Heroine? Victim? WARRIOR!

Breast Cancer - Self Portrait - Photographer: Tracey Derrick

Continuing the thread of thought from Tracey’s seminar paperwe quoted yesterday, read about photo therapy/therapeutic photography  and  how Tracey made it work for her!

Spence uses the term ‘photo therapy’, which she explains is using photography to heal ourselves. It is about transformations and change and thus challenges the fixity of the photographic image and the search for an ideal self.

Spence and Martin use a kind of internal permission giving: permission to change, to re-view, to let go, to move on.

“Ways in which I have used the camera therefore include taking naturalistic photographs as things happen to me and around me; staging things especially for the camera; using old personal photographs and re-inventing what they mean. The whole technique depends upon expecting photographs to help us to ask questions, rather than supplying answers”.

This helped her with breast cancer and she says, “As a result I see myself neither as a ‘heroine’ or ‘victim’, but merely as a person in a struggle, changing and adjusting daily, and trying to keep a state of equilibrium which will allow me to function optimally, at the same time as I strive to regain health”. 4

“Bitterness is like cancer. It eats upon the host. But anger is like fire. It burns it all clean.”


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Octobering Again!

Advocates for Breast Cancer - advocating for an equitable breast health policy for all South Africans

Whether we celebrate or dread the arrival of each October and its sudden and all too temporary focus on breast cancer, it is a crucial opportunity to amplify breast cancer awareness and advocacy we simply must ride the wave of – right in to shore!

Looking Back…

October 2013: We touched on a wide variety of topics – with a few listed below for you!
October 2014 was when we launched our Equitable #BreastHEALTHPolicy Advocacy campaign in earnest! Check out the sample of articles below – and share, share, share!


We’d love to hear from YOU! Which blog post was the most helpful for you – and why? What topics would YOU specifically like us to tackle? Tell us in the comments below – or join us on Facebook or Twitter!

Hormones and the endocrine system

The role of Hormonal / Endocrine therapies in breast cancer


Approximately two thirds of breast cancers are oestrogen positive which means they have oestrogen receptors on the surface of the cells and therefore depend on the hormone oestrogen for growth.

This has meant that a range of treatments could be developed with the aim of decreasing the cancer growth or stopping the cancer from coming back by preventing oestrogen action on the cells.

These treatments include: Tamoxifen, Aromatase inhibitors, and Zoladex injections.

But what are they, and how do they work?


How it works

This is a synthetic hormone that binds to the oestrogen receptors on the breast cells in place of the woman’s own oestrogen. Unlike natural oestrogen, it does not stimulate breast cell growth and therefore has the effect of “blocking” the receptors.

It can be used in both pre-menopausal and post-menopausal women.

Trials have confirmed that tamoxifen significantly reduces the incidence of local recurrence, metastases (spread of breast cancer to distant organs) and breast cancer in the opposite breast.

It is taken as a single tablet daily.

The benefits have shown to be optimal if taken for a period of 5-10 years.

Side effects

Tamoxifen is in the group of Selective oEstrogen Receptor Modulators (SERMS) which means that it has different effects on different tissues in the body. While it blocks the action of oestrogen in breast tissue, it also has partial estrogen activity in other tissues.

This is the basis for its possible side effects such as hot flushes, vaginal dryness/bleeding and endometrial thickening or polyps.

Other side effects have been associated with its use such as thromboembolism, nausea/diarrhoea, weight gain,headaches or dizziness, and low mood.

It is important to realise that not all patients experience these side effects and some may experience them to a very mild and completely tolerable extent.

Aromatase inhibitors (AIs)

How they work

Aromatase inhibitors are another way of reducing oestrogen effect in post menopausal women. In this group of women, oestrogen is no longer produced by the ovaries, but smaller amounts of oestrogen are still circulating. This oestrogen is derived from androgens which are converted into oestrogen by the aromatase enzyme in peripheral tissues such as fat. The AIs block this enzyme and, in so doing, reduce oestrogen production.

There are 3 main AIs: Letrozole (Femara), Anastrozole (Arimidex), and exemestane (Aromasin).

They are prescribed as a single tablet every day for or at least 5 years.

Sometimes they can be used in sequence with tamoxifen where the patient will switch to an AI after 2-3 years of tamoxifen, or as an extended adjuvant therapy where an AI may be started after 5 years of tamoxifen.

Side effects:

Due to the different mechanism of action, the side effect profile of AIs is slightly different to that of Tamoxifen.

The gynaecological side effects are less of a problem with the use of AIs compared with tamoxifen. However, the AIs may cause joint pain, stiffness and bone loss.

Women who are scheduled to start an AI should have a baseline and then periodic Bone Mineral Density assessments (an outpatient X-ray or DEXA scan). Calcium,Vit D supplementation and, in some cases, bisphosphonates may need to be considered.

Ovarian ablation/ suppression

Surgical removal of the ovaries or ablation of the ovaries with radiotherapy has been shown to arrest breast cancer growth due to the depletion of oestrogen.

Ovarian suppression can be achieved medically by using gonadotrophin-releasing hormone (GnRH) analogs. This has been shown to have equivalent effects as surgical or radiation induced menopause with the added benefit of being reversible after the completion of therapy.

Examples of these treatments are goserelin (Zoladex) and leuprorelin (Lucrin).

They are administered as an injection under the skin either monthly or 3 monthly.

These drugs can be used in combination with tamoxifen and aromatase inhibitors in both pre-  and peri-menopausal women.


Although tamoxifen and the AI’s have been proven to be extremely effective treatments, resistance to treatment has been described. Further research is being done in order to understand mechanisms of resistance and to combat resistance pathways.

Endocrine treatments such as fulvestrant (Faslodex) are being used in cases of advanced or metastatic disease or recurrence of breast cancer during endocrine therapy. It is an oestrogen receptor down- regulator and is given as a monthly injection.


The selection of which endocrine therapy or combination of therapies is individualised and depends on whether the patient is pre- or post-menopausal, whether she has contraindications to any of the treatments, treatment interactions with medication she may be taking for other conditions and the extent of the side effects she may develop on the medication. Of course, patient preference is an important consideration. Financial implications may influence treatment decisions too.

Dr Ronelle de Villiers
MBChB, DCH, BSc(med)












I look up every morning and I say ‘thank you’

“My colleague at work urged me to go for a mammogram, and she saved my life,” says Suzette Laubscher. “The worst part of it was the waiting, the waiting to find out what the diagnosis is. Its like being in limbo – you hear the words but they don’t sink in,” says Suzette Laubscher.


You can’t do this journey on your own

“Talking about my cancer helped me to be in a better state of mind and to move on with my healing,” says Beryl Arries who is a 10 year cancer survivor


I’m not a pink person but I’m wearing pink every day for October

“You can’t ask for better treatment than you get from Groote Schuur. They were fantastic,” says Laurine Viljoen, whose cancer has been in remission for four years now.

“When you hear the word cancer, you think ‘yay, I’m going to be thin!’ But no. I picked up 30kg!” she says.


Time flies, and we heal, and life carries on

Lisa Fuller is a two-time breast cancer survivor. “When it came back the second time I was extremely angry. I didn’t really want to go through chaemo again, and it has been much more hard on my son, because he is older now.” She explains that life doesn’t stop for cancer – you still have to look after your family, you still have to work and you have to just deal with it.




Breast cancer is not just the lump

Lesley Collopy’s breast cancer was diagnosed on her son’s birthday, eight months ago.

“When you hear your doctor say it is cancer, your whole world implodes. Breast cancer is not just the lump. Not enough support is given to the husbands or children of people with breast cancer. And it is difficult because I don’t think they know how to react around you.”


I expected to die, but 15 years later I’m still here, fit and healthy and positive

“You think you are invincible when you are younger,” says Jennifer Heunis, whose experience with breast cancer opened the eyes of the students that she was teaching. “We all need to educate ourselves about our bodies.”


It is amazing what you can do when you don’t have a choice

“I may have inherited breast cancer, but I also got the gene to overcome it,” says Kate Squire-Howe, a five year survivor of breast cancer. “A cancer diagnosis is a life changing experience. Growing old is not something that is guaranteed. I decided to live the life that I want to live right now.”