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An Early Diagnosis of Cancer Leads to a Higher Chance of Treatment Success

In our new series, Best Advice from Women, for Women, Ms Jayde Simpson, an expatriate from the United Kingdom shares with us on finding out about her breast cancer diagnosis, coupled with the discovery of a high-risk gene.What kind of breast health issue did you face?I was diagnosed with Stage 2 Breast Cancer, which was ER+ PR- and HER2.How did you discover it?I felt a lump whilst on vacation that didn’t go away. Upon my return I scheduled an appointment with a breast specialist who performed an ultrasound. Within the week I had a mammogram, MRI and a PET scan which confirmed the suspicion. However, it wasn’t until a biopsy was conducted that it was confirmed as breast cancer.What was your biggest revelation after you were diagnosed?I did a gene test and discovered that I have a gene that makes my risk of breast cancer higher than the general population, although only a small number of cancers are hereditary.  Lifestyle and other factors influence an individual’s risk profile.What is one thing you wish you knew before you started treatment?Understanding the type of breast cancer (ER/PR/HER2 positive or negative) can lead to different recommendations on the type of treatment you should get.  I was upset when I had to get chemotherapy, believing what I had seen in the movies about the side effects from it.  However, I sailed through this.  A friend had recommended doing something nice around chemo and for me what stood out during my treatment was celebrating the end of each chemo with a lunch with a friend. My chemo duration had plenty of nice lunches and different friends supporting me throughout.What has the journey of dealing with or managing this issue been like for you?The absolute worst part was receiving the diagnosis as I did not truly believe this would happen to me and that all the tests would show this was a false alarm.  The biopsy I received confirmed this was not the case.  After that I did everything that I could to take a holistic integrative approach.I had a great breast surgeon and oncologist who partnered to give me the best medical treatment and tailored my treatment specific to me, e.g. my oncologist added a chemo that is shown to have more effect for people with the gene that I had, while my breast surgeon helped to add regular ultrasounds so we could measure the impact the chemo was having on reducing the tumour. This helped alleviate any anxiety on whether the treatment was working or not.  I focused on ensuring that I did everything at home that I could to help – diet, exercise and I worked with a naturopath to identify supplements that would help me through the treatment.After the chemo I had a double mastectomy with immediate reconstruction and whilst this was a challenging decision, I did everything I could to minimise any future risk.  I believe all of these things helped me to achieve a ‘pathological complete response’.The cancer diagnosis gave me the discipline I needed to prioritise me and ensure that I focused on a diet and exercise regime to best support my treatment. Despite the numerous rounds of chemo, I never once felt ill and felt stronger and fitter throughout.  I had the odd tired day and some other limited symptoms. However, the treatment was nowhere near as bad as I expected.Before this cropped up, what was your attitude toward breast health?Sadly, I had a close friend who passed away from Breast Cancer and so I was very much aware of the need to do regular self-exams.  The earlier you identify an issue, the more likely you have the chance of successfully dealing with it.  I was aware of how my breasts would change during my regular cycle and so managed to self-identify the lump early enough to have a very successful outcome.Did this journey change that attitude?It only strengthened it.  I am more in tune and aware of my body and if anything doesn’t feel right.  I take care to watch stress levels and not overreact and am focused on ensuring that I have balance in my life with adequate sleep, exercise, supplements and focusing on what I eat (80% of the time).What do you think women in general feel about breast health?Whilst I was aware of the importance, I think I still thought of myself as being invincible and that something would not happen to me.  I think women in general put other family members first and neglect to prioritise themselves.  These two things together can mean that they neglect breast health.  I also think sometimes people can feel embarrassed about seeking help or not wanting to expose themselves, or think “it’s probably nothing, I don’t want to bother anyone”.What are your thoughts when it comes to general awareness/education in this area?I hear of friends who tell me they don’t really know how to do a self-exam, or they skipped the last mammogram because they had to do something else and forgot to reschedule.  I think they are missing the 2 most important factors here:  1. prevention is always better than cure (focusing on healthy lifestyle can reduce your risk) 2. the earlier you catch these things, the better your outcome.  Whilst it’s rare, the tumour I had was not present on a mammogram but could be seen on the ultrasound, MRI and PET scan.  My advice would be to listen to your body and if something doesn’t feel right, advocate for yourself and seek a referral to a breast specialist who can help allay any fears or help ensure you get treatment early.What advice would you give women about breast health?The risk is too high so early identification will give you more chance of success.  Previously I did not prioritise myself, making excuses that I needed to attend to work, husband, children and that I had limited time.  I now consider that prioritising my health means I will be around longer to enjoy time with my family.  Ensuring I take steps to monitor my health and raising any concerns to my doctor means I’m around longer to enjoy my family.  The earlier you detect something the more chance of success you have.  Everyone I met throughout my journey was empathetic, caring, listened to me and addressed any concerns; the only downside is not acting early.
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How to Regain Confidence Post-Mastectomy: 4 Tips for Breast Cancer Patients

For many women, breasts symbolise femininity and attractiveness, and a mastectomy, which is the surgical removal of one or both breasts, can significantly impact a woman’s self-confidence and body image.The scars left by the breast surgery and the physical changes that result from a mastectomy can make it difficult for women to feel comfortable in their new skin. Common struggles for women after losing a breast include feeling less “feminine” or worrying that they will be less attractive to their partner. Coping with a mastectomy’s emotional and physical aftermath can be a difficult journey. Women need access to support and resources to help them navigate this challenging experience.Impact of Mastectomy on Self-ImageThe patient’s perception of her new body image is amongst the psychosocial effects that emerge due to mastectomy. In the Body Image of Women with Breast Cancer After Mastectomy: A Qualitative Research, published in J Breast Health,  [1] many women spoke about the negative impact of an altered appearance on their body image. After a mastectomy, many women described what they saw as a “wretched, horrible, scary, ugly, crooked, collapsed body shape.” But the most commonly used description of their appearance was that they looked incomplete because they did not have their breast(s).Finding Emotional Support Post-SurgeryBeyond physical changes, an experience with breast cancer can also affect a woman’s mental well-being. While loved ones want to be there for her, it is sometimes hard to have tough conversations with those she is closest to. Finding a like-minded community is essential so the patient can talk openly about her experiences, ask for help, and know that she isn’t alone.Club Solis provides breast cancer patients with a support network in their journey against breast cancer. Through Club’s Solis befriender programme and hearing stories from patients who have undergone breast cancer, women can find reassurance and courage to take charge of their breast health.  Club Solis also provides rehabilitation and nutrition advice for women who have breast cancer.How to boost self-esteem after mastectomyRather than dwelling on self-blame or despair, use the opportunity to explore and redefine one’s identity after overcoming breast cancer. The experience may have uncovered hidden areas of resilience [2] previously unknown to the patient. A woman who has undergone mastectomy may have also developed a newfound appreciation for different new hobbies or gained a fresh perspective on her personal values and beliefs. In addition, revisiting priorities and aspirations can help a woman recovering from a mastectomy to set new realistic goals, and her support network or breast cancer physician can assist her in identifying achievable objectives.By pinpointing the societal messages and beauty norms that she has internalised from the media and other external sources, the patient can actively choose new standards that align with her values and priorities. It is also crucial for a woman who has undergone mastectomy to give herself the space and time to prioritise self-care over the persistent pressure to perform acts of kindness for others constantly. In doing so, the patient can shift her focus towards cultivating personal fulfilment and contentmentHow to address physical changes after mastectomy/ Shopping for clothes after mastectomyIf the patient foregoes reconstructive surgery after mastectomy, she’ll find that many of her old clothes no longer fit her new body. Instead of despairing, use this opportunity to shop for new clothes and try out different clothing styles. Wearing the proper clothing during her recovery may also help prevent the irritation of areas that may still be tender. The patient doesn’t have to sacrifice style for comfort, either. There are many suitable outfits that the woman can wear that are chic yet casual and, most importantly, comfortable. In addition, post-cancer care partners like Can-Care offers a wide range of personalised care products for breast cancer patients, including mastectomy bra, mastectomy camisole and mastectomy swimwear.When shopping for post-mastectomy shirts, go for a gentle fabric on the skin to prevent chafing and irritation. Cotton is a good choice because it’s lightweight, soft, and allows air to flow freely. Also, consider a roomy button-up or flowy dress and skirt for a stylish look.How to move forward after mastectomyEngage in physical activityAfter undergoing a mastectomy or breast reconstruction surgery, it’s important to prioritise rest and physical activity. Gentle stretching, arm circles, seated side bends, and shoulder rolls are some exercises that the patient can perform in the week after surgery. During the initial recovery period, walking is a great activity to include in the patient’s routine until her breast cancer specialist gives her the okay to engage in more intense cardiovascular exercise. By starting with low-impact movement like walking, the patient can gradually build up her strength and endurance while minimising the risk of injury.When exercising in the weeks after her mastectomy or breast reconstruction surgery, it’s normal for the patient to experience some tightness in her chest and armpit, but this should decrease as she does her exercises over time, according to the American Cancer Society.Focus on good nutritious foodTo combat fatigue and nausea, incorporating delicious and energising food into the patient’s diet can significantly enhance her overall well-being. Breast cancer-fighting food, such as phytonutrients, is found in plant-based foods, including fruits, vegetables, beans and grains. These include dark yellow/orange/green vegetables and fruits, cruciferous vegetables, garlic, soybeans, green tea and broccoli.[4]By adopting a positive mindset, focusing on self-care and seeking support, a breast cancer patient can regain her confidence and move forward with a sense of purpose and resilience. It’s important to remember that everyone’s journey is unique, and there is no “right” way to cope with the challenges of breast cancer. Through exploring new hobbies, redefining one’s identity and cultivating a support network, a breast cancer patient can emerge from the experience with newfound strength and appreciation for life’s precious moments.[1] J Breast Health, Body Image of Women with Breast Cancer After Mastectomy: A Qualitative Research[2] Sunnybrook Health Sciences Centre, Body image and breast cancer: a resource for women[3] Healthline, Exercise After Mastectomy and Breast Reconstruction: What You Need To Know[4] Cleveland Clinic, The Best Foods To Eat When You Have Breast Cancer
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What is Preventive Mastectomy and Who Should Consider It?

Does a family history of breast cancer put you at a higher risk of getting the disease?We speak with Dr Tan Yah Yuen, Senior Consultant and Breast Surgeon about preventive mastectomy for individuals with elevated risk of breast cancer.What is preventive mastectomy and can I remove a single breast?Preventive mastectomy (or risk-reducing mastectomy) is surgery that is done to remove one or both breasts to reduce the risk of developing breast cancer. All of the breast tissue is removed, maintaining the skin overlying the breast, and may include maintaining the nipple and areola. This is followed by an immediate breast reconstruction.By definition, a mastectomy means the removal of the entire breast. A partial removal of the breast will not be suitable if the aim is to reduce the long-term risk of cancer, which can occur in any part of the breast.For risk-reducing mastectomy, the nipple and original skin of the breast can be conserved, together with immediate reconstruction. This will restore the appearance of the breasts to as near normal as possible.Who should consider risk-reducing mastectomy?Women who are at significantly elevated risk of breast cancer may consider preventive or risk-reducing mastectomy.These include:Women with BRCA 1 or 2 genetic mutations where the life time risk of breast cancer can be as high as 70- 85%. Women with biopsy-proven breast abnormalities that place them at a significantly higher life time risk of breast cancer e.g. lobular carcinoma in situ, atypical ductal hyperplasia, atypical lobular hyperplasia etc. The risk of breast cancer in this group varies from 20-50%, generally not as high as BRCA gene mutations. For women with a strong family history of breast cancer but without BRCA gene mutations, it is debatable whether they should consider risk-reducing mastectomy. It is best for these women to have a discussion with their breast specialist about their individual risk and circumstances.Are there many women who consider risk-reducing mastectomy? How old are they?A majority of the patients who consider risk-reducing mastectomy are fairly young, with ages ranging from mid 30s-50s.Is risk-reducing mastectomy considered a last-resort measure?Rather than a looking at risk reducing mastectomy as a last resort, risk-reducing mastectomy should be seen as a pro-active, self-empowered decision on the woman’s part to reduce her life time risk of breast cancer.  This frees her from the constant psychological burden of elevated breast cancer risk, and the desire to be in control of their own fate outweighs their fear or anxiety of the surgery.How does risk-reducing mastectomy help women with elevated risks of breast cancer?A risk-reducing mastectomy will reduce a woman’s risk of breast cancer by at least 90%.  Hence, if a woman with a BRCA1 gene mutation who has a 70% lifetime risk of breast cancer undergoes bilateral risk-reducing mastectomy, her risk of breast cancer will be reduced to 7%.  This is a very significant reduction.The reduction in risk cannot be 100% because there is usually a very small amount of residual breast tissue in the nipple, under the skin or peripheral chest wall that cannot be completely removed. Hence the term “risk-reducing” is preferred over “preventive”.It is important to note that for women who choose double mastectomy when a breast cancer has already been diagnosed, the surgery does not eliminate or reduce the risk of distant organ relapse of the original breast cancer.Aside from risk-reducing mastectomy, what other options are there for women with high-risk factors/family history?A non-surgical option to reduce one’s risk is chemoprevention, which is the use of oral medication to prevent cancer. The risk of breast cancer is estimated to be halved with chemoprevention.  However, the medication is associated with side effects and as such, is not a popular option among women.A woman may also opt for high-risk surveillance. This allows for early detection but technically does not reduce one’s risk.  High-risk surveillance includes a yearly MRI of the breasts, in addition to mammogram and ultrasound.Leading a healthy lifestyle may modify one’s risk – this includes a healthy diet comprising plenty of fresh fruits and vegetables, reducing consumption of processed and red meats and reducing alcohol intake. Regular exercise and avoiding weight gain can also modify a woman’s risk of breast cancer.When can reconstructive surgery take place? Can it be done during the mastectomy itself? Are there different types of reconstruction surgeries available? Reconstruction of the breasts is preferably done at the same time as the mastectomy. This will achieve the most favourable aesthetic outcome.Reconstruction for double mastectomy is ideally performed with silicone implants, which will result in a symmetrical appearance of the reconstructed breasts.Alternatively, women may opt for reconstruction using their own body tissue (autologous) such as tummy fat, or back muscle.  For women with small-volume breasts, sometimes fat transfer using liposuction alone may even be sufficient for reconstruction.How has reconstructive surgery helped your patients in their daily lives? Reconstruction is definitely very helpful for women to move on after a single or double mastectomy.  It restores her body image and allows her to dress and carry out her daily activities including sports without worrying about appearance.Because of improved reconstruction techniques in recent years, this has made risk-reducing mastectomy more acceptable.Do you have any advice to give to women who are scared or too busy to take charge of their breast health? Women should not be scared to, or say they are too busy to take charge of their breast health.  After all, health is most important thing in our lives.Breast cancer is a very curable disease and the key is early detection and treatment. Hence, breast cancer screening is very important and I advise women to be pro-active in taking charge of their breast health. Screening will really make all the difference.Article contributed and reviewed by Dr Tan Yah Yuen, Senior Consultant and Breast Surgeon at Solis Breast Care & Surgery 
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