Breast Cancer: The most important facts

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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...

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Know your cancer, beat your cancer

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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...

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Memories that heal

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Uluru, also known as Ayers Rock, is a geological feature at the heart of Australia with huge cultural significance to people living there. For indigenous Australians, it is holy ground, representing millenia of history, mythology, and their symbiotic relationship with the land. Every inch of this awe inspiring rock is celebrated, represented, and connected with places far and wide across Australia through the “song-lines” which unite and re-unite people over time. Uluru is the ultimate Memory Space and a focus of healing for the peoples of Australia, both ancient and recent. In Africa we say “Umuntu ngumuntu, ngabantu” which means “a person is a person because of other people”. This finds expression in traditional African values around community and belonging. Psychologically, it is both constraining and liberating to hold this value. As individuals, we could feel smothered by a sense of responsibility for others or the demands of others. Yet, the knowledge that our very individuality is gathered by, with and for others infuses life with meaning and hope. This is especially true when illness, injury or loss shake up our ordinary lives until nothing is “normal” any more. Recently C, a wise and creative patient introduced us to the technique of the “memory space” as a guide and support through the process of cancer diagnosis and medical treatment. The idea was to use a dedicated space in her own home, to represent the experience of being diagnosed with breast cancer and of going through surgery. By inviting people who counted in her world, and who were interested in helping to create this special space, C began to share the burden of having cancer, as well as the hopes she had for the next steps in her journey with cancer. C has kindly given us permission to share this initiative via our website. It is a valuable exercise not only for recently diagnosed cancer patients but for anyone who is facing a personally devastating change or loss – whether that be divorce, illness, emigration or bereavement. Of course, it’s not easy to talk about cancer to others – especially when you’re still trying to get your own head around the news. The story is often shared with a chosen few; who usually try to respond in loving and supportive ways (though see our post on What Not to Say to Someone Who Has Cancer). C’s many years of experience and research in psychotherapy alerted her to the knowledge that more is possible – a deeper experience of Ubuntu and of love. Those invited to the ceremony were encouraged to bring whatever they felt moved to share: a note, a card, a piece of writing or music, a picture, an...

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What not to say…to someone who has cancer

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It’s hard to know what to say when your friend or relative tells you they have cancer. In that painful moment our tact, good sense, knowledge and insight is put to the test – and so easily fails us.  As Joanna Moorhead of the Daily Mail recently wrote, the most inappropriate comments and messages have, at least, provided some laugh-out-loud moments after she was diagnosed with breast cancer. But with just a little effort, we really can do better. Here’s a guide to What Not To Say, and a few suggestions of better options. 1. Nothing at all. Not saying anything is fine if you have another way to be there for someone who’s hurting. Eye contact, a compassionate smile, a (welcome) gentle hug or hand squeeze, a small act of courtesy or kindness – all so important, and so much better than a verbal blatt. Actions really do speak louder (and often better) than words. Yet even the blattiest, dumbest remark (“My friend died of breast cancer”, “Not another one with cancer, it’s too much”, “Oh no, I can’t lose you”, “What bad luck!”) may be better than silent avoidance, which leaves the person feeling isolated and rejected.  People with cancer know it’s difficult for others -they’ve been through those emotions of shock too – but your absence is noted, and it hurts. It comes across as not caring, even though the truth is that you fear saying the wrong thing. Rather, go for simple sincerity: “I don’t know what to say, that’s terrible news” is absolutely fine. You don’t need sophistication: “That sucks, I’m so sorry” is also quite OK. After that, let your friend or family member’s response guide what happens next. You are part of her life for a reason, so just being yourself is all that’s needed. 2. Meaningless platitudes. If you woke up with stomach flu and spent a couple of days feeling utterly washed out and miserable, would you appreciate a walking, breathing Hallmark card suggesting that you count your blessings and be strong for your family? No, you would not. So why would dealing with a longer term but equally unpleasant illness be different? The fact that someone has cancer (or any other chronic illness) does not mean that he or she is unaware of the many wonderful blessings in life. Quite the reverse, in fact. Yet an ‘attitude of gratitude’ does not do away with pain and suffering, and “being strong” does not require an elaborate pretence that this doesn’t hurt. So dig deep and find a way to be there, alongside the suffering – be one of those blessings instead of talking about them. 3. False optimism. It’s good to get...

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Benign changes to the breast

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Unlike many other organs or tissues of the body, a woman’s breasts are shaped and defined by time. Before puberty, there’s nothing there at all. Then – exciting or intimidating as it may be – breasts begin to grow, taking a few years to reach their final shape and in the process becoming an important part of our body image. In human beings breasts are sexual organs, and it doesn’t take girls (or boys for that matter) long to discover that! Their exquisite sensitivity gives pleasure and their rounded shape helps define our womanly style – small and sporty, large and motherly, firm or soft. During pregnancy and after birth, breasts have a new lease on life as we discover their miraculous capacity to feed our babies as much and for as long as we need to. Though not all women are able to breastfeed, with the right help and support most can enjoy this simple, natural way to bond with and nurture our young. As breasts age, other changes take place which are completely normal – or at least common. Some are medically insignificant, such as the gradual change around the time of menopause from firm, dense glandular tissue to softer fatty tissue. Others tend to draw attention and cause anxiety because until investigated we cannot be sure that they are harmless. These are the benign conditions of the breast or “aberrations of normal development”. Lumps within breast tissue Lumps are common, occurring not only in aging breasts but also sometimes in younger breasts. A lump is a small piece of tissue or area under the skin that feels firmer than the surrounding tissue and can be felt from the outside. It doesn’t usually develop overnight and won’t be noticed until it reaches a certain size – at which point finding it can cause alarm and concern. Lumps that are medically concerning are those which stay there regardless of the menstrual cycle. Some women have naturally lumpy or uneven breasts and when the tissues swell under hormonal influence these “lumps” are more easily felt. For your own peace of mind, don’t hesitate to ask your doctor or nurse to check anything that worries you, but it’s the distinct lump which will require further investigation. Worrying as they are, many such lumps turn out to be “benign”. This means that although it is not normal breast tissue and may be growing larger, it does not spread or invade other tissues, either locally or by travelling through the lymph system (as cancer cells do). If you visit your doctor with a breast lump that worries you, he or he will ask you how long it has been there, whether you’ve...

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Birthday parties – 14 million of them

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Any excuse to celebrate, and millions of birthday parties around the world tell the story – cancer, though still a big public health concern, is not a death sentence. Since reaching a peak in the early 1990’s, cancer death rates have been steadily falling – at around 20% for women and over 25% for men. This is according to Cancer Research UK and the American Cancer Society. Probable reasons for this improvement are: – fewer people smoking – improved screening and early diagnosis for common cancers – more treatment options – targeted drug and/or radiotherapy treatment – new surgical techniques – more effective treatment and prevention of co-occurring conditions such as diabetes, obstructive airways disease, stomach ulcers, chronic infection and so on “We needed to give patients more options and better news about their future. I was impatient for more advances sooner and I still am. But clearly we’re moving in the right direction” – Prof Peter Johnson, Cancer Research UK There are still challenges. Pancreatic cancer appears to be on the rise, and amongst women, lung cancer has increasing by around 8% (whilst falling amongst men). This is thought to be the tragic harvest of 1960’s cigarette marketing, which successfully targeted millions of women by promoting tobacco smoking as an aid to slimming. Whilst older women tend to take better care of their health, younger women sometimes fail to notice or to report symptoms that could serve as early warnings of cancer. These include: – unexplained weight loss – bloating – breast changes: lumps, thickening, persisting rash, discharge, nipple changes – unusual bleeding – skin changes (moles, pigmentation, scaling) – difficulty swallowing – blood in urine or stool – gnawing abdominal pain especially associated with depression (may indicate pancreatic cancer) – indigestion for no apparent reason – white patches or spots in the mouth (especially if you are or were a smoker) – unexplained pain: not likely to be cancer but get it checked out – a swelling under the armpit, in the neck, or anywhere else – unexplained fever (sometimes associated with early blood cancers) – persistent fatigue, even if you think you have reasons to be so tired – persistent coughing There are a few ‘wild cards’ in our future whose effect on rates of cancer diagnosis and death are still unknown. The most worrying of these is the so-called “obesity epidemic”, especially insofar as it affects younger people. Recent research has connected excessive sugar consumption with a variety of conditions including auto-immune and inflammatory conditions which may predispose to some forms of cancer. We really need to start dealing with this!  ...

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