Breast diseases are a leading disorder of females world-wide. Breast cancer being at the top, benign disorders are encountered not infrequently.
Breast screening services are an essential component of any facility claiming to foster Women’s Health and well-being.
Pakistan being one of the few countries in Asia with highest incidence of breast cancer, voids in in Research for in-depth study of this disorder imposes a moral obligation on health care services to delve into seeking novel/ existing risks contributing to high prevalence.
South City Hospital has established itself as a facility envisioned with quality care.
With ready access to the premises, both by patients and physicians, there emerges a need to modify its outward visage beyond therapeutic services.
A major incentive to achieve this is non-financial, prorating time between clinical care, training and research.
Henceforth Breast Services is foreseen to be not just a service providing surgical consultation and treatment, but establishing an excellent comprehensive program encompassing Awareness, Screening, MDT planning of Oncological care, Cancer Survivorship, Data Base for Research. Training is foreseen to be a visible entity both of Medical and Ancillary personnel.
Early detection of breast cancer is now well established as a key factor in improving survival. With a deft of awareness in masses, cases present at a late stage. Regular educational activities to enhance in print and informative sessions are required. At least annual events marking with Breast Cancer promotional periods would be required.
Besides catering to routine screening of women with average risk, service for screening of high risk women needs to be established. This would entail Genetic Counselling and Screening for Mutation.
It is foreseen that this would yield high patient volumes commensurate with state of art imaging and diagnostic services for rapid One Stop Clinic processing.
To secure top crust competitive entity, Digital mammography with Tomosynthesis. Ultrasound and Breast MRI are the best options.
To complement early detection, image detected lesions warrant expertise of image guided biopsy inclusive of Stereotactic techniques. Futuristic vision would deploy MRI guided biopsy facility also, currently not available in Pakistan.
HIGH RISK SCREENING SERVICE
Rapid advancement to detect mutations over and above BRCA I & BRCA II for Hereditary syndromes is the call of the day. With limited Genetic Counselling services locally, innovations through Telemedicine consultations can be offered. With risk stratification individual patients for screening, chemoprevention can be planned.
Surgical expertise with current practices encompassing Breast Conservation, Ablative and Reconstructive procedures are the essentials.
Oncoplastic Breast Conserving surgery are undeniably want of the day. Ablative procedures should be complemented with Immediate or Delayed Reconstructions
Nipple sparing, Skin Sparing Mastectomies with well selected patients offered reconstructions should be the target. Support services for those forfeiting reconstruction, prosthetic replacement to sustain body image should be ensured.
Multi disciplinary Teamwork via Tumour Board is the back bone of comprehensive cancer care. Both for new entrants as well as members of survivors group. This facility should cater to both patients as well as trainees aspiring in the field of Breast Cancer Care.
As foreseen, a State of Art facility should be fully encashed to benefit trainees in Clinical as well as Ancillary service. With recent approval of Breast Fellowship by CPSP trainees would seek affiliation with experts to enhance their knowledge and clinical acumen
Mandatory to providing therapeutic care for cancer patients, a survivorship service should also be made available for in-house and external survivors.
As the service develops a prospectively maintained data base is essential to study disease patterns as well derive research directions.
To accomplish the projected tasks, significant investment of person hours and work force would be required. It is foreseen that a well-planned strategy should fruition the outcome.