Cancercare cancer survivors day

Well done Linda Greef for organising a excellent survivors summit at His Peoples Church in Goodwood.  It was well attended and everyone I spoke to was very impressed.

The summit was opened by Hanif Hamdulay from Cancercare.  (GVI have become Cancercare). They are a national network of oncology centres with 9 centres in the Western and Eastern Cape.

The MC for the morning was the charming Dr Michael Mol who trained as a medical doctor years
ago but has spent most of his working life in other areas including being a presenter on Top Billing.  The first speaker that he introduced was Conn Bertish, a cancer survivor and creator of Cancer Dojo.  What an incredible speaker.  What an incredible story.  He was diagnosed with a brain tumour and was teated with surgery and radiotherapy.  He has made an excellent recovery and is now a member of "the world's scariest club".  He has used his background in branding and advertising to set up Cancer Dojo.  The concept is fascinating and he encourages people to "take themselves out of helplessness".

The next speaker was the oncologist Dr Jill Harris, who Michael likened to the actress Sigourney Weaver.  She talked about the guidelines for follow up for cancer survivors.  The debate for many is about how many investigation should survivors have? Should they have regular expensive scans exposing them them to the risks of radiotherapy or should they be followed up symptomatically?  The point she made that really resonated with me was that seeing a well, longtime survivor for for a follow up is a privilege for all of us who work in the cancer field.

I spoke afterwards about some of the aspects of the the Na/utroceutical industry.  I will blog about my talk separately.

Rod Warner is a resilience consultant and author of the book "The Building Resilience Handbook".  His talk can be summed up with a phrase he used.  "Life is 10% what happens and 90% how you react to it".

DrAaron Motsoaledi (Minister of Health) was unable to join us and was ably represented by Prof Melvyn Freeman, the chief director of NCD from the Dept of Health.  He expanded the idea of a survivor being the individual with cancer to the notion of the family being survivors of the
experience.  However, the most poignant part of his speech, for me, was when he quoted from Mike Marqusee's book, The Price of Experience.

I was unable to stay for the parallel workshops which I heard were excellent.  To all of you who attended and helped organise the event: thank you


Isolates, Herbs and Formulations in Breast Cancer Care

Yesterday, I spent 3 hours at Cape Town's Mount Nelson Hotel listening to Dr Weber on the subject of isolates, herbs and formulations in breast cancer care.  I am not a homeopath and have never attended a lecture on the subject before.  I found it fascinating.

Dr Weber, the CEO of Panaxea, a company which "provides our practitioners with the most efficacious natural remedies available"  He is based in Australia and is a visiting professor at Tianjin
University.  His talk was based on the content of his book "Botanical Oncology:isolates" which was published in 2014.  He went through 220 slides and it would be an impossible task to even begin to summarise all the information presented. Nearly all the slides had a least one reference cited.

His talk was a mixture of traditional Chinese medicine, evidence based medicine and translational research. The different approaches were applied variously to different subtypes and stages of breast cancer.   I found it difficult to follow.  It is perhaps because I am not au fait with many of the concepts (eg phlegm which in traditional Chinese medicine apparently refers to interstitial fluid).  What bothered me was the lack of clinical outcome data.

When a drug is being developed, it has to go through at least 3 phases:
When a drug is being considered for use for cancer treatment, the oncologist wants to know whether or not the administration of the drug will lead to improved outcome (There has been a lot of criticism about the pharmaceutical companies.  Amongst other issues, they often do not publish the results when a drug is shown not to work and do not always take account of patient side effects).  Herbal products fall outside the current legislation omitting the need for outcome based studies, and controlled trials do not have to be conducted before they are marketed.

In a short three hours, an amazing number of products were discussed (I think, over 100) but survival data was given on only 90 patients: half of whom had received "herbs" or JLBSHJ formula.  All of the rest of the data was anecdotal.

Western medicine does not always get it right and there is an increasing demand from patients for Complementary and Alternative Medicine.  Dr Weber urged oncologists to engage in more dialogue with integrative oncologists.  I am encouraged by his commitment to "research and evidence based medicine" and am sure as the evidence for the usage of isolates, herbs and formulations in the management is produced, a more integrated approach will result.


Cancer survivors conference, Cape Town

Last weekend, the 2016 Olympics came to a glorious end.  The UK did spectacularly well but so did South Africa.  They brought back 10 medals which put them in 30th position overall.  Well done to the team.  I am sure that there are many individual stories that are remarkable but there are 2 young men who won silver for RSA whose lives have been affected by cancer in the last few year.

Both Chad le Clos' mother and father have been treated for cancer.  His mother had a recurrence of documentary, (which I haven't watched) he talks about knowing what was going on with them and how it affected his training.
her breast cancer and his father prostate cancer.

Lawrence Brittain and Shaun Keeling won a silver in the mens coxless pairs.  Lawrence was treated for Hodgkins lymphoma in 2015 and unbelievably still managed to compete.  In 2014, his performance was dropping despite working harder.  "I was beginning to think there was a limit" he said.  His mother, a palliative care nurse, became suspicious and ordered routine blood tests which led to the diagnosis.  He put on 15 kg during his treatment and started training again in 2015.  Having achieved his remarkable triumph, he now says, "Maybe there's no limit to what I can achieve"

Santiago Lange and from Argentina was the oldest Olympic medal winner at the age of 54.  With his
team mate Cecilia Carranza Sasoli, he won a gold in a sailing event.  He had lung cancer diagnosed last year and had half a lung removed.  He was back on his bicycle 5 days post op and became obsessed with competing in Rio.

These inspiring stories and many other like them mean that I will am looking forward to attending the first Cancer Survivors Conference in Cape Town on 10th September 2016.  If you haven't got your (free) ticket, please book before it is too late.


Breast course for Nurses: annual fundraising event

We had our annual fundraiser/thank you event on Friday.  It was held at the Atlantic Imbizo at the V & A Waterfront.  Although largely sticking to the familiar format of previous events, this year we had a lunch rather than brunch.

I gave a summary of courses taught in recent months and new nuances in our approach, we then had a discussion about teaching adults rather than children.  We had contributions from different perspectives, including those of Prof Dave Woods, Joy Crane, Merunisa Mohammed, Josie Edge and Karen Hill.

Several points were raised:
-Karen Hill stressed that the content needs to be relevant, teaching things appropriate to work places
-Time spent talking needs to be short: Joy pointed out that after 10 minutes attention starts drifting off
Tony Brutus, Prof David Woods, Joy Crane
-Technology should be used appropriately (not as a barrier).  Josie Edge is my niece.  She has been visiting schools in Cape Town and noticed that as a result of less technology, there was a closer communication between teacher and pupils.
-Dave Woods recommended that we should not try and teach but to share understanding.
-Merunisa has been involved in teaching for many years and now teaches teachers.  She said that it was time to change from focus on the teacher, to the knowledge already in the class when teaching children as well as adults.

Ariella in action

After an excellent meal, fund raising took the form of an auction.  We were lucky enough to have Ariella Kuper as the auctioneer this year.

Watching her in energetic, inimitable action was remarkable.
We had many lovely gifts and I would like to thank all those who donated them as well as those who bid for them.  The raffle raised a record amount.

The event was extremely well organised: a special thank you to Michelle, Lieske, Nadia, Gadija and Josie.

Nadia, Gadija, Michelle and Josie wearing the new T shirts

As a result of all the generosity of those who support us, we can start another year of projects and we have plenty of requests and new ideas in the pipeline!

Lieske's BCN nails


BISSA: a surgeons perspective

BISSA, the Breast imaging Society South Africa, held a conference at Spier this weekend. It was a joint meeting with SBI (Society Breast Imaging) and RSSA (Radiological Society of South Africa)

The majority of the first day was about breast screening.  The speakers were all radiologists from the USA so the emphasis was on mammographic screening.  There was little debate about the problems
with screening programmes.  For example: does breast screening lead to the over treatment of breast cancers that would never cause a problem?
Perhaps, not surprisingly as it was a radiological conference, that problem was attributed to treating clinicians who over treat them!  (The argument put forward was that the radiologists only diagnose the small cancers:  it is the surgeons and oncologists who over treat them).

I may be biased but I don't think that is a true reflection of the situation!

There was a lot of discussion about supplementary imaging of the breast.  Breast screening generally starts with a mammogram.  When should an ultrasound be performed?  Are more cancers picked up as a result of doing more US?  When should a breast MRI be performed?

The important question that is much more difficult to answer is does more imaging stop women dying from breast cancer?

The second morning was spent on interpretation of images: mammography, US and MRI.   Prof Michael Linver gave a talk about the role of the Radiologist as a clinician.  He stressed the importance of doing a thorough breast examination and communicating with both the women being imaged and other members of the multidisciplinary team.

The afternoon session was a multidisciplinary session.  The first talk, given by Dr Jakolsen, was about screening for metastatic lesions after the diagnosis of breast cancer.  She made 2 main points. Patients with early breast cancers (Stage 1 or stage 2A) need no screening for metastatic lesions.  Physiological screening (PET Scans) may be better than anatomical imaging for those who do.

Dr Sarah Nietz gave an excellent talk on the changing face of breast surgery. She was followed by Prof Frank Graewe who talked about breast reconstruction and then Dr Rika Pienaar who talked about how the histological subtype of the cancer should direct follow up imaging rather than stage of disease.

The final day started with Dr Simon Nayler (pathologist) who talked about the information needed from radiologists.  Once again, the need for multidisciplinary discussion was stressed.  Dr Smilg gave an excellent talk on breast changes in HIV positive men and women.  Dr Ramaema gave an overview about TB of the breast. There have been no prospective studies done on the subject.  A retrospective study done in SA by Dr Ramaema looked at the use of PET scan/MRI scan in differentiating breast TB from breast cancer.  (My experience in Cape Town is that only 50% of women who present with TB of the breast are HIV positive).  Dr Loftus gave an overview of the Xhosa perspective of breast cancer.

The majority of talks at the the conference were from the guest speakers, Prof Jessica Leung, Prof Michael Linver, Dr Maxine Jochelson, Dr Reni Butler and Prof Wendy DeMartini, who are all from the USA.  I learnt a lot from all of them but as this is a Cape Town blog have chosen to write more about the local speakers.

Many thanks to the local organisers: Prof van Rensburg, Dr Eugene Jooste and on a personal note, I would like to thank Dr Richard Tuft.  Please come to BIGOSA in Joburg on 21st and 22nd October.


The people behind the Breast Course for Nurses in Harare

We have run a number of courses throughout South Africa and Southern Africa. Each one is different. Standardisation of what we teach is difficult to combine with the flexibility that makes our course appropriate to our audiences. What is standard is the amount of work involved in the organisation of a course!
Students with the Pathcare and Lancet sponsored Breast Care books

The catering department

The driving force behind the Harare course has been Dr Anna Nyakabau. She is a well known oncologist in Harare and devoted an enormous amount of time to getting the week up and running. The course was run at Parirenyatwa Hospital. It is an enormous complex of hospitals. The grounds are beautifully kept and are about 400 000 square metres. We were made to feel extremely welcome. We had our lectures in the rooms used by WHO and, everyday, had an excellent lunch served on time to a variable number of people.

Dr Anna Nyakabau

 I know that Anna had many meetings with the staff at the    hospital. For me to try and name them individually would    mean I would exclude some who had been instrumental in  ensuring the course succeeded. However, I had the              pleasure of meeting Mr Zigora, the CEO of the hospital,    and would like to thank him for his support.

Anna is a great organiser. She had the team she worked with behind, beside and in front of her! Primrose and Nyasha were at the forefront and coped with all the registrations and day to day work. The tech team: Vimbiso, Alban, Brighton, Benias and Gift, were excellent. What a difference it made to me to be able to give my laptop to various people and ask them to fix it!

Nyasha and Primrose
Dr Linda Kumirayi 

On 08/04/16, we ran a workshop on the management of the axilla in women with breast cancer. The day would not have been possible without the help of Dr Nancy Jonker and her team at the Well Woman clinic, Prof Godfrey Muguti and Prof Chidzonga from the University of Harare Medical School.
Workshop: management of the axilla in women with breast cancer
Dr Maita Mvere

A course like this costs money. There were many sponsors both of the 3 day modules and of the workshop held for surgeons on the 08/04/16. Please find their logos (in no particular order) and links to their sites below.

Dr Anna Nyakabau and Dr Costa Maonei (of Novartis)
Finally, a huge thank you to Dr Sarah Nietz who joined me for the workshop on 08/04/16, Prof Woods who joined me at the beginning of the week and Sr Lieske who was there all week.

BCN Module 1 course group







Breast course for Nurses Module 3: Zimbabwe

Discussion - Module 3 course
For the first time, we have run a day for doctors and oncology sisters. By dividing the course up into 3 modules, we have been able to stratify the course content to suit different health professions. Nonetheless, we started the day with the normal breast and assessment of the breast.

When looking at the provision of health resources in developing countries, pathology has often been overlooked. Without a reliable diagnostic service, it is impossible to treat patients appropriately. It was really inspiring to hear Prof Rudo Mutasa speak about different types of breast cancer. She referred to the cancer registry of Zimbabwe and talked about the need to collect accurate data.

Prof Rudo Mutasa
After the tea break, Dr Linda Kumirayi, Dr Sandra Ndrukwa and I talked about the importance of neoadjuvant therapy in the management of locally advanced breast cancer. In Zimbabwe, as in many neighbouring countries, a lot of women have locally advanced breast cancer at the time of diagnosis. Instead of surgery always being the first intervention, it is preferable to use systemic therapy first whenever possible.

The diagnosis of breast cancer is often difficult so we had a session on breast biopsy. In most of the developed world, biopsies are done under image guidance. However, when the cancer is easily palpable, it is not always easier to use imaging: it may be accurate and more appropriate to biopsy without imaging. Dr Mvere and I ran the session and debated the pros and cons as we went.

In the afternoon, we had a discussion about appropriate breast screening in Zimbabwe. Cervical screening clinics are fairly readily accessible in most provinces. Should breast examination be offered at the same time? According to the cancer register, the incidence of cervical cancer is much higher than breast cancer. Is that a true reflection of the disease profiles or as a result of improved screening?

Doctors and oncology nurses attended the course

Many thanks to everyone involved and of course to our sponsors, to name a few: Lancet, High Tech Medical, Bettercare and all individuals that have supported the course through funding.