FEMININITY DOES MATTER

 Women’s health care has taken a major leap in the kingdomwith the opening of the first ‘one-stop’ Breast Clinic at Bahrain’s newstate-of-the-art King Hamad University Hospital (KHUH) in Muharraq.

All residents of Bahrain can take advantageof the clinic, which is open on Thursday mornings and aims to provide patientswith a complete breast check-up with results on the very same day.

The clinic is led by Dr Sara Al Reefy,consultant breast surgeon who is also the first Arab female surgeon who has aBreast Oncoplastic Fellowship from the UK, along with a team of doctors, nursesand health care specialists who include consultant radiologist, Dr Majid Dowaikand consultant pathologist, Dr Khalid Ahmed Al Sindi.

Articulate, determined andhighly-motivated, Dr Sara, who opted to work in her home country despitereceiving a highly-tempting job offer from a leading breast cancer hospital inLondon, said: “Statistics show that the rate of breast cancer in Bahrain isvery high and we want to support the various screening campaigns run in thecountry with a comprehensive unit with trained staff and excellent facilities.

“God forbid, if you discover a lump on yourbreast you will be on the go, eager to get an answer immediately, or as fast asyou can. We don’t want to make a patient’s anxiety worse by wasting her timethrough a series of appointments.

“At the breast clinic we go by what we call‘triple assessment’. A patient will be seen and examined by a breast surgeonand on the very same day, she will be referred to the radiology departmentwhere they will undergo a mammogram or ultrasound or a magnetic resonanceimaging (MRI) on the basis of her age and physical findings.

“If there is need for a cytology or biopsy(a tissue sample taken for testing) there is a mobile cytology unit available.So, if a patient is having the scan and the doctor suspects something, thecytology is available at the same time.

“Our pathologist will be there to look atthe slides and give the results. After which the patient can come back to thebreast surgeon who will explain the results and offer further advice.

“We are a new hospital and we are trying tobring in expertise and offer a full spectrum of services with internationalstandards of quality and qualification. We want to make a difference and wewant our work to count.

“It may be a life-changing experience butwe are looking to cure a woman of breast cancer with procedures that avoiddisfigurement wherever possible.”

Experts say that breast cancer can becompletely cured if detected in the early stages and a screening including amammogram is advised for every woman over 40 and even earlier if there is afamily history of breast cancer.

The doctor said that any woman above theage of 40 can visit the clinic if they have benign lumps, small lumps and bumpsin the skin, nipple discharge or any other symptoms. It is also for women whohave no symptoms or even for someone who wants to discuss their screeningstrategy to be on the safe side.

There is one per cent chance of men havingglandular breast tissue and suffering breast cancer too, especially if theyhave a family history. They can also attend this clinic.

While the one-stop facility reduces thestress and burden on a patient for making repeated visits to the hospital, theresults of every check are stored electronically and can be reviewed on anannual basis.

KHUH is also the first and only centre inthe kingdom that is providing skin sparing mastectomy and implant-basedimmediate breast reconstruction, which means that a woman who has to have amastectomy need not lose her entire breast.

Dr Sara said: “You remove all the breasttissue from inside but we leave the skin envelope. We replace the breast tissueimmediately with an implant or tissue flap from the back so that a woman wakes upafter a surgery without the trauma of losing her breast.

“With this procedure, patient satisfactionfor a woman is very, very high. The shape is acceptable. She can still have acleavage. You don’t have to wear fillers and you can look good in your lingerieand swim suit. Most importantly, it does not stop her from enjoying her normallife and femininity.”

Future plans at KHUH include setting up anoncology facility so that a patient detected with breast cancer can followsurgery with cancer treatment such as chemotherapy and radiotherapy. 

The breast clinic is also affiliated to theLondon Breast Care Centre in the UK so cases requiring a second opinion orpatients opting for treatment abroad can be directed to a trusted centre. DrSara said: “When we have affiliations with an institution we trust we do notlose touch with the patient.

“We can also take second opinions through apicture archiving and communication system (PACS), a medical imaging technologyprogramme that allows us to transfer high quality images to another centreabroad for referrals.

“You get a doctor from London Breast CareCentre, which is a top facility for breast care, to give an immediate secondopinion. It is the beauty of using technology in our set up.”

The hospital is equipped with digitalmammogram machines, which is recommended for a digital high resolution imageand is said to be less painful. “You can detect very small lesions even beforethey get to be cancerous,” said Dr Sara. “The aim is to detect it as early aspossible because there is a 98 per cent complete cure rate if you receive theappropriate treatment at an early stage.”

A highly-sophisticated PET/CT scan machine,which is a specialised medical imaging device that can detect cancer cells bylighting up areas of abnormality, is also available in the hospital. It isconsidered the latest technology in diagnosing cancer.

Advising women to take advantage of theexcellent medical facilities, Dr Sara said: “In our society many women arescared of breast cancer and my message to all of them is that breast cancer, ifdetected early, is curable.

“It is not a death sentence anymore. Wewant women to let go of the fear and change their attitude towards the disease.

“There are many women who will not report alump fearing that she will lose her breast and then her husband will divorceher or marry another woman. I would advise husbands to be supportive andencourage their wives to get their checks done regularly.”

Dr Sara graduated from the Arabian GulfUniversity and underwent training in general surgery at Salmaniya MedicalComplex.

She received her breast surgery specialisttraining from St George’s University, UK and Oncology Fellowship from LondonBreast Institute. She was funded by a Ministry of Health scholarship tocomplete her education abroad. She has published 10 papers on genetics andmolecular biology of breast cancer in the last three years.

She said: “We don’t have many femalesurgeons in the region and being a woman in a field dominated by men we have tostruggle to do what we do. So I wanted to help women and give something back tosociety.

“I see lots of women who do not want toexpose their bodies because of the tradition and culture. They do not want toconsult male doctors although there are some great male surgeons in the countryworking in this field.

“Many feel at greater ease if there is awoman doctor. My goal is to detect breast cancers in the country at a very,very early stage. We are also hoping to increase the value of research becausewe have a high rate of cancer and we have to explore the causes.”

According to the 2007 GCC (GulfCo-operation Council) cancer registry, breast cancer accounted for 37.1 percent of all incidences of cancer in Bahrain.

In the two-year period – January 1998 toDecember 2000 – 11,396 breast cancer cases were reported across the region. Itwas noted that 11.8 per cent of all cancer cases in the GCC, and 23.5 per centof cancer cases among females, were breast cancer.

The report also stated that breast cancerwas found to be the most common cancer in the region, stating: “Breast cancercontinues to increase over the last 10-year period among GCC women. The totalnumber of newly-diagnosed cases increased by 20 per cent between 1998 and 2000.”

KHUH is a university hospital with acapacity of 311 beds and boasts 1,731 members of staff. It is affiliated to theBahrain Defence Force.