Making an impact

The Breast Course for Nurses: who we are and what we have done over the last 12 months     

We have run several courses over the last 12 months:

Cape Town, South Africa – 15 nurses trained
Lilongwe, Malawi – 26 nurses trained
Windhoek, Namibia – 30 nurses trained
Ongwediva, Namibia – 30 nurses trained
Harare, Zimbabwe – 257 health care providers trained
Johannesburg, South Africa – 42 nurses trained

An account of each course can be found on the blog: and Facebook page:

blog 2The course is constantly evolving and I want to highlight some of the new changes we have made this year.

The major challenge we have addressed is allowing the course to run independently.

I have learnt a lot about teaching through the whole process.  The course was set up along the principles of the flipped class technique.

blog 2.1Unlike teaching at school, the participants on the courses are very varied and most are experts in their own areas.  We were constantly faced with the challenge of having large numbers of health care workers with vastly differing levels of knowledge about breast cancer and differing needs from the course.  In Zimbabwe, we were asked to extend the training to include doctors.  We met the challenge by dividing the 2 day course into 3 day long modules:
Module 1 was capped at 80 students and aimed at primary health care workers, breast cancer advocates and registered nurses.
Module 2 was capped at 50 participants and was aimed at registered nurses from the clinics, oncology sisters and doctors.
Module 3 was capped at 30 participants and was aimed at oncology sisters and doctors.  It allowed us to teach biopsy techniques.

blog 2.2We were also asked to have a “train the trainers” day. In many ways, the request ran against our aim to equip nurses to be self sufficient in their learning.  (The principle behind PEP is that health care workers should educate themselves with the material provided.)  Nevertheless, we blended the 2 approaches and Prof Woods and I ran a day in which we looked at different teaching modalities and tried to apply them to the course.  We defined “teaching” as the “sharing of understanding”
The result was that Module 1 of the Breast Course for Nurses was entirely taught by the nurses who attended the train the trainer’s day and studied the book (Breast Care).  I was immensely proud!

In Johannesburg, we took a different approach to deal with the challenge.  The course was run at Charlotte Maxeke Hospital by Dr Sarah Nietz and her team.  I wasn’t there at all.  I understand that 45 nurses completed the course.  The faculty were entirely local.

blog 2.3

Many thanks to everyone who has been involved with the Breast Course for Nurses.  If you wish to become involved, run a course or know more, please contact us.

Dr Jenny Edge, Founder and director of Breast Course for Nurses (PBO No.: 930050375)






The Breast Course for Nurses: who we are and what we do

Regular readers of this blog will know that the Cancer Alliance is a collective initiative by South Africa’s main breast cancer organisations. We will be introducing each of our partners over the next few months. Today, meet Breast Course for Nurses. This blog was written by Dr Jenny Edge, Founder and director of Breast Course for Nurses.


It is an indisputable fact that women who are diagnosed with breast cancer at an earlier stage have a much better outcome than those diagnosed at a later stage.  Breast cancer screening programmes are well established in high income countries.

The modality of screening used is generally mammographic screening.

There has been a lot of debate about why women are diagnosed late in low income settings.  Do they present late because they are scared or cannot afford to access the health facility?  Do they present with symptoms that are not recognized as cancer by the health care worker (generally a nurse in a primary clinic)?  Do they get lost in the journey of diagnostic tests?

We don’t have the answer to these questions.  The Breast Course for Nurses aims to educate nurses working in primary clinics and equip them with the skills to recognise normal changes to the breast and differentiate them from changes associated with breast cancer.  We teach clinical breast examination with an aim to identifying breast cancers at an earlier stage.

Does clinical breast examination work as a means of breast screening?

Clinical breast examination, as a screening modality, has been studied with mixed results.   A recent study carried out in Sudan showed that clinical examination does pick up breast cancer at an earlier stage than in the control population.1    In Canada, where clinical breast examination was compared to mammographic examination, the mortality from breast cancer, 20 years later, was similar in both groups although more cancers were diagnosed in the mammographically screened population2.

The Breast Course for Nurses is a combination of a self-learning program (PEP educations series) and a residential program that contextualizes the theory in the book, encourages networking amongst the participants and stimulates debate as to how to improve access to care.  The courses are taught by local faculty and no course is the same.

Does our method of transferring understanding work?  We will be doing various projects to look at the impact of running our course.

In the next blog, we will give details of the courses we have run over the last 12 months.


  1. Abuidris DO1, Elsheikh A, Ali M, Musa H, Elgaili E, Ahmed AO, Sulieman I, Mohammed SI. Breast-cancer screening with trained volunteers in a rural area of Sudan: a pilot study. Lancet Oncol. 2013 Apr;14(4):363-70. doi: 10.1016/S1470-2045(12)70583-1. Epub 2013 Jan 31.
  1. Anthony B Miller, Claus Wall, Cornelia J Baines, Ping Sun, Teresa To, Steven A Narod.. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast. Screening Study: randomised screening trial. BMJ: g366 doi:10.1136/bmj g 366




ABC - Advocates for Breast Cancer - Breast Course 4 Nurses

Chemo Q & A
Original colour photograph by Mary Elizabeth Gentle from the article by writer, Allison W. Gryphon, Stage 3a Breast Cancer Survivor: “What Does Chemo Look Like?”


How often is the chemotherapy given and how long does it take?

This is decided by:

  • the type of cancer.
  • the goal of the treatment — i.e. either curative or to relieve symptoms.
  • the different chemotherapy drugs.
  • how your body copes with the chemotherapy.

It can be given daily, weekly or monthly and given in cycles where treatment is alternated with rest periods. Just make sure that you stick to the schedule so that you can get the best results.

Can I take other medication?

It depends what you are taking. Make sure that you give your oncologist a list of any prescription drugs or over-the-counter medication you are taking so you can get the best advice for your specific situation. e.g. vitamins, allergy pills, indigestion aids, pills for colds and flu, aspirin, pain killers and any minerals or herbal supplements.

ADVOCATES FOR BREAST CANCER_what is chemo_what does chemo look like_south africaBlack and white photograph of a chemotherapy drip/cancer treatment - via The Why Foundation: "What Does Chemo Look Like?"










~ original colour photographs by Mary Elizabeth Gentle from “What Does Chemo Look Like?” by Allison W. Gryphon ~

How will I know if the chemotherapy is working?

When necessary, you will be sent for examinations and tests which will help your oncologist determine how effective the treatment has been. Please ask your oncologist to explain these tests to you.



Important questions to ask before you start:

When you are having treatment, it is sometimes difficult to know what to ask about — so here are some ideas to get you started:

  • Why should I receive chemotherapy?
  • What are the benefits of chemotherapy?
  • What are the associated risks of chemotherapy?
  • Are there any other methods of treatment available for my specific cancer?
  • What is the standard of treatment for my type of cancer?
  • Are there any ongoing clinical trials for my type of cancer?

Ask these questions about your TREATMENT SCHEDULE:

  • How many chemotherapy treatments must I get?
  • Which chemotherapy drugs/agents will I receive?
  • How will the chemotherapy be administered?
  • Where will the chemotherapy be given?
  • How long will each chemotherapy treatment take?

Ask these questions about the SIDE EFFECTS of chemotherapy:

  • What are the possible side effects of my chemotherapy?
  • When will the side effects start?
  • What side effects usually occur with my type of cancer?
  • Are there any side effects that need to be reported immediately?
  • What can I do to minimise the side effects?

To ask any more questions – or answer other users’ questions – join us on Twitter here or Facebook here!


A must-read by THE WHY FOUNDATION:

What Does Chemo Look Like? 




In a series of witty PSA videos, the masked superhero Deadpool is using his new popularity to extend the benefits of self-examining your breasts to check for breast cancer. So, #TouchYourselfTonight.

“Did you know that one in eight women will be diagnosed with breast cancer at some point in their life? So it looks like you’ve got some fumbling to do yourself.” #TouchYourselfTonight


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).

What about radiotherapy?


When a patient is diagnosed with cancer, it is usually a turning point in their life. Few forget the initial shock and disbelief after the diagnosis, as well as the fear and the feeling of helplessness that is experienced. In between all these emotions there are usually further tests that must be done and an urgency to start treatment – and to start experiencing the haven of care and empathy that is the oncology unit.


Treatment of cancer can be labelled curative (when the treatment is aimed at  the remission of the cancer and the healing of the patient is possible ) or palliative (when the treatment is aimed at ensuring symptom control and focuses on improving quality of life of the patient ) cure is not possible patients can live long and well before they pass on.

The oncology team will decide on the best possible treatment for you, depending on the type of cancer and the stage it is in. We talked about this coordination of care in this post and about the teams who will take care of you in this one.

One of the ways in which your cancer may be treated is though radiotherapy. This is the use of high-energy x-ray beams that can penetrate tissue, causing cell damage and cell death and reducing the cancer growth.

Normal cells are also influenced by radiation, but most of them recover from the effect of radiation. Normal tissue still needs to be protected from radiation as far as possible so the total amount of radiation is limited to the dosage normal tissue can tolerate.

Every patient’s treatment is planned individually with the use of highly sophisticated 3-D computer technology. Normal tissue is protected from radiation beams when possible and the newer radiation machines have built-in  shielding that is very sensitive and effectively protects the patients sensitive organs.

The aim of radiotherapy is to kill cancer cells with as little risk as possible to normal cells.  Radiotherapy can be used in the treatment of different kinds of cancer in nearly any part of the body.

Radiation, like surgery, is a local treatment. It influences only the tissue in the specific area of the body that is being radiated.

Radiation is often used in combination with surgery to treat cancer. Radiation can be given before surgery to shrink a cancer mass, this may enable them to remove all cancer tissue by using less extensive surgical methods. Radiotherapy can also be given after surgery to reduce the chances of regrowth of any remaining cancer cells.

In some cases radiation is used in combination with chemotherapy. The radiation can be given before, during or after chemotherapy. Combination therapy is tailored carefully to suit each individual patient’s needs according to the type of cancer, the location and the disease stage.

Where a cure isn’t a realistic option anymore, radiation is often used to shrink cancer masses and in doing so to relieve pressure, pain and other symptoms associated with uncontrolled cancer growth. This treatment is known as palliation (symptom relief). Most cancer patients find that they can lead a better quality of life after radiation for problematic symptoms.


Next week we will explain what to expect when you go for your radiotherapy treatment.


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