Introducing… The Breast Health Foundation

The Breast Health Foundation was launched in 2002 to raise awareness of breast health among women through a series of community based education projects and creating awareness via community health facilities.

The projects currently employ six women, themselves breast cancer survivors, who give talks at churches, places of employment and public clinics about breast health, breast self-examination and the importance of early detection.  Fourteen years on and there has been a noticeable increase in the number of women being diagnosed early.

Over the years the organisation has, through expansion, based itself in the Vaal/Sedibeng area, Cape Town and Durban. The women based in those areas facilitate educational talks, counselling and patient navigation. These educators are also at the regional breast care centres to assist the patients that have been referred and provide counseling if diagnosed.

To date our community educators have directly impacted 72 811 women through community education projects and have made 291 clinic visits. In total, 2913 women have been navigated and 376 diagnosed with various stages of breast cancer throughout all our active areas.

Bosom Buddies (BB) was established as a project of the BHF, a support group for survivors and their family and friends. The group aims to provide emotional and informative support to all individuals diagnosed with breast cancer and is run by survivor volunteers. The ‘buddies’ provide support to people affected by breast cancer at point of diagnosis and during treatment. BB hosts public meetings in Johannesburg every seven (7) weeks and speakers are invited to share knowledge and experiences with the buddies.

Buddies for Life, a bi-monthly lifestyle magazine, is published by Word for Word Media on behalf of the Breast Health Foundation. In sustaining the aims of the Breast Health Foundation. All of the persons involved with Buddies for Life are either medical or healthcare professionals, and they have been affected by breast cancer themselves or have been inspired by a breast cancer survivor. Each issue of Buddies contains a section dedicated to the early detection of breast cancer.

The Breast Health Foundations purpose is to:

  • increase the awareness of breast health;
  • promote education and treatment and
  • provide support in respect of breast health.

Our mission is to

  • create breast health awareness in the community,
  • ensure individual access to information,
  • potentiate access to appropriate healthcare resources,
  • create an ongoing audit of operational effectiveness and
  • offer emotional and informative support.

 And through our projects, we have succesfully managed to realise great results.

You can connect with us on a daily through our social media pages:

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BHF: https://www.facebook.com/BreastHealthFoundation/

BB: https://www.facebook.com/groups/31260668033/?ref=br_tf

Buddies For Life: https://www.facebook.com/BFLMagazine/?fref=ts

EBC:  https://www.facebook.com/groups/903665216386353/

BHF: @BreastBhf

Buddies For Life: @BFLmagazine

This post was written by R.Vanessa Mthombeni for The Breast Health Foundation

 

 

 

Targeted biological therapies

Approximately 20% of breast cancers are known as HER2 positive. This means that a gene mutation has caused the cells to have an over expression of HER2 receptors and this protein signals the cancer cells to grow and divide.

The HER2 receptor can be tested for by:

  1. Immunohistochemistry (IHC)- which shows how much of the protein is on the cell surface
  2. In-situ hybridisation (ISH)- which tests the number of copies of the gene inside the cell..

HER2 positive breast cancers tend to be more aggressive than HER2 negative cancers.

Trastuzamab (Herceptin) is a biological therapy that has been designed to specifically target the HER2 receptor in HER@ positive breast cancer. It reduces the risk of recurrence and death in women with HER2 positive breast cancer and prolongs survival in women with HER2 positive metastatic breast cancer.

Lapatinib (Tykerb) is another “HER receptor blocker” that is sometimes used in combination with Herceptin

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Side effects:

Although Herceptin has been shown to have greatest benefit when used in combination with chemotherapy, it is not in itself a chemotherapy treatment. Chemotherapy treatments affect all rapidly dividing cells whether they are cancer cells or healthy cells.

Herceptin, however, targets only those abnormal cells with increased display of the HER2 receptor and it spares the healthy cells.

For this reason the side effect profile is substantially less.

Its main possible side effect is on the heart and the use of Herceptin in some patients may require baseline and periodic cardiac function tests. This side effect is usually reversible. In some cases hypersensitivity or allergic reactions can occur and for this reason it should be given in an appropriately equipped facility by staff who are trained to manage a possible reaction. Other less common and mild side effects may include fever, throat irritation and runny nose.

It is an intravenous therapy administered via a peripheral drip into a vein ideally every 3 weeks for one year.

However, it is unfortunately extremely expensive, not yet available in State hospitals and not covered by many Medical Aid schemes.

For those who can afford it, or those whose medical aids will cover it, Herceptin has significantly improved the prognosis and survival of patients with HER2 positive breast cancers to the extent that the outcomes are even better than some patients with HER2 negative breast cancers!

This blog was kindly supplied by Ronelle de Villiers at http://www.capebreastcare.org

 

Buddies for life!

bhf circleBuddies For Life is a bi-monthly lifestyle magazine, published by Word for Word Media in association with the Breast Health Foundation, for breast cancer patients, their families and friends. It was launched in June 2011, and 22 issues have been published to date with many more to come.

The glossy print and online magazine aims to educate, encourage and provide support. An array of medical professionals and experts write supportive and educational articles for the magazine on topics such as treatment, health and wellness, diet, fitness, sexuality, new advances and psychological advice that will assist those affected by cancer to understand the disease and treatment.

The content is essential reading written in a style that simplifies terminology. Super Survivor is featured on the cover of every issue and the breast cancer survivor’s story is told. On the Chemo Couch is another platform for survivors to share their unique story.

In keeping with the aims of the Breast Health Foundation, each issue contains a section dedicated to the early detection and awareness of breast cancer.

Oncology Buddies, supported by CANSA, is a new section within the magazine catering for other cancer awareness, early detection and various support groups.

Buddies For Life is available in print at hospitals, private clinics, oncology practises, Buddies for lifemammography units, radiology centres and support groups. Medipost courier the distribution of the print magazines to all the various distribution points.

A digital version is also available on www.buddiesforlife.co.za and yearly subscriptions are offered.

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The Breast Health Foundation is one of the partner organisations in the Advocates for Breast Cancer (ABC)

Hormones and the endocrine system

The role of Hormonal / Endocrine therapies in breast cancer

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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?

Tamoxifen

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.

Resistance

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.

Selection

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)

 

 

 

 

 

 

 

 

 

 

 

The DITTO project

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The Ditto project is an initiative run by Reach for Recovery to provide indigent women access to a silicone prosthesis which helps to restore her self-image and confidence after the traumatic breast cancer diagnosis and surgery.

Surgery after a breast cancer diagnosis may involve part or all of a breast being removed (mastectomy). Having a mastectomy leads to a tier of decision making regarding whether to have surgical reconstruction, wear an external breast prosthesis, or not wear anything at all to replace the amputated breast.  External breast prosthesis may be the best option a woman has, especially if she cannot afford to undergo reconstructive surgery.  However, not all patients can afford the cost of a permanent prosthesis.

Reach for Recovery believes that all women who have had breast cancer surgery should have access to appropriate breast prostheses, regardless of whether they can pay for it or not. The reality is that many breast cancer patients in South Africa cannot even afford a bra, let alone a breast prosthesis. Reach for Recovery wants to help these women who come from low income groups to feel confident again after the traumatic diagnoses and surgery.  We believe that a breast prosthesis is an important step in her recovery, especially to those women from communities where a there is still a stigma attached to a cancer diagnoses.  A more natural appearance with a breast prosthesis, together with the emotional support that she can continue to receive from Reach for Recovery volunteers through support groups, will help her to return to her place of employment and continue to provide for her family.

Any breast cancer patient who can present a current Provincial Hospital Card qualifies for access to subsidised silicone prosthesis.  The patient is asked to make a donation of R80 towards the project (R160 in case of a bilateral).   However, no patient has ever been turned away because she could not afford to make a donation.  The prosthesis may be replaced after three years.

Unfortunately Reach for Recovery cannot provide the paying customer with an invoice to claim back from their medical aid as we do not have a Medical Practice Number.  However, we do offer as much support as possible in terms of general information on local and international manufacturers, suppliers etc.

The Ditto Project started in 2011.  Since then, a total of 3235 silicone prostheses costing more than R2 million were given to women who could not afford one.  Many women donated a small amount (R80) as a token of their gratitude, but we also supported women who could not afford any donation at all.

Apart from state patients, a growing number of women only have a Hospital Plan which does not cover breast prostheses. Pensioners are particularly hard hit.

We have also seen a steady increase in the number of women needing silicone prostheses since 2011:  from 475 in 2011 to 930 in 2015.  There is without doubt a growing need for this service.   Unfortunately a silicone prosthesis is guaranteed to last for only two years; therefore we are also experiencing women returning to Reach for Recovery to have their prostheses replaced.

The need for silicone prostheses for newly referred breast cancer patients plus the need for replacements impacts heavily on the funds that we use to subsidise these products. A needs analysis has shown that we would subsidise at least 1000 women with a new silicon breast prosthesis in the new financial year.  This includes women who would need a replacement.

We are extremely thankful to our donors who help us to ensure the sustainability of this project!

Reach to Recovery is one of the breast cancer organisations that is a part of ABC.

 

Reach for Recovery Logo (2)

Keeping the balance

Over the next couple of weeks, we will be posting a series of recipies that will help you as you go through treatment. The Cancer Lifeline recipies are divided into three phases:

  • Tough Times, for use when you are very ill, during treatment, while the appetite is poor and the weight low.
  • Clean Machine, for detoxification of the body, post cancer treatment, or to kickstart a holistic health creation programme.
  • Eat Right, to set the right style of eating for the rest of your life to generate optimum health.

The recipies have been created by celebrity chef and nutrition consultant, Jane Sen, for the nourishment and healing of people with cancer. The recipies are part of the Cancer Lifeline Kit by Dr Rosy Daniel, which she has generously shared with us.

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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: http://www.jennyedge.co.za and Facebook page: www.facebook.com/breastcourse4nurses

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.

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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)

Facebook: http://www.facebook.com/breastcourse4nurses

Blog: www.jennyedge.co.za

Email: lieskewegelin@gmail.com