Laparoscopic surgery

Surviving Breast Cancer

 SURVIVING BREAST CANCER

Michael McFarlane, Contributor

 A diagnosis of breast cancer is always of great concern to women and their families but it need not be considered a death sentence. Breast cancer is survivable and advanced treatment has proven that large numbers of women are able to have extended survival with prompt treatment. It is always important to detect the cancer early since the stage of the cancer is the most important predictor of survival.

 A small tumour less than 2 cm in diameter without involved lymph nodes in the armpit or axilla is considered a stage I cancer and has the best chance of survival. When the diagnosis is made at this stage the survival is nearly 100%. Stage II cancers are usually larger than 2cm in diameter but less than 5 cm in diameter. The majority of these cancers are associated with axillary lymph node spread. These cancers are still considered to be early and the survival is very close to the survival of stage I cancers. State III cancers are larger than 5 cm and frequently associated with skin involvement such as dimpling or ulceration of the skin with a significant number of axillary lymph nodes.

These cancers usually represent a late diagnosis and this can be avoided if the diagnosis is made at an early stage. The survival with stage III cancers is fair with a 50% to 60% chance of survival.

The poorest survival occurs when the diagnosis is made at an advanced stage referred to as stage IV. These cancers have spread outside the confines of the breast and lymph nodes to involve other distant sites in the body such as the lungs, brain and bone marrow. Treatment at this stage requires several modes of therapy and survival is guarded, with long-term survival less than twenty percent.

 Doctors often discuss survival in 5-year intervals using statistics that apply to studies of large numbers of women with breast cancer. These figures don’t often apply to an individual woman since each woman will have a different outcome based on the unique behaviour of the tumour and her own biologic defences to the tumour. In reality most women who receive modern treatment will outlive the cancer and will have the same survival as a woman without breast cancer.

 Many women gain benefit from support organizations such as Reach to Recovery, which in Jamaica is affiliated with the Jamaica Cancer Society. Reach to Recovery works through a group of committed volunteers some of who have been diagnosed with breast cancer and have been successfully treated. The Reach to Recovery group is a part of a larger international organization that provides support for individuals who have been diagnosed with cancer and their families. Reach to Recovery volunteers are able to offer comfort and support and are able to help with decision-making in the early days following a diagnosis of breast cancer when apathy and confusion are likely to be present. They are also trained to give advise on the use of breast form devices and prostheses that help in restoring normal contour.

The treatment of breast cancer involves five medical interventions and usually begins with surgery. Modern approaches including breast conservation surgery (lumpectomy) are in most early stage cancers able to preserve the cosmetic appearance of the breast and are as successful as mastectomy (breast removal). Recent improvements in mastectomy surgery such as skin sparing and nipple sparing mastectomy result in an excellent cosmetic appearance. Surgery is considered to be the primary treatment for breast cancer since the majority of early stage patients are cured by surgery alone. Other forms of treatment include radiotherapy, chemotherapy and hormonal therapy. Additional therapy sometimes referred to, as targeted therapy, with newer agents called monoclonal antibodies, may be necessary in some types of cancer.

Careful frequent follow-up visits are necessary to reduce the risk of recurrence or relapse and all breast cancer survivors need to see their doctors at regular intervals. Yearly mammograms are also an important part of the follow-up. Women with hormone receptor positive tumours will be placed on medication, which will be continued for at least 5 years. This medication has been shown to reduce the risk of recurrence by more than 40 percent. Recent research shows that nearly 90% of all women who survive for 5 years will survive at least 10 years when the diagnosis is made early and 80% will have long-term survival of at least 15 years. The importance of early diagnosis and treatment cannot be overstated.

Breast cancer survivors are always a very good source of information for newly diagnosed women and many women are encouraged to become volunteers and to participate in support groups which will help them to increase their knowledge and to provide a sense of community and camaraderie for other women similarly affected.

Many breast cancer survivors develop a new perspective on life after the diagnosis has been made. The journey that results in overcoming this disease quite often results in a life that is more rewarding and fulfilling for many women and filled with more enjoyment than ever before.


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