Sometimes, it can seem as though breast cancer is everywhere: everyone knows someone, everyone’s family is touched by it.
The chord struck by breast cancer is evident in the avalanche of pink ribbons that’s everywhere from the Internet to our streets, and the many stories of those who have survived as well as tributes to those who did not.
There are many spin-offs from this high level of public awareness, and one of them is ready funding for more research, which is showing great results.
But even though the general public may be more aware of “breast cancer” than is true for most other forms of cancer, international research shows that most women who have been treated for breast cancer, do not know what kind of tumour they had. Yet from any doctor’s point of view, this is first-ranking information!
Momentum Health’s JUMP magazine recently interviewed some top South African breast cancer specialists to find out what they regard as the most important facts about breast cancer (see Issue 1, 2015).
So here’s what you should know:
* Don’t panic. The great majority of lumps that appear in breast tissue are not cancer. But don’t ignore a lump either – expert advice is needed to determine whether or not you need further treatment.
* Like any other cell, a cancer cell has its own specific programming which tells it how to behave: its genetic material or DNA. This includes the likelihood of spreading to other organs, the speed at which it grows and divides to form new cancer cells, and even how it will respond to various forms of treatment. That’s another reason to get immediate expert help, because no matter how small it may be, an aggressive tumour will soon become a much worse problem.
* Patients should know about the four main types of breast cancer and the treatment you can expect for each one – if you are able to catch it at an early stage.
1. Luminal A: The most common type affecting around 70% of patients and especially older women. Treatment is by cutting off the supply of oestrogen (female hormone) that feeds it; you’ll be on anti-oestrogen medication for up to five years but you won’t need chemotherapy or any other treatment.
2. Luminal B: This less common type also needs oestrogen to thrive but can continue to grow without oestrogen, so in addition to anti-oestrogen medication you will be offered a course of chemotherapy to achieve a better result.
3. HER2: This is a form of breast cancer that usually has a family history. It is treated – with much success – by a combination of chemotherapy and “molecular therapy” targeted specifically at the cancer cells.
4. Basal: This fairly rare form of breast cancer (affecting 5 – 10% of patients) will not respond to anti-oestrogen treatment, you will need chemotherapy to beat it.
* Family history is important. Although medical schemes are reluctant to cover the cost of genetic testing, if you have close female relatives with breast cancer and/or ovarian cancer – especially if the cancer occurred at a younger age or in more than one site – it may be worth paying for the test to be done. Not only will you know your risk now and in the future, but you may be able to avoid unnecessary chemotherapy.
* The big research focus in breast cancer treatment: Molecular therapy. Already available in some forms, these treatments are very expensive but over the next few years, the cost is expected to come down to the point where individuals and medical schemes can afford it. As more is known about the genetics and specific chemistry of cancer cells, medical science is acquiring the means to target these cells specifically. This means cancer cells can be wiped out with no damage to healthy cells, no hair loss, nausea, pain or other nasty side effect of chemotherapy.
* More advanced cancers require much more aggressive treatment: surgery, chemotherapy, radiotherapy and hormonal therapy may all be needed. These cancers will be labelled Stage 3 (i.e. a larger lump which has spread to the lymph nodes in the armpit, or to other parts of the body); or Stage 4, a cancer which has spread to more distant sites (metastasis).
* The stressful time of waiting to find out whether you have cancer has been cut down to 48 hours in most cases. It will take a specialist no more than a few minutes to perform a biopsy and the lab will call your doctor with the results within two days.
* If it’s big enough to feel like a lump, simple surgery won’t be enough. Not even “Stage Zero” cancers (picked up on X-ray or ultrasound) are necessarily safe to leave untreated. Cancer cells that spread via the bloodstream to other sites can lie dormant for years (or be suppressed by your own immune system), with the potential to cause metastatic cancer at a later stage. This is where genetic testing comes in: if the genetic profile of the cancer is known, doctors can make better decisions about how best to target those cells, wherever they may be.
* Prevention can save your life. Experts support women like Angelina Jolie who make the difficult decision to remove hormonal tissue (breasts and ovaries) that are at risk of inherited cancer. If you have one of the gene mutations known as BRCA1 or BRCA2, your lifetime risk of cancer can be as high as 90%. Angelina’s choice has dropped her risk to 2%. Remember, family history on BOTH sides of the family is important, as both fathers and mothers can pass on the faulty gene and the increased cancer risk that comes with it.
* Mastectomy is no longer the great fear it once was – but also no longer a simple, quick job for a surgeon! Patients want to look and feel “normal” afterwards, with healthy parts of their natural breast spared and restored. With the help of a plastic surgeon, this can happen immediately after the removal of the breast tissue, leaving only two small scars. Always discuss reconstruction with your oncology surgeon and if in doubt seek a second opinion.
* Cancer changes your life, and it should. Not only should you expect treatment to continue for several years, you will probably want to revise many aspects of your personal health. For instance, It’s now known that regular exercise and maintaining a healthy weight offer a greater improvement in your chances of living a long, healthy life than even chemotherapy.
* Add to that Vitamin C and D supplementation, calcium for bone health (very important if you’re on anti-oestrogen therapy which can weaken your bones), a cut in sugar and starch to improve insulin sensitivity, and well maintained blood pressure. What’s the point of surviving cancer only to suffer heart disease or a stroke that you could have avoided?
This holistic approach is not a reason to avoid taking advantage of the latest medical research into chemotherapy and especially molecular therapies – but it is a reason to celebrate health.
So – since knowledge is power – let’s get into the pink and take to the road!
Breast cancer patients tend to be a well informed bunch, who turn up to medical appointments with print outs and well considered questions.
However, a recent study in California found that only a small minority of breast cancer patients understood all the key aspects of their tumours.
The stage, grade and sensitivity of your tumour determines the type of treatment you will have. Whilst thorough patient education would not necessarily change the outcome of the treatment in a direct way, it is likely to improve the patient’s experience of that treatment as well as her ability to stick with it.
All of this key information is available soon after you have your first surgery. Staging indicates the spread of the tumour – how big it has grown as a single clump of cells, and/or how much it has been able to travel to other areas.
Sensitivity to Oestrogen (Estrogen in America), to Progesterone and to Epithelial Growth Hormone or HER-2 is a key element of treatment because if cancer cells need these hormones for “fuel” then by blocking the hormones the growth of the cancer cell will also be blocked.
Grading refers to the general aggressiveness of a tumour. If it’s made up of cells that are fairly similar to the healthy cells around it, but different to cells in other body organs, that is a low grade, less aggressive cancer. Cells that are more abnormal – more dedicated to being a cancer cell than to the function of the tissue they’re in – are higher grade and more aggressive.
Knowing more about your cancer enables you to feel “part of the team” and to take more responsibility for your treatment, as well as to know what questions you want to ask (or not ask).
This will ease your stress – you’ll feel much less helpless – and may help you deal with difficult side effects of the treatment such as hormone changes or chemo side effects.
For most people today, the idea that “doctor knows best” is no longer enough. We want our doctors to be experts but we want to be knowledgeable as well! For doctors, this means that patient education is an important part of the treatment, time consuming as it may be.
Just a treatment is individual – there is no “one size fits all” in breast cancer – so patient education also needs to be individualised. The level of explanation that is helpful for a University professor isn’t likely to be as helpful for a domestic worker, but both women need to be as informed as they can about what’s going on with the cancer and the process of treatment.
There’s good news for doctors here too – patients who understand the basis for their treatment are more likely to be satisfied with the treatment, and to value their relationship with the doctor throughout their journey with cancer.
Dr Linda Whitelock-Jones MBChB (UCT) FCS.SA MMed Surg
Linda is a surgeon practising in Port Elizabeth with a regular clinic in Jeffrey’s Bay. She has a special interest in medically indicated breast surgery (including reconstructions) and management of burn injuries. Her consulting rooms are at 5 How Avenue, Centrahil, Port Elizabeth and you can contact her on 041 450 0196 or by email Linda (dot) Whitelock-Jones (at) breastsurgeonpe (dot) com.
Linda is married with two children and lives in Port Elizabeth.
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Isabel Strydom National Diploma in Food and Clothing Technology
Isabel Strydom has a background in studies of anatomy, physiology, and clothing technology. During 2001, she realised that after going through mastectomy, South African women were being left with few options. The available breast prostheses were poor and specially designed bras were not available at all. It was as though cancer survivors weren’t expected to care anymore about pretty, well-fitting clothes!
Fired up to change this situation, Isabel completed the necessary training. She now has a registered practice – the only one of its kind to serve the women of Port Elizabeth and surrounding areas. Personal fittings take place by appointment, at no charge, in the privacy of her home.
As part of the service, Isabel liaises with medical aids: most schemes will cover the costs, either from the appliance benefit or from the oncology benefit.
Call Isabel on 082 484 8358 or 041-3673095 for more information or to make an appointment.
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