"Cancer affect all of us, whether you’re a daughter, mother,...

"Cancer affect all of us, whether you’re a daughter, mother, sister, friend, co-worker, patient. "

Jennifer Aniston

My friends

In 440 BC, the Greek historian Herodotus describes the first breast tumour operation on Atossa, Queen of Persia and daughter of Cyrus the Great. The operation was carried out by Democedes, a Greek slave. The procedure is believed to have been successful, temporarily. We can only imagine the trauma and the pain; no anaesthetic; no antisepsis.

Oh my, how things have changed! The surgery now is certainly less traumatic. The anaesthesia, the magic of unconsciousness, has reduced what must've been horrendous pain. With the patient rendered unconscious, the surgery is certainly much less traumatic for the patient, and probably for the surgeon. The discovery of anaesthesia and the germ theory with antisepsis in the 19^th century, and antibiotics in the 20^th century have transformed surgery, greatly reducing the operative mortality and trauma. But, in terms of the breast cancer itself, are the results as dramatically changed. The operations are often successful, but very often, temporarily.

You see my friends, though much refined in terms of the actual process, the problem of cancer surgery remains the same. To paraphrase a famous slogan; “It’s the biology of cancer stupid.” The biology of the cancer has not changed since Democedes operated on Atossa. Atossa’s cancer recurred, and she died. But we can’t blame Democedes. He did not have cell theory. He could not tell if he left cancer cells behind. But, 2,500 years later, things are very different. But are they? The biology of cancer cells is most definitely unchanged. Two and a half thousand years later, we have remarkable macro imaging to diagnose the presence of lumps which could only have been felt by palpation or when they broke through and ulcerated the skin. We now have the technology, which Democedes could not have dreamt of. We can see the cancer cells at operation. The cells can now be seen with Optiscan’s confocal laser endomicroscopy(CLE). So why oh why do they continue to operate blind. Tiresias can suggest a few reasons, most of them a touch insulting. Tiresias is an admirer of Diogenes of Sinope, Diogenes the Cynic, and can only suggest reasons which Diogenes would suggest. Would checking for cancer cells left behind slow the surgeon. Well yes and no. Not if the surgeon is using frozen section biopsy. It would significantly speed the operation. But because frozen section is flawed, and slows the procedure so much, most breast surgeons don’t use it. They prefer a quick lumpectomy, and then reoperate if the excision pathology or post operative scans show tumour left behind. Tiresias will leave it to his friends to explain why this goes on.

We know that the Optiscan and ex vivo breast cancer study which should immediately demonstrate that this should be applied to every breast cancer surgery. Unfortunately, in our current medico-bureaucratic climate, Tiresias suspects that to meet with the bureaucratic requirements of the FDA, the TGA et al, women will continue be subjected to suboptimal surgery and cancer cells will be left behind. They will be re-scanned, re-operated irradiated and have chemotherapy. At the very least call focal laser – microscopy would significantly reduce the current 30 to 40% repeat surgery rate. Where are the cancer foundations? where are the patient groups? Where is all this money that is being raised for breast cancer going? Linus Pauling once said; "Everyone should know that most cancer research is largely a fraud and that the major cancer research organisations are derelict in the duties to the people who support them". Well Linus was a genius a dual Nobel Prize winner and had some provocative ideas, but one wonders if he got it absolutely right in this, as he was in most other things. Optiscan, over to you.