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;
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.
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.
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.
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
10. Never breast fed a child
Modified Risk Factors
1. Hormone replacement therapy
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
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)
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)
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.
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.
Usually, systemic treatment is advocated for patients with advanced breast cancer. There are several modalities,
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.
Gayathri’s flair for style and elegance
Fashion has the incredible power to transform not just the way we look, but also the way we feel. It can empower individuals, boost their confidence and enable them to express their authentic styles She the vision founder behind Silk Wraps by Gees understands this better than most. Her journey from a passion for fashion to the creation of Silk Wraps by Gees is a story of perseverance, sustainability and a desire to revolutinise the way for clothing.From her young days, Gayathri had a natural flair for style found joy in dressing up, experimenting with textiles, and exploring the art of style.The sarees worn by celibrities here are designed by Gayathri Jayasinghe of Silk wraps by Gees
Q : Your journey to success and tell us about yourself?
A : Well to tell you about my self I’m Gayathri Sedara Senarath Jayasinghe.
I’m very courageous, sincere, witty and chill person of 48 years of age.town is Matara. Being the youngest in the family of two brothers I was always surrounded by much love and guidance throughout my childhood.
I was educated in St’ Mary’s Convent, Matara and I excelled well in my studies with eight distinctions at O levels and district rank number one at A levels and I completed my LLB at the University of Colombo.
I’m married to Mangala Jayasinghe , and I’m blessed with two beautiful young daughters Ranthini and Yoneli.
I always had a passion for fashion. Although I could pursue a career in the field of law, the love for fashion in my veins led me towards starting my own business in the field of fashion.
Q : Can you tell us about your journey as a women founder in the fashion industry and how you navigated any challenges along the way?
A : I always had a passion for fashion. Being a LLB graduate I could have easily pursued a career in the field of Law but my love for fashion has always led me to move towards a career in fashion industry. Before I stepped into designing I owned a fashion store, salon and spa under the name Gees gallery. I had to close down that business for personal reasons and after five years I identified a different need in the market and I re entered the industry with a new name and face. Today my fashion store , Silk Wraps by Gees is a renowned haute couture Fashion Studio and my dream for the future is to take my label to greater heights that will create a benchmark in the Sri Lankan fashion industry. Further I have plans to expand my business to few other avenues as well specially food and beverages in the near future .
Regarding navigating through challenges I must admit that once I entered into the industry I understood that it was not as easy as it looked from the outset and not always a glamorous world as it is believed to be. Behind the glamour there is hard work, stringent deadlines, last minute changes and many sleepless nights. Apart from these I had to face many other challenges in the process but these are all part and parcel of any career. With determination and motivation were strong factors I was able to navigate these obstacles that came up throughout my journey.
Q : Your fashion boutique and its specialisation?
A : My fashion boutique is called Silk Wraps by Gees. I create exclusive custom fitted clothing made from high quality fabrics. They are sewn with close attention to detail and finished by capable and dedicated tailors and seamstresses under my direction and is made specifically for the specific wearer. My range of products include Indian Sarees and kandyan outfits embellished with intricate hand work, simple yet elegant and easy to wear. Modern saree gowns,voluminous or tight fitting evening silhouettes and elaborate lehengas, in addition to all types of bridal and retinue outfits are my forte.
Q : What inspired you to become a designer and when did you realise you had a passion for fashion?
A : As I mentioned earlier my love for fashion has always led me to move towards a career in this field. I have always loved the transformative power of dressing up hence my passion to this field of work. I believe fashion is a language in itself and a vessel to carry groundbreaking messages out into the world.
My passion for fashion dates back to my birth I guess .I still recall how I used to constantly nag my mother by standing next to her sewing machine when she used to make clothes for me. As a little girl of eight or ten years, until I’m totally satisfied with my fitting and design I used to get my mom to alter my dresses.
Q : Can you tell us about your creative process when designing clothes for celebrities? How do you decide what suits them?
A : There is no such special process when it comes to celebrities. Every client is equally treated and given equal priority and importance . I simply love to innovative designs when I have to decide what suits a client . When I see a piece of fabric that a client chooses I picture hundreds of ways in which I can transform it into an artistic piece of clothing and out of those I get the client’s opinion too to do the final pick . I really enjoy all of the creative, artistic and technical aspects of designing. I also believe how to convert my mental picture to the final product. Further more I have the ability to understand and visualise my clients requirements and thereby able to enjoy total customer satisfaction with the delivery of the end product.
Q : What was the inspiration behind turning an entrepreneur?
A : Being an entrepreneur is fulfilling . You can transform your dreams and ideas into reality and you can create something artistic for the wearer
Q : Your design are known for their intricate detailing and luxurious fabrics. How do you source materials, and what goes into creating a truly exceptional peace?
A: I source materials from many places. I have suppliers in Bombay , Chennai and Dubai. I have many places in Sri Lanka as well.
I put my heart and soul into my creative process. I really enjoy all of the creative, artistic and technical aspects of designing. I believe i can interpret every aspect of life using art as a tool and can always bring revolutionary changes into the trends. Basically I could tell a story using the integral parts of my creation yet my creations stand exceptional.
What have been your personal milestones ?
A milestone for me was when we opened our first fashion boutique – it gave me a lot of joy and it showed me that I can grow my business. When you start out, you don’t know where this journey will take you and you think that you will have to always tend to every aspect of it. But opening Silk Wraps by Gees showed me that we had become a brand which can grow in the years to come.
Oman National Day : Time for Gratitude and Loyalty
by Zanita Careem
Shangri-La hotel was the venue for the Sultanate of Oman Ahamed Ali Said Rashdi to host a reception to celebrate thier 53rd National Day of the Sultanate of Oman. A large and distinguished gathering among whom were heads from the corporate sector, diplomats from many countries stood attention to the national anthems of both countries of Oman and Sri Lanka after which Ambassador of the Sultanate of Oman to Sri Lanka spoke of the close ties between the two countries in elucidate confidence. Excerpts of the speech.
Thank you very much for being here with us to celebrate Oman’s 53rd National Day. Year after year, my country has celebrated this day. It is a chance for us to reflect on Oman’s past and draw inspiration for Oman’s future. We remember Oman’s renaissance and rally together to achieve further progress and development.
This year my priority is to reaffirm Oman’s unwavering support for the Palestinian people’s legitimate right to freedom, dignity, and self determination. Gaza is currently subject to brutal and random Israeli aggression. This aggression has killed tens of thousands of people, and injured many more, leaving their loved ones distraught. Civilian infrastructure, humanitarian facilities and homes have been destroyed. Hundreds of thousands are displaced. Let there be no doubt that this aggression has surpassed all justification. It flagrantly violates all human ethics.
Today, I call on all policymakers to listen to their conscience and do everything in their power to stop this senseless war immediately. I call upon everyone to do all you can to achieve peace, to support those civilians who are suffering, and to stop the violence. We must widen the passages for the entry of relief aid into Gaza. And we must intensify political action, to appeal to the international community to fulfill its moral and legal duty. History has proven the impossibility of a military solution to the Palestinian issue.
The only solution is to end the illegitimate Israeli occupation of Palestinian territories and establish an independent Palestinian state, with the borders of June 4, 1967 and East Jerusalem as its capital. This solution is in accordance with international law and the resolutions of the United Nations. And the establishment of a two state solution is the clear objective of the Arab Peace Initiative. Oman takes this opportunity to emphasize that we are dedicating all our energy and capabilities to delivering security and peace at all levels. This means achieving justice for Palestinians. In our view, it is a moral imperative to stand alongside the legitimate Palestinian cause. In today’s world, it is impossible to be blind to the suffering. You cannot look the other way. And we have a responsibility to act in pursuit of justice, in whatever way we can.
Oman will continue to use all means available to achieve peace, security, and justice.
The Sultanate of Oman and the Democratic Socialist Republic of Sri Lanka are traditional friendly countries with the relations dating back over many decades. The two countries established full diplomatic relations and set up Resident Embassies in each other’s capitals, Sri Lanka opened its Embassy in Muscat in 1987, and in 2013 the Embassy of the Sultanate of Oman was opened in Colombo. The two countries celebrated the 40th Anniversary of the diplomatic relations in 17 February 2021. Both countries always strive to strengthen political and diplomatic cooperation.
Oman National carriers, Oman Air and Salam Air operate daily flights from Muscat to Colombo with future expansion plan. There are many Sri Lankan companies investing in the Sultanate of Oman and likewise many Omani companies investing in Sri Lanka. Several memorandum of understanding have been signed between the two countries with many more in the pipeline.
Oman Vision 2040 was set up as a fundamental guide for development between 2021 and 2040. It integrates reality with objective foresight. It aims to elevate Oman to the ranks of advanced countries in the fields of economy, society, environment, governance, and institutional development.
As part of Vision 2040, Oman is pursuing national strategies for economic diversification, energy transition, and carbon neutrality by 2050. Oman aims to take a leading position in the world’s green hydrogen industry. It has the main components necessary: abundant land, renewable energy potential, and human resources. Our experience in energy production and export, our strong international partnerships, and our position close to global markets and trade routes, will enable us to excel.
Festive luxury with Minor Hotels Sri Lanka
An unparalleled host of festive celebrations and getaways at the Minor Hotels Sri Lanka, home to the luxurious Anantara Peace Haven Tangalle Resort, the enchanting Anantara Kalutara Resort, and the vibrant Avani Kalutara Resort said a press release.
There will be many extraordinary line-up of gastronomic journeys, elegant celebrations, and enchanting experiences, at each of thier unique resorts, during the holiday season.
Nestled on the southern coast of Sri Lanka, Anantara Peace Haven Tangalle will be secluded paradise for a world of dazzling festivities and blissful relaxation. The release said reunite with family over a festive high tea at the lobby, indulge in a delectable Christmas feast at Journeys on Christmas Eve or usher in the new year at a stylish soirée with a toast to new beginnings as the sky lights up with magnificent fireworks. Opt-in for an exclusively intimate cliff-side dining experience with your better-half, with live entertainment, on the 31st of December and relish an authentic, Italian 5-course menu while sipping on the finest Champagne stated the release. Anantara Tangalle is prepared to mesmerize you with a fusion of classic Yuletide traditions and refined revelry.
The release said ” One can enjoy a delightfully sophisticated journey this season with Anantara Kalutara Resort- where contemporary luxury meets Sri Lankan hospitality. Indulge in a decadent dinner surrounded by your family as your kids are kept occupied with a myriad of kids’ activities, opt-in for an intimate candle-lit dinner on Christmas Eve with your better half or waltz into the new year, a glass of champagne in hand, and behold the magnificent fireworks painting the tranquil lagoon with splendour. Be a part of our 7-day count-down to Christmas where each day takes you on a nostalgic or immersive festive experiences. From Christmas movies nights by the lawn, festive mixology lessons and poolside Yuletide quiz nights, the team is geared up to keep the resort buzzing with joyous activities.
The release said in December at Avani Kalutara Resort and embrace the sun, sea and the sparkle. Sip tropical cocktails by the pool, enjoy a delectable Christmas lunch on the 25th December with your loved ones or shimmer and shine at the New Year’s Eve countdown party as you end the year on a high note. The Christmas eve dinner buffet at #AvaniKalutara is an exceptionally festive affair with an unmatched international flair, live entertainment, and kids’ activities.
December brings friends and family from across the world together and each of our resorts offer state-of-the-art villas and suites with stunning views and upscale amenities for the perfect holiday unwind said the release.
The release said there will be a seamless blend of authenticity, luxury, seasonal warmth and genuine celebration as we invite you to join Minor Hotels Sri Lanka for a unique experience for your festive family reunions and warm gatherings.
About Minor Hotels : Minor Hotels is a renowned name in the world of hospitality, with a portfolio of luxurious properties that reflect our commitment to delivering exceptional experiences. We believe in turning moments into memories, and our resorts in Sri Lanka are no exception.For reservations and more information, please visit our respective websites. Embrace the joy of the season with Minor Hotels Sri Lanka, where every moment is a celebration.
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