Doctor HealthHealth Tips

When someone well-known such as Christina Applegate is diagnosed with breast cancer, many adult women become concerned as to what the future holds for them.

While it’s true that 1 out of 8 American women will be diagnosed with breast cancer at some point in her lifetime, there are also a lot of misconceptions about the disease floating around.

Although Applegate is just 36 years old, the fact remains that breast cancer is more likely to strike women over the age of 50.

Still, many women under the age of 40 may now be tempted to run out and demand mammograms.

But mammograms are ineffective for most young women, Dr. Diana Zuckerman, president of the National Research Center for Women & Families, told FOXNews.com in October.

“Young women’s breasts are dense and if they get mammograms, their breasts show up very white on mammograms and cancer shows up as white,” she said. “But, as women get older, their breasts are less dense and show up gray on a mammogram, which makes it easy to identify the white cancer. If there is a family history, and women are worried, they can start earlier and in this case a digital mammography may work better than a traditional mammography.”

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As women, especially American women, much of our femininity is centered on our breasts. No matter where you look, there are pictures, billboards, commercials, television shows, and movies with women with these beautiful breasts and ample cleavage. The thought of losing one or both breasts, to breast cancer, can be devastating for many of us. Sure, there’s reconstruction, but will it ever really look the same again? Even if you have reconstruction, you’ll never have sensation there again and, for many of us, that definitely affects our sexuality.

I went through two separate mastectomies, for my breast cancer, despite the fact that I wanted them both done at the same time. Two different surgeons told me that wasn’t necessary. They found out, later, that it was, as I had the same breast cancer in both breasts. Through these surgeries, I learned a few things about what to expect, and how to get up and running again, after a mastectomy for breast cancer.

The first thing to realize is that, apart from the emotional aspect of such an operation, this is a simple surgery. The breast is composed, mostly, of fatty tissue and, of course, milk ducts and lobes. The removal of this breast tissue is way easier than operating on an organ, but carries much more emotional impact for most of us. Most surgeons will get as much of the breast tissue out as they can to help alleviate the chance of a recurrence of your breast cancer. You will typically wind up with a horizontal scar about four inches long. The scar may be red for quite a while but, ultimately, should fade to where you can hardly see it anymore.

You want to be sure to take loose-fitting, button-down shirts (raiding your hubby’s closet is helpful) with you, to the hospital, as you won’t be able to raise your arms over your head for a while. You will also need a sports bra and I would highly recommend one that fastens in the front. They will put that on you after your surgery. Typically, you should be able to stay in the hospital for one night. If you’re going to have lymph nodes removed, a small pillow, to slip under that arm, will help make you more comfortable. Check with your local American Cancer Society as they may have small pillows for you. An extra pillow to hold to your chest, if you need to cough, sneeze, or laugh, can help keep your incision from hurting.

When you wake up, you will have a couple of drain tubes for each side you have done. These tubes are important as they allow the excess fluid, which your body will produce, to drain out. If you didn’t have them, the fluid would have to be aspirated with a needle. The drains, even though they’re no fun, are better than that. These drains will have to be emptied a couple of times a day and you will have to write down how much fluid you drain so the doctor will know when you’ve slowed down enough to remove them. You may not know where to put these drains under your clothing. I pinned mine up to the sports bra and that way, they didn’t pull when I moved.

When you get home, plan on having someone there to help you for the first few days. You won’t be allowed to reach into your cabinets and definitely won’t be able to clean house or pick up your children, if you have little ones. You’ll be sent home with pain meds and definitely take them if you need them. Studies show that you will heal faster if you keep yourself out of pain, so don’t be afraid to take them as prescribed.

If you have a recliner, you might consider moving it into the bedroom as you won’t be able to lie flat for a while. You’ll need to sleep in a partial sitting position. If you don’t have one, or don’t have space for it in your bedroom, lots of pillows will work, too. That’s what I used. Just be sure you have enough pillows to keep yourself comfortable propped up.

If you would like someone who’s been there before you to visit with, be sure to call your local American Cancer Society and ask for a Reach 2 Recovery volunteer. This is an American Cancer Society program where they try to match you with one of their volunteers who have as similar experience as you’re facing. This woman will come visit you and will bring you all sorts of brochures and information on conventional treatment. She will also bring you a list of exercises you can start to do to regain your mobility and range of motion.

This is VERY important. It hurts to stretch your arm up, after surgery, but if you haven’t had reconstruction, and you don’t start soon, you will lose that range of motion. I would recommend starting to gently, slowly reach your arm up … let your body be your guide … the day after your surgery. This is ONLY if you have not had reconstruction. If you have, let your plastic surgeon tell you when to start stretching. Push to where it hurts just a little, but do not push too far past that. Little by little, you’ll find yourself able to stretch a little farther every couple of days.

Most of all, allow yourself to heal emotionally, as well as physically. Some of us just can’t look at that incision right away. That’s OK. Take as much time as you need. I know I felt like some kind of freak with no breasts and, even six years later, I still do sometimes. But remind yourself that these scars are your battle scars. They do not make you less of a woman. They make you a warrior.

By Melissa Buhmeyer

What are the treatments for breast cancer?

Almost all women with breast cancer will have some type of surgery in the course of their treatment. The purpose of surgery is to remove as much of the cancer as possible, and there are many different ways that the surgery can be carried out. Some women will be candidates for what is called breast conservation therapy (BCT). In BCT, surgeons perform a lumpectomy which means they remove the tumor with a little bit of breast tissue around it but do not remove the entire breast. BCT always needs to be combined with radiation therapy to make it an option for treating breast cancer. At the time of the surgery, the surgeon may also dissect the lymph nodes under the arm so the pathologist can review them for signs of cancer. Some patients will have a sentinel lymph node biopsy procedure first to determine if a formal lymph node dissection is required. Sometimes, the surgeon will remove a larger part (but not the whole breast), and this is called a segmental or partial mastectomy. This needs to be combined with radiation therapy as well. In early stage cancers (like stage I and II), BCT is as effective as removal of the entire breast via mastectomy. Most patients with DCIS that have a lumpectomy are treated with radiation therapy to prevent the local recurrence of DCIS (although some of these DCIS patients may be candidates for close observation after surgery). The advantage of BCT is that the patient will not need a reconstruction or prosthesis to appear like she did before the procedure.

More advanced breast cancers are usually treated with a modified radical mastectomy. Modified radical mastectomy means removing the entire breast and dissecting the lymph nodes under the arm. Patients with DCIS that have a mastectomy do not need to have the lymph nodes removed from under the arm. Some patients are candidates for BCT but choose modified radical mastectomy for personal reasons. Your surgeon can discuss your options and the pros and cons of either procedure. Most women who have modified radical mastectomies choose to undergo a reconstruction. There are many different procedures for creating a new breast mound, and you should talk to your plastic surgeon before your surgery to discuss your options and decide on how you would like to proceed. For more information on breast reconstruction, see Breast Reconstructive Surgery Options.

Chemotherapy

Despite the fact that the tumors are removed by surgery, there is always a risk of recurrence because there may be microscopic cancer cells that have spread to distant sites in the body. In order to decrease a patient’s risk of recurrence, many breast cancer patients are offered chemotherapy. Chemotherapy is the use of anti-cancer drugs that go throughout the entire body. The higher the stage of cancer you have, the more important it is that you receive chemotherapy; however, even stage I patients may benefit from chemotherapy in certain cases. In early stage patients, the risk of recurrence may be small, and thus the benefits of the chemotherapy are even smaller. However, the option to receive chemotherapy should be offered to most patients with breast cancer and they can decide if the potential benefits of chemotherapy outweigh its side effects in their own particular case.

There are many different chemotherapy drugs, and they are usually given in combinations for 3 to 6 months after you receive your surgery. Depending on the type of chemotherapy regimen you receive, you may get medication every 3 or 4 weeks; and you may have to go to a clinic to get the chemotherapy because many of the drugs have to be given through a vein. Two of the most common regimens are AC (doxorubicin and cycolphosphamide) for 3 months or CMF (cyclophosphamide, methotrexate, and fluorouracil) for 6 months. There are advantages and disadvantages to each of the different regimens that your medical oncologist will discuss with you. Based on your own health, your personal values and wishes, and side effects you may wish to avoid, you can work with your doctors to come up with the best regimen for your lifestyle.

Sometimes patients have a recurrence of their cancer, or present in stage IV with disease outside of their breast. These patients will all need chemotherapy, and a variety of different agents may be tried until a response is achieved. Sometimes we give chemotherapy before surgery, and this is called neoadjuvant chemotherapy. This is usually reserved for very advanced cancers that need to be shrunken before they can be operated on.

Radiotherapy

Breast cancer commonly receives radiation therapy. Radiation therapy uses high energy rays (similar to x-rays) to kill cancer cells. It comes from an external source, and it requires patients to come in 5 days a week for up to 6 weeks to a radiation therapy treatment center. The treatment takes just a few minutes, and it is painless. Radiation therapy is used in all patients who receive breast conservation therapy (BCT). It is also recommended for patients after a mastectomy who had large tumors, lymph node involvement, or close/positive margins after the surgery. Radiation is important in reducing the risk of local recurrence and is often offered in more advanced cases to kill tumor cells that may be living in lymph nodes. Your radiation oncologist can answer questions about the utility, process, and side effects of radiation therapy in your particular case.

Hormonal Therapy

When the pathologist examines your tumor specimen, he or she finds out if the tumor is expressing estrogen and progesterone receptors. Patients whose tumors express estrogen receptors are candidates for therapy with an estrogen blocking drug called Tamoxifen. Tamoxifen is taken by pill form for 5 years after your surgery. This drug has been shown to drastically reduce your risk of recurrence if your tumor expresses estrogen receptors. However, there are side effects commonly associated with Tamoxifen including weight gain, hot flashes and vaginal discharge that patients may be bothered by. There are also very uncommon side effects like blood clots, strokes, or uterine cancer that may scare patients from choosing to take it. You need to remember that your chances of having a recurrence of your cancer are usually higher than your chances of having a serious problem with Tamoxifen, but the decision to undergo hormonal therapy is a personal one that you should make with your doctor. There are also newer drugs, called aromatase inhibitors that act by decreasing your body’s supply of estrogen; these drugs are reserved for patients who have already gone through menopause. Talk to your doctors about these new therapies.

Biologic Therapy

The pathologist also examines your tumor for the presence of HER-2/neu overexpression. HER-2/neu is a receptor that some breast cancers express. If your cancer expresses it, you usually have a higher chance of having your tumor recur after surgery. A compound called Herceptin (or Trastuzumab) is a substance that blocks this receptor and helps stop the breast cancer from growing. Some patients are candidates for this medicine. Talk to your medical oncologist to see if Herceptin is right for you.

Follow-up testing

Once a patient has been treated for breast cancer, they need to be closely followed for a recurrence. At first, you will have follow-up visits every 3-4 months. The longer you are free of disease, the less often you will have to go for checkups. After 5 years, you could see your doctor once a year. You should have a mammogram of the treated and untreated breasts every year. Because having had breast cancer is a risk factor for getting it again, having your mammograms done every year is extremely important. If you are taking Tamoxifen, it is important that you get a pelvic exam each year and report any abnormal vaginal bleeding to your doctor.

Clinical trials are extremely important in furthering our knowledge of this disease. It is though clinical trials that we know what we do today, and many exciting new therapies are currently being tested. Talk to your doctor about participating in clinical trials in your area.

OCTOBER is Breast Cancer Awareness Month. What is the message during the month? Breast lumps are very common in women but some of these lumps can be dangerous. In most cases when such lumps are identified, they are removed and examined by the doctor to determine whether they are cancerous or not.

When found cancerous the immediate advise is to undergo the treatment
A diagnosis of cancer often elicits feelings of shock, fear and despair. This is not surprising because cancer is one of the killer diseases.

In Uganda, it is estimated that 85 percent of the breast cancer patients die within two-three years after the treatment. So being diagnosed with breast cancer is assumed to be synonymous with a death sentence. This attitude is partly due to low levels of awareness about cancer in general, and breast cancer in particular, which results in late reporting to health workers. These scary statistics do in turn contribute to the fear and despair exhibited by the patients, their families and friends.

For example, in Uganda one of the most commonly used methods of treating breast cancer is mastectomy (cutting off the affected breasts), which is usually followed by radiotherapy (burning of the cancer area with X-ray) and chemotherapy (treating using anti-cancer drugs). Like any treatment, there are side effects. In the case of chemotherapy, there is often the loss of hair, discolouring of the nails and sometimes loss of appetite and vomiting. These conditions disappear after treatment.

However, because of low levels of awareness, many newly diagnosed patients lose time before accepting to undertake treatment. The notion of having one breast or none makes patients go from one doctor to another in search of another opinion. If the second opinion is the same, it may be accepted at a price; the cancer may have spread to other parts of the body and difficult to stop.

The social environment can be equally scary. Some friends and relatives do not help the situation. They advise the patient not to have mastectomy and instead take them to herbalists, prayer groups and sometimes witch doctors. They tell married patients that their husbands will desert them. The unmarried ones are told that no man will marry them if they undergo mastectomy. Some clan leaders advise that such treatment will spell a curse on the clan such that their girls and boys will have difficulty finding suitors. They will be considered as outcasts.

The above fears and stigma are understandable in our circumstances where, in addition to low levels of awareness, the health system is not adequately equipped to handle breast cancer. For example, the few available facilities such as mammography machines, a functional radiotherapy centre and chemotherapy centre are all based in Kampala. In addition, cancer is not a priority like HIV/AIDs and malaria. These inadequacies therefore require women to be vigilant and play their part so as to help in reducing the incidence of death due to breast cancer.

Let all women be watchful over their breasts and do routine breast self examination every month. Get to know the size, shape and feel of your breasts. In that way any unusual lumps can be felt. In addition, let women take interest in seeking information related to the health of breasts. For example, women above 40 years of age should have a mammography every year. A mammography is an X-ray that can detect breast cancer before the lump is even obvious. It is currently the best way of detecting breast cancer.

Friends and relatives should give support to their loved ones who have been diagnosed with breast cancer. Encourage them to undergo treatment. Mastectomy and other modes do not deter one from conceiving and having a baby after. Remember that early detection and treatment improves your chances of living longer and resuming your usual activities.