimate the actual extent of the problem due to fear, stigma, and barriers to disclosure. It is important to remember that child sexual abuse can happen in any family, school, community, or institution, and awareness, prevention, and early intervention remain critical in protecting children.

Quote for the article:

“One of the greatest misconceptions about child sexual abuse is that it is rare or only happens in certain families. The reality is that it can affect any child. The responsibility for prevention and protection lies with all of us parents, educators, professionals, communities and society as a whole.”

By Zanita Careem

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