Home' Trinidad and Tobago Guardian : May 26th 2013 Contents B1
RHONDA KRYSTAL RAMBALLY
T&T has catapulted to the 21st
century with respect to its treat-
ment and care of breast disease and
breast cancer, says surgical oncol-
ogist and oncoplastic and recon-
structive breast surgeon Dr Rajen
There s now a breast surgery unit
and a breast centre which offer first-
"More women are now proactive
and are more educated. There s less
cultural taboo and we are a far more
open society than 50 or 60 years
ago," Rampaul said.
He expects that "more and more"
breast cancers will be diagnosed ear-
lier and there will be an increase in
numbers, but thinks that women
will be in need of greater care.
Hollywood actress Angelina Jolie
announced two weeks ago that after
discovering she was genetically pre-
disposed to cancer she had a pre-
ventive double mastectomy.
A mastectomy is surgery to
remove a breast. It is performed
either to treat or to prevent breast
cancer. Only high-risk patients have
surgery to prevent cancer.
Rampaul also performs nipple
sparing mastectomy which "saves
everything on the outside." The
patient s breast skin, areola and nip-
"I rebuild the patient on the inside.
"The strength of those decisions
come from women who have seen
somebody or lived with someone
who has suffered from it.
"These decisions become straight-
forward for them."
On May 16, Rampaul was inter-
viewed at Pink Hibiscus, Woodbrook,
where he is the medical director.
He said he was receiving a lot of
questions about genetic risk and
breast cancer in young women.
He said, "I think breast cancer in
Trinidad is a big problem. One of
the problems is that it is much more
common in young women in their
"The other problem is that we are
seeing very few cases being diag-
nosed in the last five years via
screening which is being detected
very, very early. So most cases are
detected at a later stage which is not
T&T as good as any
first world country
Rampaul boasted that he per-
formed all forms of breast and breast
cancer surgeries which includes pro-
phylactic, reconstructive and sentinel
lymph node biopsy.
Since he returned home three
years ago he s seen close to 5,000
He said, "I think we ve catapulted
to the 21st century.
"I have worked hard to introduce
many new, pioneering techniques
and many of the things that I got
involved in, I have introduced, as far
as I know were not on the ground.
"I could tell you that there was
never a breast surgery unit before,
there was never a breast centre before
and I am proud to say that the stuff
we offer women are the very things
that celebrities get up on TV and
say they have had...that women can
get in this country.
"There s nothing in breast disease
or breast cancer not offered locally
But raising awareness is a tough
job, he said.
He said one of the biggest prob-
lems was cultural taboos and that
lack of awareness which makes
women put off going to deal with
"Statistics show that five per cent
in five years of breast cancers are
detected at the stage of one to two
which is at the screen...I mean 95
per cent are coming through at a
point where it shouldn t be coming
through," he said.
Asked if T&T was as good as any
first world country, Rampaul replied,
"Easily I would say so. Absolutely.
He sees many women who have
cancer either on one side who choose
to have preventative surgery on the
Many women test positive for
BRCA (breast cancer). There are two
genes---1 and 2.
He said, "What happens is that
when these genes get defective they
cannot allow the breast tissue to
repair itself properly. So the problem
is when there are defects in the
"Basically it can t make proteins
that help it to repair properly and
this inability to repair is called can-
BRCA1 is linked strongly to breast
cancer. There is an 80 per cent risk
if there s an abnormality in the gene
but a woman also carries the risk of
Whereas in BRCA2, there is a
smaller risk of breast but higher risk
of ovarian cancer.
Rampaul said, "You can tell pre-
dictions of whether a woman carries
a BRCA gene by doing a pedigree
analysis and then you can use soft-
ware to tell whether the patient has
a high risk compared to the popu-
lation, or no risk at all."
In an article titled A Tale of Two
Titties, Rampaul said there were sev-
eral approaches to assessing what
can be done with a patient once
she s deemed to be high risk.
One is to do nothing and accept
that cancer can develop, consider
doing a detailed assessment and sur-
veillance which would be more fre-
quent mammography, breast MRI
or even consider surgery.
He sought to clear the miscon-
ception that oncology surgery with
reconstructive surgery of high quality
does not compromise cancer care.
"There s been a lot of research
and data on that. Ms Jolie underwent
things are safe.
"They have to be done by experts
who know what they re doing, who
have good rates of success and low
rates of complications."
Rampaul said the mastectomies
are done and while the patient is
asleep, reconstruction begins.
"When she awakes, she has her
breasts and cleavage. She s not
Women more proactive in
breast cancer fight---oncologist
• Get screened if over 40
• Get a digital mammogram, not
• See a specialist if you have a
• Eat healthy
• Exercise regularly
"I think breast cancer in
Trinidad is a big problem. One
of the problems is that it is
much more common in young
women in their mid 40s.
"The other problem is that we
are seeing very few cases of
being diagnosed in the last
five years via screening which
is being detected very, very
early. So most cases are
detected at a later stage
which is not very ideal."
About Dr Rampaul:
Rampaul graduated in general
surgery and surgical oncology from
the University of Nottingham, and
plastic and reconstructive surgery
from the University of Newcastle.
He's completed an oncology fellow-
ship at the University of Kent
awarded by the European Society of
Surgical Oncology and has written
100 scientific publications on breast
He's also medical director of Pink
Hibiscus Breast Health Specialists
and head of the breast cancer sur-
gery unit at St James Medical Com-
intuitive art ---Page B3
my food ---Page B6
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