From Diagnosis to Recovery: The Breast Unit Pathway and Advances in Oncoplastic Breast Surgery in Bangladesh
Authors: Dr. Ali Nafisa, FCPS; A/Prof. Md. Mokhlesur Rahman
Institution: Labaid Cancer Hospital and Super Speciality Centre ,Dhaka
Introduction
Breast cancer care in Bangladesh has evolved over the past five years, with increasing emphasis on early diagnosis, breast conservation, oncoplastic surgery, and multidisciplinary management. Dedicated breast units are contributing to the integration of diagnostic imaging, image-guided biopsy, surgical treatment, reconstruction, and follow-up care. Breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB) are increasingly being incorporated into the management of appropriately selected patients, supporting a shift towards less extensive surgical interventions while maintaining oncological safety. The study describes the development of breast unit services in Bangladesh over the past four to five years, highlighting diagnostic pathways, trends in breast-conserving surgery, sentinel lymph node biopsy, and oncoplastic breast surgery.
Methods
This study evaluated the development of breast unit services in Bangladesh, focusing on diagnostic pathways, image-guided localization of non-palpable breast lesions, breast-conserving surgery, sentinel lymph node biopsy, and oncoplastic breast surgery. Clinical service data and surgical outcomes from the relevant clinical experience were reviewed to describe developments in diagnostic and treatment practices.
Results
Over the past five years, 14,096 patients presenting with breast-related problems were evaluated, and 1,869 patients were diagnosed with breast cancer, representing 13.26% of the total. Between December 2018 and June 2023, a separate clinical series included 747 patients evaluated for non-palpable breast lumps, of whom 512 underwent core needle biopsy and 152 were diagnosed with malignancy. Image-guided localization, wire-guided and ultrasound-guided wide local excision, therapeutic mammoplasty, and implant-based reconstruction contributed to the expansion of breast-preserving treatment options. Over the past four years, 446 breast cancer operations were performed, of which 377 were breast-conserving surgeries, representing 84.53% of the reported surgical cases. Sentinel lymph node biopsy was performed in 252 of 429 patients with breast cancer (58.74%). In a series of 19 patients undergoing level II oncoplastic breast surgery, all achieved clear surgical margins, with satisfactory cosmetic outcomes reported. These clinical data demonstrate the growing role of breast-conserving approaches, sentinel lymph node biopsy, and oncoplastic techniques within the reported clinical experience. In appropriately selected patients, breast-conserving surgery can preserve the breast while maintaining oncological safety, and sentinel lymph node biopsy can support axillary staging while reducing the need for more extensive axillary surgery in eligible patients.
Conclusion
The development of dedicated breast units has contributed to advances in breast cancer diagnosis and surgical management within the reported clinical experience in Bangladesh. The observed breast-conserving surgery rate of approximately 84.5%, together with the use of sentinel lymph node biopsy and oncoplastic techniques, reflects progress towards individualized, less invasive, and cosmetically favorable treatment. Continued investment in specialized breast units, trained breast surgeons, diagnostic facilities, radiotherapy services, and multidisciplinary collaboration is essential to improve access to evidence-based care and enhance functional, cosmetic, and oncological outcomes.
