Your Breast. Your Life. Your Decision. The choices confronting women with Breast Cancer

They say that cancer is a word and not a sentence, and these days, most women survive breast cancer.

However, when the phone rings or you step into the doctor’s office and hear the words, “I’m sorry to tell you it’s cancer”, all the positive advice you have ever heard flies out the window.

From that moment on, your total focus is on the malignant process that is going on inside your breast. Suddenly you are consumed by fear – fear of death, fear of pain, fear of disfigurement, fear of losing your husband or lover, and the fear of not seeing your children grow up.

Yet, within minutes, hours or days of receiving this devastating news, you are asked to consider a choice about the treatment you will need. But how can a lay-person make an educated decision based on a five minute explanation in the doctor’s rooms – a decision that will affect their life.

I wonder how many women, when listening to the diagnosis delivered in clinical language, understand the terminology they are confronted with. Words like ductal, lobular, in-situ and multi-focal are lost in a sea of bewilderment and apprehension – emotions that are all-encompassing.

Few women realise that not all cancers present as a single lump. That certain types of breast tumours can arise bilaterally (in both breasts) and multi-focally (as many tiny cancer seedings scattered about in the tissue); therefore the removal of a lump, or even of one complete breast, may not prevent the cancer from recurring.

Unfortunately, as far as treatment is concerned, there is no one hat fits all.
Therefore, having some understanding of the disease processes and the different types of cancer affecting the breast makes it easier to understand why different treatments are prescribed.

But even then, the surgeon’s approach can raise questions. He might consider he is looking after his patient’s best interests (in the case of very early or in-situ lesions) by advising he will do nothing but ‘wait and see’ but, from a psychological point of view, the ‘wait and see’ option leaves the patient fearful of what is going on inside her. How fast if the tumour growing? Is it a ticking time-bomb that is about to explode.

Depending on the location and nature of the tumour, many women, especially younger women, are offered conservative surgery thereby avoiding mutilating surgery – a frightening term. For others, however, particularly those with advanced disease, radical mastectomy is deemed appropriate.

But even with a small and early tumour, some women feel compelled to be rid of the offending breast. And those with a strong family history of breast cancer, even though they are cancer free, may opt to have both breasts removed as a prophylactic procedure.

The period of grace between receiving that diagnosis and surgery is often quite brief but for every minute and every hour of that time your mind is consumed with thoughts of the disease. Clear constructive thinking and concentration in the workplace is virtually impossible. Yet it is in this mind-frame that you must make the decision that will affect you for the rest of your life.

While some women prefer not to know all the facts or learn of the ramifications, there are many, particularly younger women who want to know everything they can about the disease that is affecting them.

Whatever decision your make, it must be based not only on factual evidence and sound expert advice but should take into account your inner feelings and desires. It must be an informed decision and one you can live with.

It has been proven, that women who consider all aspects of their cancer, consider the options available and subsequently make those hard decisions, will find the experience changes their outlook on life. They will discover a new inner strength. Battling and beating cancer offers a life changing opportunity to try new things they have never done before.

Kathy LaTour in her book, The Breast Cancer Companion wrote that breast cancer is a battle fought on two fronts – the physical and the emotional. But that the emotional battle is unique to each woman and varies greatly according to her age, her history, her personal power, her sense of self, her support system and her determination.

Kathy added: ‘Those cancer patients that do the best are those who are active in their treatment option and feel empowered in their choices for a cure.
It seems logical that in order to live one has to want to.’

Take control of your life.
The choice is yours.
The decision is in your hands.
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The facts:
Today, most women survive breast cancer.
Belgium has the highest rate of breast cancer in the world.
The UK has the 7th highest breast cancer rate followed by the USA which is 9th and Australia and New Zealand 17th and 19th respectively.
In Australia, 1 in 8 women are affected by breast cancer at some time in their lives.
Scientists estimate about 42% of breast cancer cases in the UK could be prevented through drinking less alcohol, being physically active and maintaining a healthy weight.
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Author’s note:

Following a fine needle biopsy, I was diagnosed with lobular carcinoma in-situ in 1994. My surgeon suggested I do nothing but ‘wait and see’. However, having worked as a cytotechnologist for 20 years diagnosing cancer cells down a microscope, and having lost my sister, and maternal and paternal aunts to breast cancer, I opted for an immediate bi-lateral mastectomy. Since then my life has changed. I have gained in self-confidence and done things I never dreamed I was capable of doing including becoming a published author.

Take control of your life. The choice is yours. The decision is in your hands.

Breast Cancer in 15-39 year olds – are their special needs being met?

For teenage girls, young mums, or women looking towards marriage and motherhood, the psychological effects of a cancer diagnosis and breast surgery can be devastating.

When I spoke with Heather White (not real name), some time ago, she recounted how isolated and frightened she had felt when confronted with the diagnosis at age twenty-seven. At the time she had a 15 month-old child and was hoping to have another baby. A year after her operation and the loss of both breasts (bilateral mastectomy), Heather gave birth to a daughter.

Heather believes that the needs of young women in the prime of their reproductive years, often with a baby, or planning a family are quite different to those of the women old enough to be their mothers or grandmothers. Their need for emotional support is much higher than that of older victims.

Women of menopause age and older have usually raised a family, and have the support of a husband or long-term partner. Conversely, many younger victims (some little more than girls) have no partner to provide the emotional support necessary, or may have only been in a relationship for a short time.

While some marriages breakdown in consequence of the treatment, younger women suffer greater psychological effects in seeking or retaining a partner after mutilating surgery (the term the surgeon uses).

“Body image is important,” Heather said. “A lot of girls go into denial over how they look.” Hence the reason they opt for breast conservation options such as lumpectomy and less radical surgery, and many opt for breast reconstruction following mastectomy.

From a positive standpoint, today’s young victims are better educated than their older counterparts. They ask more questions and are more inclined to take a greater part in the decision making when it comes to surgical options.

Looking back at the level of support she received pre- and post-operatively, Heather felt that the breast support services from early diagnosis to follow-up were directed towards older women and that the psycho-social needs of young victims like herself were largely unmet.

It has been shown that the anxiety levels in younger breast cancer victims are three times higher than found in older women. Radical mastectomy with the loss of one or both breasts, results in loss of confidence and self-esteem. This can then lead to increased levels of depression, withdrawal and social dysfunction. Though the physical support these women receive is good, the psychological and emotional support is often lacking.

While the psycho-social needs of young breast cancer victims are recognized, more research into the field of psycho-oncology is essential. Hopefully this will lead to further improvement in the supportive care provided for young victims of breast cancer.

At the time of writing, 61 young women aged from 15-39 were diagnosed with primary breast cancer compared to 1020 over 40 years of age. These figures changed little over 5 years (Western Australia).
The author was diagnosed with early breast cancer at age 48 and worked in the field of cancer diagnosis for 20 years.
Pic: Copacobana Beach, Rio - what woman would not want to be seen there?
Pic: Breast Cancer survivors paddle a Dragon Boat.