Thursday, 16 October 2014

Breast cancer and all that jazz

For the rest of October, as my contribution to breast cancer awareness month, I will be featuring a number of stories about diagnosis and treatment from younger women with breast cancer on my blog, written in their own words.
Before I do this, I wanted to write a post containing information about breast cancer that you may not be aware of. I’ll mostly be using information taken from sites such as Breast Cancer Care, with a smattering of information about my own personal situation.

Contrary to popular opinion, breast cancer isn’t just ‘one thing’. It’s a complex beast and there are a number of different types. I won’t go in to this in too much detail now but if you wanted to find out more about the different types of breast cancer you can find this here. Because all breast cancers are different, people have different treatments depending on what will work best for them.

Some facts about breast cancer (taken from the Breast Cancer Care website):
  • The lifetime risk of developing breast cancer is 1 in 8 in women
This means that 1 in 8 women in the UK will develop breast cancer in their lifetime– it also means that 7 out of 8 women won’t develop breast cancer.
  • Estimated risk of developing breast cancer according to age
Risk up to age 29, 1 in 2,000.
Risk up to age 39, 1 in 215.
Risk up to age 49, 1 in 50.
Risk up to age 59, 1 in 22.
Risk up to age 69, 1 in 13.
Lifetime risk, 1 in 8.
  • Both women and men get breast cancer
Although it is much rarer than in women, men can get breast cancer too. Every year about 400 men are diagnosed in the UK.
  • Older people are more likely to get breast cancer than younger people
After gender (being female), age is the strongest risk factor for developing breast cancer – the older the person, the higher the risk. Around 81% of breast cancers occur in women over the age of 50.
  • Most cases of breast cancer don’t run in the family. Most cases of breast cancer happen by chance. Only around 5% of breast cancers are caused by inheriting an altered (faulty) gene.

  • Breast cancer can affect any woman, regardless of the size of their breasts (trust me mine are very modest!).

  • Finding a lump in your breast doesn’t mean you have breast cancer. There are several benign (not cancer) conditions that can occur in the breast and may cause a lump. Also many women will experience lumpy breasts just before their period. This is a normal response to changing hormones and often the lump or lumpiness disappears after the period. However, if this doesn’t go away, it’s important to get it checked out by a doctor. Any new lump should always be assessed by a doctor.
Even though breast cancer is more common in older women it can and does happen to younger women! Please check regularly and visit your doctor with any changes or lumps. And never be fobbed off. If you are unhappy push for a referral to a breast clinic.

Please click here for information about what breast changes look and feel like.

Breast cancer can be oestrogen receptive or not, HER2 positive or negative or triple negative. If a breast cancer is oestrogen receptive, simplistically it means that oestrogen is making it grow. My tumour is as strongly oestrogen receptive as you can get. This means the little bastard is doing the happy dance on the stuff. 

However, this is apparently a good thing as because they know what’s making it grow, they can use drugs to try and stop it coming back.
Tamoxifen (or Tamoxibollocks as its affectionately known) is a drug that they give women who have had oestrogen receptive breast cancer. Sometimes it is given to women with an increased risk of breast cancer as a preventative measure. Tamoxifen is usually given for five years after active treatment (chemo, surgery, radiotherapy) for oestrogen receptive breast cancer has finished. However, studies are now showing that ten years may be the more effective treatment strategy. I’ll be having Tamoxifen to try and reduce my risk of recurrence.  Because breast cancer can come back. Unlike some cancers, the term ‘cured’ is not used with breast cancer. It can return – either as a local, regional or distant recurrence. Most people do not have a recurrence, however it can and does happen.
So there are measures that you can take to try and prevent this happening. Tamoxifen is one. On the whole I am happy about this, but there are things that I find a little difficult to deal with. The first one is that you can’t get pregnant on Tamoxifen due to the risk of damage to the foetus. So ten years would take me to the age of 43 - fertility is not at its peak by this point. That’s if the chemotherapy hasn’t fried my ovaries first. But, for me I think I’d be terrified to get pregnant even if it were possible. All that oestrogen flying around. Would be like bloody Christmas for breast cancer. So, children more than likely out the window for me. Not literally obviously. I don’t go around throwing children out of windows…
Anyway, Tamoxifen also has some lovely side effects, mainly in the way of menopausal symptoms such as hot flushes, weight gain and osteoporosis. Delightful.
On to surgery. As I have one node involved I will need to have a full axillary node clearance. This means taking out all the lymph nodes from under my arm pit and possibly the right side of my chest. Cutting through layers of muscle and nerves. Not pretty. I’m still in pain from having four nodes out so having around 20 removed doesn’t bear thinking about. It also leaves me at risk of lymphoedema – a permanent, painful and sometimes disfiguring condition which can involve having a very swollen arm.
I’m having chemotherapy first to try and shrink the tumour as the surgeons want to do a lumpectomy rather than a mastectomy. If they took it out now it would leave me quite disfigured as I’m definitely not Kelly Brook in the boob department. I think the words my consultant used were ‘quite small breasts’…
Chemotherapy is usually a given if you are a young woman with breast cancer. They want to try and give you the best chance possible to live a long and happy life essentially. The main purposes of chemo are to try and blast any other stray cancer cells that may have done a runner from the original tumour and be floating around the body and also to try and reduce the risk of recurrence.  Chemo is nasty and makes you feel like shit, but I’m happy to lay back and take all the NHS has got to try and give this thing an almighty battering.
When they perform a lumpectomy they need to get what is called ‘clear margins’. This means that when tested, there are no stray cancer cells in any of the healthy tissue that has been removed with the lump. If there is, it can mean another lumpectomy. And if this then fails again, a possible mastectomy. So, not as straight forward as whipping the bugger out and stitching it up!
Breast reconstruction

A mastectomy means removing all the breast tissue. Essentially taking the whole boob off. I wanted to clear a few things up about mastectomies and reconstruction. Breast reconstruction after a mastectomy is not like having a boob job. You do not just get a ‘new boob’ Pamela Anderson style. Reconstruction is a lot more complicated than that. I’m not an expert but here is my limited knowledge about breast reconstruction:
One method of recon is to build a new boob from tummy fat. This wouldn’t be an option for me as I don’t have enough. Reckon they would be able to build about a nipple from mine
Another is an implant. However, if radiotherapy is required, an implant can’t be inserted at the same time as the mastectomy as the radiotherapy is likely to damage the reconstruction. In this case, something called tissue expander can be used. This involves inserting an empty implant which is gradually over a period of time filled with saline. This essentially stretches the skin and tissue so that an implant can be fitted at a later date. But then this means another lot of surgery later down the line. And obviously no feeling or sensation in that boob.
Or you can just go flat and wear your battle scars with pride.
There is also an operation that involves taking tissue and muscle from your back and reconstructing breasts from that. My friend Sarah, who will be having a double mastectomy and this op due to a gene fault, described it like this:
'They take muscle and tissue from your back. I think this is what I'm having. It's basically swung round from your back to front. So boob removed at front chunk taken from back, swung round to front and stitched in to the gap, and hole in back sewn together. Lovely!  

There are other options and I’ve definitely explained reconstruction very simplistically - its much more complicated than this, but as you can see, definitely not a boob job!

So there we have it. Some breast cancer facts and information. Please do click on the links I have put in this post to find out more as I am definitely no medic and no expert! i hope you have found this whistle stop tour through the land of breast cancer informative - please stop by again soon! 

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