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Breast Cancer…The Positive Strokes~ Dr. Thomas Varghese, St. Joseph’s Cancer Hospital And Research Centre

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Dr. Thomas Varghese, a distinguished Surgical Oncologist and Reconstructive Surgeon, brings a wealth of expertise to the field of oncology. With qualifications including MS, FICS (Oncology), FACS, and recognized as an MCh teacher by the Medical Council of India, Dr. Thomas Varghese currently serves as the Medical Director and Head of the Cancer Division at St. Joseph’s Cancer Hospital and Research Centre in Kochi. Dr. Thomas Varghese is deeply committed to advancing cancer treatment and patient care, contributing significantly to the medical community and providing hope to numerous patients.
In his insightful article, Dr. Thomas Varghese addresses the challenges posed by breast cancer, emphasizing the psychological impact and societal misconceptions that often accompany a diagnosis.

“Diagnosis of breast cancer can fall like a bombshell into the life of one out of five women in their lifetime” is the tagline that WHO is spreading across continents. Definitely, there is an increase in incidence in the Western world but changes in lifestyles, incorporation of Western lifestyles in own life have changed the scenario in the Third World too. This is shown as an increase in breast cancer incidence even in younger women.

The breast cancer issue is compounded by several factors. Since less than 30 years is no more rarity in cancer incidence, poverty, lack of insurance coverage, and presentation in the locally advanced or metastatic stage are all not uncommon, and many times non-oncologists, treat cancer patients with bizarre end results.


Diagnostic accuracies, and treatment nuances, especially surgical, medical and immune-oncology have progressed in leaps and bounds, however, it’s sad to observe that the percentage of individuals presenting in the advanced stage has not dwindled and remains to the tune of over 50% and death rates also approx 50%.


Apart from the factors mentioned what else could be the driving force for such late presentations?
When we ask breast cancer victims this question, 99% of women in the current generation will have only one answer, “fear of losing breasts”. The wrong information that has percolated in the minds of ordinary women, and even educated lot is in every breast cancer there is a need to “chop breasts” for cure. This fear is circulated far and wide hence many women even refrain from undergoing a screening program, unlike their Western counterparts, to detect cancer in the early stage. But once the cancer diagnosis is disclosed, they are the ones who become hysterical. On several occasions, non-oncologists, and quacks utilize this soft corner and offer unscientific treatments to further push the patients to a non-treatable stage.


Well-educated ladies also will follow this suit and finally perish from a curable status. Since long time in dedicated cancer centers or units, surgical management of breast cancer in the operable stage has been handled by cancer surgeons and later from mastectomy, the concept of BCT, Breast Conservation Therapy evolved.
Cosmetic issues regarding the same forced clinicians to think of better options in the local management of breast cancer and thus “Oncoplastic” procedures evolved. Onco means Cancer, and plasty means to mould.


Breasts are considered as a separate organ in itself, an organ of beauty sign of sexual attraction, bilateral symmetry, and an organ providing confidence to a lady in addition to the primary function of lactation.
Hence such a procedure should offer bilateral symmetry, confidence, sexual attraction, and overall better adjustments with society, workplace, and career.


Oncoplasty urges the cancer surgeon that primary priority is on cancer and the surgical procedure should be oncologically acceptable which can help in avoiding local disease recurrence. There cannot be any corner cutting which is the pre-requisite. The resections are also planned based on the primary evaluation of breast volume tumor volume ratio by an expert, dedicated, breast ultra sonologist and based on the tumor aggressiveness as per core biopsy. We plan reconstructions only when the Frozen section report by the pathologist tells that all the margins of resections are free of disease.

The beauty of this procedure is reconstruction is planned as per resection which may differ from original pre-operative planning.
Although in dedicated centres this procedure has become the norm, the majority of the patients who are evaluated by non-oncology specialists, like primary physicians, gynecologists, and surgeons may not disclose such progress with the new subjects whom they evaluate.
This will leave behind the patient with a mastectomised flat chest, even though such a surgery as per modern studies is inferior to oncoplastic surgeries.
Breast cancer affects not only the body or physique but the mental trauma, anxiety, and agony is far beyond imagination. The first Question a lady with a diagnosis of breast cancer will ask to herself will be “Why God oh me? What in me has precipitated the cancer? Fate Karma?”
Then this will lead to denial, depression, anger, fear of recurrence, and finally “acceptance”. Mourning over the lost breast adds to trauma and external pads will never be incorporated into the body image.
Most of these women especially the young may have just entered into the professional career ladder, some may be just married, some unmarried, and others may have postponed pregnancy for a career, and getting a mutilating mastectomy further destroys the morale.

Hence Oncoplasty will be a boon considering the fact that breasts are a sign of beauty, symmetry and feminity. Offering a normal-looking, and feeling breast, on many occasions even preserving nipple and areola will help the lady to get adjusted to the further treatments with increased confidence.
A dedicated, and compassionate cancer surgeon, well trained in plastic and oncoplastic surgery is the pre-requisite to an excellent cosmetic outcome.

The emergence of a perforator artery-based flap, a local flap, has emerged as one of the versatile options to offer the best oncoplastic surgery for tumors localized in most of the quadrants of the breasts.
Morbidity to the “donor” area of the body like the back in the LD flap, lower belly in the TRAM flap, or gluteal region in the microvascular flap are well known. In perforator artery-based local flap that issue is avoided.
Common perforator arteries and flaps that are employed for such novel reconstruction procedures include, Lateral Intercostal Perforator Artery Flap (LICAP), Anterior Intercostal Perforator Artery Flap (AICAP), Combination of both (LICAP+AICAP), Middle Intercostal Perforator Artery Flap (MICAP), LICAP +AICAP combination could be used even for Mastectomy with Immediate Reconstructions (MIBR). Whereas, LICAP flap in general is the preferred flap for reconstruction of tumors located in the lateral, inferior, or central quadrants, after wide resections.


These novel concepts have paved a new way to address breast cancer management, in a different perspective to offer better confidence in the minds of women with breast cancer so that they could get solace at the earliest. It offers a better quality of life and confidence. Avoidance of morbidity to the donor area is definitely a boon because no scar marks of reconstructions(stigma) will be visible on the body.
Management of breast cancer has changed a lot over a period of time as technological improvement and understanding of genetics have become an integral part. Breast cancer is a lifestyle disease in more than 90% of the cases. Around 10% have a genetic predisposition. BRCA1, BRCA11, HER2, triple negativity, etc all have strong genetic links.
Obesity, lack of exercise, high fatty diet, red meat, lack of breastfeeding, late pregnancies, contraceptive pills, and fertility treatments with estrogens are all said to influence.

If one aims to have a 100% cure, early detection of cancer is a must. Breast self-examination (BSE) should be popularized which could pick up one cm-sized tumors. Ultrasound breasts and mammography could detect cancers in non-palpable stages. Another important fact is such mammographically detected tumors could be managed with wire localizations and scarless surgeries with no adjuvant treatments.
Personalized treatments, immunotherapy, and targeted treatments in addition to conventional treatments like chemotherapy or radiation after an oncoplastic surgery have paved the way to better cure rates.
Breast cancer is a curable disease in the majority of the early detected cases. Beauty could be restored. Why can’t we have a concerted effort to conquer the number one killer? Media has a large role to play in spreading the good news.

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Switzerland: Police shoot dead axe-wielding hostage-taker on train

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In Switzerland, police intervened in a hostage situation on a train near Yverdon, resulting in the fatal shooting of a man who had taken 15 passengers captive. The perpetrator, reported to be a 32-year-old asylum seeker from Iran, armed himself with an axe and a knife before coercing the train driver to stop and enter the carriage with the passengers.

Despite attempts by authorities to negotiate with the hostage-taker, who spoke both English and Farsi, their efforts proved unsuccessful. As negotiations faltered, police, including a special unit from Geneva, surrounded the train and initiated communication with the perpetrator. However, after several hours, the situation escalated when the hostage-taker moved away from the passengers, prompting law enforcement to take decisive action.

When the hostage-taker attacked the police during the intervention, officers responded by using firearms to protect both the hostages and themselves. Regrettably, the confrontation resulted in the fatal shooting of the perpetrator. The motives behind the hostage-taking remain unclear, although witnesses reported that the perpetrator appeared visibly distressed during the ordeal.

Following the resolution of the hostage situation, authorities are providing support to the hostages and their families through the Swiss health service’s psychological department. The man responsible for the incident was originally from Iran and had been residing in an asylum seeker center in Neuchatel. While hostage incidents are rare in Switzerland, past occurrences have been recorded in various settings, including banks and businesses, underscoring the importance of effective law enforcement responses to such crises.

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Ireland women’s basketball team refuse to shake hands with Israel

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During a EuroBasket 2025 qualifier in Riga, the Ireland women’s basketball team declined to shake hands with the Israeli team before the match. Israeli player Dor Saar accused the Ireland team of being “quite anti-Semitic,” which Basketball Ireland strongly refuted, calling the comments inflammatory and inaccurate.

Before the game, the Ireland players stood for their anthem beside their bench rather than at the center court, a departure from the usual protocol. Despite concerns expressed by Irish players and pressure to boycott the fixture due to the ongoing conflict in Gaza, the match proceeded. Basketball Ireland reported Saar’s comments to Fiba Europe and explained their decision not to participate in traditional pre-match rituals.

Earlier, Basketball Ireland’s CEO warned of heavy fines and expulsion from the competition if the team boycotted their matches with Israel, stating it would harm women’s international basketball for years. Saar’s remarks were made in an interview on the Israeli Basketball Association’s website, where she suggested that the Irish team’s perceived animosity fueled a desire for a strong performance from Israel.

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Finnish presidential candidate surprised at renewed focus on his sexuality

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Finnish presidential candidate Pekka Haavisto has expressed surprise and dismay at the sudden focus on his sexuality in the final days of campaigning before Sunday’s election, particularly by journalists from the national broadcaster, Yle. Haavisto, who could become Finland’s first Green and first gay president, noted that while his sexual identity was discussed in his 2012 campaign, it hadn’t been a central topic this time until the second round of voting.

He questioned why his sexuality had become an issue now and suggested that some journalists’ active pursuit of the topic raised questions. This comes after a poll found that a third of voters wouldn’t support him because he is gay. Despite this, Haavisto has been gaining ground on his rival, Alexander Stubb, according to the latest Yle poll, though he still trails 46-54%.

The campaign has also seen debate over nuclear weapons, with Haavisto opposing their storage in Finland, while Stubb advocates for a change in the law. Both candidates have diverse support bases, with Stubb favored among pensioners and Haavisto drawing support from younger voters, making turnout crucial for him.

As the campaign enters its final days, Haavisto continues to engage with voters, particularly focusing on female and young voters. If elected, he aims to prioritize addressing the climate crisis on the global stage, seeking to form an informal coalition to pressure international bodies for urgent action.

Haavisto is surprised by the sudden focus on his sexuality in the campaign’s final days, believes it to be an artificial topic, and remains committed to his platform of climate action and engagement with voters ahead of the election.

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Putin challenger Boris Nadezhdin barred from Russia’s election

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Russia’s election commission has rejected Boris Nadezhdin, an anti-war challenger, as a candidate in the upcoming presidential election, citing flaws in the signatures submitted with his candidate application. Despite his efforts to contest the decision, the commission upheld its ruling. Nadezhdin, however, vowed to challenge the decision in the Supreme Court.

The commission stated that over 9,000 signatures out of the 105,000 submitted by Nadezhdin were invalid, leaving him just short of the required 100,000 valid signatures. Nadezhdin expressed frustration, claiming widespread support and citing polls that positioned him as the second most favored candidate after Putin.

Nevertheless, the commission chairwoman, Ella Pamfilova, declared the decision final, suggesting that Nadezhdin could pursue legal action if he wished. The election is scheduled for March 15-17, with Vladimir Putin expected to secure victory as opposition candidates perceived as Kremlin-friendly dominate the race.

Despite the setback, Nadezhdin remained resolute, asserting that his candidacy was a crucial political decision. He had garnered significant support, amassing over 200,000 signatures nationwide. Nadezhdin, known for his appearances on state-run TV as an anti-war figure, emphasized his commitment to ending the conflict in Ukraine and normalizing Russia’s relations with the West.

Although his candidacy initially faced skepticism from some opposition figures, prominent voices like Alexei Navalny and Mikhail Khodorkovsky endorsed Nadezhdin’s campaign. However, pro-Kremlin commentators accused him of being a pawn for “Ukrainian Nazis,” reflecting the divisive nature of his candidacy.

Nadezhdin’s bid for the presidency echoes previous attempts by candidates to run on an anti-war platform, underscoring the prevalent sentiment of opposition to Russia’s involvement in Ukraine. Despite being barred from the race, Nadezhdin’s campaign resonated with segments of Russian society, particularly those affected by the conflict.

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French actress Judith Godrèche accuses director Benoît Jacquot of historical rape

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French prosecutors have launched a preliminary investigation following actress Judith Godrèche’s complaint against filmmaker Benoît Jacquot, alleging historical rape. Godrèche, now 51 years old, claims that Jacquot, aged 77, raped her when she was just 14 in 1986, with subsequent offenses occurring during a relationship that extended into the 1990s. The complaint was officially submitted by her lawyer to the Juvenile Protection Brigade in Paris.

Godrèche, who gained recognition for her roles in Jacquot’s films such as “The Beggars” (1987) and “The Disenchanted” (1990), had previously hinted at their relationship in an autobiographical TV program titled “Icon of French Cinema.” Last month, she publicly identified Jacquot on social media after watching a documentary where he discussed his relationship with an adolescent.

In response to the allegations, Jacquot has firmly denied them, as stated in an interview with Le Monde newspaper. He has chosen not to provide further comment, reiterating his stance from the newspaper.

Godrèche, recognized for her performances in films like “The Overnight” (2015) and “The Spanish Apartment” (2002), has a notable career in French cinema. Meanwhile, Jacquot has been directing films since the mid-1970s, with his 2012 film “Farewell, My Queen” premiering at the 62nd Berlin International Film Festival.

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Former Irish PM John Bruton dies after long illness

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Former Taoiseach John Bruton, a prominent figure in Irish politics known for his contributions to the Northern Ireland peace process, has passed away at the age of 76 after battling illness. His family confirmed his death, expressing their sorrow and remembering him as a devoted husband, father, and patriot.

Bruton served as Taoiseach from 1994 to 1997 and played a significant role in advancing peace in Northern Ireland alongside UK Prime Minister John Major. Together, they launched the Anglo-Irish Framework Document in 1995, a pivotal moment in the peace process.

John Major paid tribute to Bruton, highlighting his dedication to peace and describing him as a formidable servant of Ireland. He emphasized Bruton’s commitment to prioritizing peace over political interests during challenging times.

Born in Dublin in 1947, Bruton began his political career in 1969 when he was elected to represent Meath in the Irish Parliament. During his tenure as Taoiseach, he led a coalition government and notably oversaw a referendum leading to the legalization of divorce in Ireland.

Current Fine Gael leader Leo Varadkar praised Bruton as a “doer and a philosopher,” emphasizing his efforts to bridge divides and reach out to the unionist community. President Michael D Higgins also honored Bruton’s energy and dedication to politics, particularly his contributions to the Northern Ireland peace process.

Bertie Ahern, Bruton’s successor as Taoiseach, remembered him as a gentleman and a genuine advocate for the people. European Parliament President Roberta Metsola expressed deep sadness at his passing, echoing sentiments of loss across political spheres.

In Northern Ireland, political figures including First Minister Michelle O’Neill and Deputy First Minister Emma Little-Pengelly extended condolences to Bruton’s family. Assembly Speaker Edwin Poots and Secretary Chris Heaton-Harris also expressed sympathy, acknowledging Bruton’s positive impact on Anglo-Irish relations and his role in laying the groundwork for the Good Friday Agreement.

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Tucker Carlson to interview Russia’s Putin

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Former Fox News host Tucker Carlson has announced plans to conduct a one-on-one interview with Russian President Vladimir Putin in Moscow. Carlson stated that he aims to provide Americans with a deeper understanding of the conflict in Ukraine, which he believes mainstream media coverage has failed to deliver. He emphasized his personal funding of the trip, highlighting his commitment to independent journalism.

This interview would mark President Putin’s first engagement with a Western journalist since the invasion of Ukraine in February 2022. Carlson’s decision to pursue this interview underscores the significance of the conflict and the need for diverse perspectives in understanding its complexities. It also reflects a departure from traditional media channels, as Carlson intends to broadcast the interview live and unedited on his social media platform, X.

Critics have raised concerns about the potential risks and ethical implications of such an interview, given Putin’s track record and the ongoing humanitarian crisis in Ukraine. However, Carlson remains steadfast in his belief that Americans deserve access to unfiltered information about the conflict. The interview is expected to spark significant interest and debate, shaping public discourse on both sides of the Atlantic.

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Ukraine war: Baby killed in Russian strike on Kharkiv hotel

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A tragic incident occurred in northeastern Ukraine as a Russian missile struck a hotel, resulting in the death of a two-month-old baby and injuring his mother. The governor of Kharkiv region, Oleh Synehubov, reported the retrieval of the baby’s body from the collapsed building in Zolochiv. This attack, carried out with two S-300 missiles, also wounded two other women. The village’s proximity to the Russian border renders it vulnerable, as Ukrainian air defenses cannot adequately cover such areas.

Originally designed for Russia’s air defense, the S-300 missiles have been repurposed to target Ukrainian ground installations, deemed a cost-effective alternative to more precise cruise missiles. Recent months have seen increased assaults on the Kharkiv region, with another hotel targeted in Kharkiv city previously, resulting in numerous injuries, including journalists covering the conflict.

In response to Russia’s aggression, Ukrainian forces launched a lethal strike on Belgorod, near the border. Additionally, Ukraine’s SBU security service apprehended five individuals suspected of involvement in a Russian espionage ring, allegedly providing sensitive information to Russia’s FSB, including details on military assets and infrastructure.

As Ukraine braces itself amidst the ongoing conflict, President Volodymyr Zelensky contemplates strategic shifts, including potential changes in leadership within the armed forces. Despite challenges and setbacks, Zelensky emphasizes the importance of perseverance and unity in achieving victory.

While US military assistance to Ukraine faces delays due to political wrangling in Congress, the European Union has approved a substantial aid package for Ukraine, highlighting its steadfast support amid the approaching third year of conflict.

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John Cage: Organ playing 639-year-long piece changes chord

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The composition titled “Organ²/ASLSP (As Slow as Possible),” known for being the longest and slowest music piece in existence, reached a noteworthy moment on Monday as it changed chord for the first time in two years. Avant-garde composer John Cage initiated this experimental project in 2001, employing a specially-built organ for its performance. The composition, set to conclude in the year 2640, attracted crowds to a church in Germany, where volunteers added a new pipe to the mechanical organ to introduce the latest chord.

The unique musical endeavor began with 18 months of silence, and the first notes were only heard in 2003. The score, spanning eight pages and intended for piano or organ, carries the instruction to be played as slowly as possible without specifying an exact tempo. This recent chord change marked the 16th alteration in the composition, with the last one occurring exactly two years ago on 5 February 2022. According to the project’s website, the next scheduled chord change is set for 5 August 2026.

John Cage, an American composer who played a pivotal role in experimental and avant-garde music during the 20th century, passed away in 1992. His most famous piece, “4’33”,” is unconventional in that it instructs musicians to refrain from playing their instruments. Instead, listeners experience the ambient sounds of their surroundings during the four minutes and 33 seconds of the performance. The extended rendition of “Organ²/ASLSP” was born out of a meeting of musicians and philosophers following Cage’s death, employing a mechanical organ designed for practicality using an electronic wind machine and sand bags to create a drone-like sound.

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