World Cancer Day highlights urgent need for a breast health policy in South Africa

 

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It has been 16 years since World Cancer Day (WCD) was declared as part of the Paris Charter adopted at the World Summit Against Cancer for the New on 4 February 2000, but for most cancer patients in South Africa little has changed.

“Cancer is still not regarded as a priority in South Africa,” says Salomé Meyer, spokesperson for the Advocates for Breast Cancer (ABC), a coalition of interested breast cancer organisations in South Africa.

ABC was formed in 2014 to campaign for a national breast health policy for South Africa and to prioritise the management of this disease. Eight breast cancer organisations – The Breast Health Foundation, Reach for Recovery, CANSA, Pink Drive, Project Flamingo, Breast Course for Nurses, People Living with Cancer and Wings of Hope – are working together to lobby government to create and implement an equitable breast health policy for all South Africans.

“We know that breast cancer is still the leading cause of cancer related deaths for women in our country,” Meyer said. “But we still do not have a cancer registry which would provide the vital real-time data that is needed to plan or budget appropriately.

“This World Cancer Day we are calling on the Minister of Health, Dr Aaron Motsoaledi, to urgently develop a breast health policy for our country.”

As part of its advocacy campaign, ABC provides information about breast cancer on its blog at www.blogforbreastcancer.wordpress.com and through its Facebook page at https://www.facebook.com/AdvocatesForBreastCancer/.

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What will happen during radiotherapy?

 

strongRadiation can be given externally or internally. The treatment you will receive depends on the type and stage of the disease as well as the location.

Most people who receive radiation therapy for cancer have external beam radiation. The beams are generated in a machine called a linear accelerator. The machine directs the high energy x-rays at the cancer, treating that and a small margin of normal tissue around the edge of the treatment field.

When internal radiation therapy is used, the radiation source is placed inside the body. This method of radiation is called brachytherapy.

Some patients have both forms of radiation, one after the other.

What does treatment planning mean?

Before starting with the actual radiotherapy treatment, the precise location of the area to be radiated must be determined. Your radiation will be planned specifically for you as an individual in order to deliver the maximum amount of radiation to the cancer mass while limiting the dose to the surrounding normal tissues to the minimum.

You will be asked to lie very still on a treatment couch while a radio therapist will use a special x-ray machine, the simulator, to define your treatment field. Depending on the location of your cancer, single or multiple treatment fields may be necessary. The planning process may also involve a CT scan of the affected area in order to plan radiation fields more accurately by taking different tissue densities into account. After completion of the CT scan it may take another day or two to develop a final treatment plan, a process during which different radiation combinations and options are considered in order to determine the best possible treatment plan for every individual patient.

Small tattoos in the form of pinpointed dots will be placed on your skin to define the treatment area. This is to ensure that treatment is delivered to exactly the same area every day; the tattoos also enable one to determine areas where radiation has been delivered previously, even years after treatment. Non-permanent pen marks will also be used to ease daily setup and treatment field determination.

Before your first treatment a set of special x-rays will be taken. This is to again confirm that the radiation will be delivered to the correct area; it also serves as a record of your treatment. These x-rays are often repeated during your course of radiotherapy to verify their correctness.

How long does treatment last?

Most cancers are treated with radiotherapy for 5 days per week over a 6 to 7 week period. (When radiation is given for symptom control only, shorter treatment periods are used, which could be from a few days up to 3 weeks.) Every treatment lasts 10 tot 20 minutes, the actual radiation therapy takes only a few minutes per day, while setting you up in the correct position, and adjustments between various radiation fields make up for the remainder of the time.

The use of smaller daily doses of radiation given over a longer period of time instead of a few large doses over a shorter time period helps to protect normal tissue in the treatment area. Rest periods over weekends also help normal cells to recover from the radiotherapy.

What happens during radiation treatments?

Wearing clothes that are easy to take off and put on is advisable.

The radiotherapist will use the marks on your skin to position you correctly and to determine the treatment field. You will be asked to lie very still on the treatment couch; although you will be alone in the room during the treatment, continuous monitoring through a closed circuit camera system will be done. External beam radiation is painless, and is comparable to x-rays taken for diagnostic purposes. You will not see or smell the radiation.  You may hear a sound whilst the radiation beam is running, this is normal. The radiation will not make you radioactive. After starting treatment, your doctor will monitor your treatment progress as well as your reactions to treatment.

You need to remain very still during the treatment so that the radiation reaches only the area where it’s needed and the same area is treated each time.

 

You don’t have to hold your breath – just breathe normally. The radiation machine is  controlled from the control area nearby. You will be watched on a television screen from the control room. There is also an intercom system. If you should feel ill or very uncomfortable during the treatment, tell your therapist at once. The machine can be stopped at any time and treatment restarted without any bad effects on the treatment.

What are the side effects of treatment?

External radiation therapy does not cause your body to become radioactive. There is no need to avoid being with other people because you are undergoing treatment. Even hugging, kissing, or having sexual relations with others pose no risk of radiation exposure.

Most side effects of radiation therapy are related to the area that is being treated. The side effects of radiation therapy, although unpleasant, are usually not serious and can be controlled with medication or diet. They usually go away within a few weeks after treatment ends.

Depending on the area being treated, you may need to have routine blood tests to check different levels as radiation treatment can cause decreases in the levels of different blood cells.

What can I do to take care of myself during therapy?

Each patient’s body responds to radiation therapy in its own way.

Some general guidelines:

  • Before starting treatment, be sure your doctor knows about any medicines you are taking and if you have any allergies
  • Your body will use a lot of extra energy over the course of your treatment, and you may feel very tired. Be sure to get plenty of rest and sleep as often as you feel the need. It’s common to feel tiredness for 4 to 6 weeks after your treatment has been completed
  • Good nutrition is very important. Try to eat a balanced diet that will prevent weight loss
  • Check with your doctor before taking vitamin supplements or herbal preparations during treatment
  • Avoid wearing tight clothes over the treatment area
  • Be extra kind to your skin in the treatment area:
  • Wear loose, soft cotton clothing over the treated area
  • Do not scratch, rub, or scrub treated skin
  • Do not use adhesive tape on treated skin. If bandaging is necessary, use paper tape and apply it outside of the treatment area
  • Use only lukewarm water for bathing the area
  • Use an electric shaver if you must shave the treated area. Do not use a pre-shave lotion or hair removal products on the treated area
  • Protect the treatment area from the sun. Do not apply sunscreens; cover treated skin (with light clothing) before going outside
  • Ask your doctor about washing the affected area as no scented or coloured soaps or talcum powder should be used (non perfumed and glycerine soaps are available and Maizena is a good substitute for talc).

Explaining lymphoedema

B9319068312Z.1_20151002152238_000_G2FC3T7CP.1-0Breast cancer related lymphoedema (BCRL) Lymphoedema is a chronic, debilitating condition that is caused by the malfunctioning of the lymphatic system due to damaged lymphatic vessels and lymph nodes. Breast Cancer Related Lymphoedema (BCRL) is one of the most dreaded side effects post breast surgery and radiation therapy.

All diagnosed with breast cancer are at risk of developing BCRL in their life time. It might never or it may develop years post cancer treatment. It is important to be aware of the risk factors, symptoms and most importantly how to reduce the risk and manage early stage BCRL.

So how does the lymphoedema develop? The lymphatic system in our bodies is responsible for draining all the toxins from the tissue spaces, transport it to the lymph nodes where the toxic waste is removed from fluid known as lymph.

With surgery and radiation therapy lymph nodes may be removed and lymph vessels damaged resulting in a partial mal-functioning of the lymphatic system especially on the side of body affected by the treatment. It is also referred to as the blockage of the lymph vessels. This may result in swelling of the upper limb and alternative pathways are required to facilitate the drainage and flow of lymph from the affected areas.

So what are the symptoms of BCRL? The physical symptoms occur most commonly on the side where the cancer was treated and these may include:

Early stage symptoms

  • Feeling of heaviness, numbness, pain of the upper limb
  • Swelling of the limb and subsides after elevation
  • Fingers swelling so ring not able to fit, or sleeve too tight or wrist swollen so watch strap not able to fit Moderate to Late stage symptoms
  • Pitting of skin and swelling which does not subside after elevation – Hardening and or discolouration of skin
  • Skin may tear or become infected (cellulitis)

The psycho–social symptoms may include:

  • Anxiety and fear of cancer recurring
  • Anti-social to avoid questions about the condition
  • Low self- esteem and poor body image due to enlarged upper limb How to reduce the incidence risk?
  • Be aware of the early stage symptoms
  • Exercise is very important
  • Taking good care of the skin to prevent damage through cuts and burns
  • Don’t wear too tight clothing or jewelry
  • Avoid very hot water, so wear gloves when washing dishes and bath and shower in warm but not very hot water
  • Protect the skin by wearing long sleeve clothes or gloves when working in the garden
  • Apply anti-bacterial cream immediately if cut or tear of the skin.
  • If skin becomes very red and painful go to the community health center, or medical facility to receive antibiotics for the infection (cellulitis)

BCRL is a chronic condition that cannot be cured but it can be managed through a range of treatments and these include:

  • Manual lymph drainage (gentle massage technique)
  • Multi-layered compression bandaging or compression garment
  • Exercise
  • Skin care

Finally all breast cancer patients and survivors must become aware of the early symptoms and how to prevent or manage BCRL.

Compiled by: Colleen Marco Lymphoedema Therapist

I decided to live!

Thobeka Dadisaid that chaemotherapy was very difficult: “I thought I would rather die” but support from her family, colleagues and community pulled her through.

 

 

Reconstruction after mastectomy

There are various types of reconstructions that can be offered to a patient after a mastectomy. There are many factors that need to be considered before one can decide on a reconstruction and this needs to be discussed between the patient and the surgeon. Each person is different and the type of reconstruction is based on many various factors including:

  1. The choice of the patient as discussed with the surgeon and multidisciplinary team
  2. The type of cancer
  3. The location of the cancer
  4. The build of the patient
  5. Involvement of the nipple
  6. Whether the patient will still need radiotherapy or not

 

There are many types of reconstruction, most of which are available in South Africa. Reconstruction can be done as an immediate reconstruction or a delayed reconstruction.

  1. A flat chest: many people will request a flat chest. Women will often choose this procedure as it is a fairly quick operation with minimal pain post operatively and has a low risk of complications. A prosthesis with a special mastectomy bra can be fitted a few months after the operation. The patient can also have a reconstruction a few years after having a flat chest mastectomy, this is known as a delayed reconstruction.
  2. A reconstruction using expanders: this is where an expander is placed beneath the muscle in the chest wall. It is then inflated every few weeks until it reaches the appropriate size. An operation to remove the expander and replace it with a prosthesis will follow.
  3. An immediate reconstruction using prosthesis: this is done in certain cases where a skin sparing mastectomy is performed and the tissue is immediately replaced with a prosthesis.
  4. Reconstruction using body tissue:
  5. A flap from your back (latissimus dorsi flap) – the surgeon will make a new breast by using the muscle, skin and fat from your back.
  6. A flap from your abdomen (a TRAM flap) – the surgeon uses part of the muscle with its skin, fat and blood vessels to make a new breast.
  7. A flap from your abdomen (a DIEP flap) – the surgeon takes only the fat and skin from the abdomen to make a new breast. This procedure often has a very good outcome as the breast looks and feels natural as it consists of fatty tissue.
  8. A flap from the thigh (TMG or TUG) – the surgeon will use the fat, skin and muscle from the thigh, either making use of the outer or inner thigh.

Once a mastectomy with reconstruction has been performed, a nipple can also be made. This would be done only once the reconstruction has entirely healed and would involve small procedures. A tattoo can be done to give the nipple areolar its colour.

Reconstruction is a very personal decision and the patient should not be rushed into something that they do not feel comfortable with having. It is important as a patient to look into the various options that are offered before making a decision.

 

Sr Lieske Wegelin

ABC - Advocates for Breast Cancer - Breast Course 4 Nurses

Never give up!

Nontobeko Sikiti, who was diagnosed in 2012, says that after treatment, there are good results, so she advises other survivors to never give up!

(we apologise for the bad sound quality on this video)

It has been a good journey!

Merlin Osborne – a survivor for eight years – says that running keeps her sane – including running away from negativity!

walk