Celebrate being different.

In his excellent book, Emperor of all Maladies, Siddharda Mukherjee traces the history of cancer treatment.  He covers the history of oncological surgery and notes that many surgeons are competent
musicians.  I am sure that is true but I know more  surgeons who are artists or photographers.

Basil Stathoulis, an orthopaedic surgeon in Durban, spends much of his free time taking photographs. If only for a second.  He sent me a link to a French video clip:

The clip takes a number of people who are having chemotherapy and makes them up with wigs and makeup.  A photographer (behind the mirror) takes a picture of their faces as they see their images.  It is fun.  They are made up to stand out from the crowd.
Many women who are having chemotherapy have told me that they cannot get away from being a "cancer patient".  Their hair loss and change in the shape of their face means they lose their identify.  Wigs resembling their usual hair style can help redress the balance but nothing can replace feeling "normal again".

There are a number of organisations who help women having chemotherapy feel better.  What was remarkable about this clip was, in typical French style, they were made up to be different.

I have recently been to Lyons: a wonderful city to visit.  Although it is the third largest city in France, incredibly well organised for tourists, has 22 museums, there is very little English spoken.  There is little attempt to conform to the generally accepted demands of international tourism.

Perhaps we should all take a leaf out of the French book and celebrate being different rather than trying to conform.


Protocol driven medicine versus individual medical practices.

Mr Paterson worked in Solihul Hospital as a breast surgeon.  There have been a number of stories emerging about his practice.  Basically, he performed cleavage sparing mastectomies which resulted in a lot of breast tissue being left after a mastectomy had been performed.  Thereafter, a number of women  experienced recurrence of their breast cancer.  The question is whether that happened as a result of their inadequate surgery or whether the behaviour of the cancer determined the outcome.

I trained as a doctor in the UK and have worked in South Africa for the last 20 years. I have thought about the pros and cons of a protocol driven system on many occasions.  The NHS is an example of a protocol driven system.  There are clear guidelines set out for all health practitioners and they exist for almost all conditions.  In South Africa, outside the teaching hospitals, there are few guidelines although the health funders do apply some.  There are advantages and disadvantages in either system.

Protocols can be cumbersome and can result in many unnecessary investigations being performed.  They don't allow common sense to be applied.  They don't allow for the Art of Medicine.  My father was treated in Solihul Hospital and the seriousness of his condition (24 hours before he died) was not appreciated as the "score" being used did not reflect his illness.  No health professional looked at him and saw a sick man needing urgent intervention.  They saw a chart.

A system allowing individual freedom is equally wasteful.  Doctors who are not experts in their fields may treat conditions sub-optimally.  Patients get treated with unproven management.  Multidisciplinary approaches to treatment are not mandatory resulting in individual non-evidence based medicine being practised.  

However, although there are some individuals who do not benefit from protocols, the majority do.  Protocols save patients from our ignorance and arrogance.

I am not sure whether we will ever find out why Mr Paterson was able to treat women with unconventional surgery for so long and why no one in his team drew attention to the problem earlier.

Do you have any thoughts on protocols?


Mandela: the listener

It would be impossible to blog from South Africa at this time without discussing the legacy and life of Nelson Mandela.  He was the world's most famous advocate.

In 2001, he was diagnosed with prostate cancer.  He made very few references to his illness.  The only quote I have found was "As a result of the treatment, the doctors took a blood sample and said "Your blood is clean of cancer"".  His disease did not seem to cause him further health issues.  There are millions of cancer sufferers who would love to be able to say the same about their disease.

Last week, I argued that the definition of ADVOCACY should include defining the problem before campaigning for a change.  Mandela spent decades in prison and used that time to study Afrikaans.  He stated that it was important to "Know your enemy and learn about his favourite sport".  His clear understanding of the issues dividing the population of the country made him such a successful negotiator for equality, reconciliation and empathy.

There are so many life skills we can learn from studying the lifetime of sacrifice of Madiba.   During his  imprisonment in Robben Island, he shared his cell with Dr Saths Cooper.  The two did not agree politically.  Cooper said "You could sense his resistance but he would listen anyway.  He was a very good listener and would try and insinuate his viewpoint through a carefully considered question of  clarification or positing another position.  But he listened, he may not have liked what he was hearing, but he listened none the less".

His famous quotes are in all of the newspapers.  What cannot be published is the silence needed to listen.


The breast course for nurse: discussion about advocacy

On Wednesday, Thursday and Friday, we finished the Cape Town breast course for nurses.  The last 3 days consolidate the theory learnt over the preceding 6 months.  On Wednesday, we divided into 4 groups.  Biopsy and sonar techniques were demonstrated (and practised on chicken breasts and fruit).  Downstairs, there was a workshop on breast imaging.  In the afternoon, Sister Yvonne Jackman from St Luke's Hospice discussed terminal care cases with us.

On Thursday, the main part of the day was spent on lymphoedema management. Colleen Marco, Carola Schoonheim and Isla Muhl explained the theory behind lympheoedema management and showed us bandaging techniques to help alleviate the symptoms.

We started the last day with a gala breakfast at the hospital.  It allowed me the thank all our sponsors and all the health professionals who gave their time freely so we could run the course.  Our main sponsors were represented at the breakfast: Chris Tilney from Netcare, Dr Nauta from Care Cross, Jean-Claude from Blue Spier and Carol from WWD.  Bard spent the day with us on Wednesday.

The remainder of the day was spent discussing community activities.  Linda Greef, PLWC (People living with Cancer) led the discussion.  We spent sometime discussing what we mean by ADVOCACY.  It is a word that is used very freely without much thought a to what it means.

As defined by Linda, it means identifying problems and campaigning for changes to address the them.  As defined by Wikipaedia, it is: "political process by an individual or group which aims to influence public-policy and resource allocation decisions within political, economic, and social systems and institutions."  The free online dictionary defines advocacy as : "The act of pleading or arguing in favor of something, such as a cause, idea, or policy; active support."

I like Linda's definition.  Too much time is spent by many organisations trying to solve problems that either don't exist or will make no difference to the intended cohort.  TIME MUST BE SPENT RESEARCHING AND DEFINING THE PROBLEM before advocating for change.

Do you think the word advocacy should be redefined?



I have just returned from the AORTIC conference in Durban.  AORTIC is an organisation concerned with cancer from an African perspective.  The majority of the talks I went to were about breast cancer and cancer registries in Africa.

Karposi's sarcoma, breast and cervical cancer account for the majority of cancer cases in women in Africa.  In some countries, cervical is commoner.  In others, breast.  Unlike breast cancer, cervical
cancer is associated with an infection: papilloma virus.  In general, deaths due to infectious diseases are decreasing in sub saharan Africa.  Conversely the disease burden due to non communicable disease is increasing as women here adopt a more western life style.

As I have alluded to in previous blogs, women in this country are seen with more advanced disease.  We have referred to the phenomenum of women presenting late.  Dr Joe Harford (NCI) has pointed out that this only tells half the story.  Women in Africa are diagnosed at a later stage.

There are many reasons why women do not seek medical attention.  Doctors are a scarce commodity in Africa.  Ines Buccimazza (Durban) gave an excellent talk looking at the number of doctors in Africa. Africa has 24 % of the global health burden and 3% of the global health spending.

More sobering facts emerged: in Nigeria, 38% of women are divorced within 3 years of having a mastectomy.  In Tanzania and the Congo, over 90% women with breast cancer have locally advanced disease at the time of diagnosis.  We need African solutions to the health crisis in the continent.

On Saturday morning, there was a workshop discussing the training of health professionals in Africa.  How are doctors, once trained as a specialist, persuaded to stay in their country of origin?  Prof Lynette Denny (UCT) emphasised the need for appropriate training for overseas doctors.

The conference was illuminating, sobering and yet full of exciting initiatives.  However, I came to the conclusion that although we spend a lot of time discussing different prognostic factors, the main prognostic factor in the outcome of breast cancer is geographical location.

Let me know if there are geographic disparities in health care in your part of the world.


Your stories

It has been my intention to start a new section to the blogsite which is a space for you to publish your stories.  Please feel free to send your stories about your breast cancer journey to me at: jmedge@mweb.co.za.


School cancer campaigns

My son is lucky enough to go to St George's Grammar School.  It is the oldest independent school in South Africa and prides itself on both it's academic achievements but also on it's community involvement.
Last week, they had a civvies day and wanted to raise funds for a cancer support group.  My son asked me which organisation they should raise money for.  I gave the matter some thought and suggested PLWC: people living with cancer.  They support women with breast cancer but I had to ask my self why I had come up with PLWC and not a breast cancer specific group.

There are several reasons. Firstly, it is a local (Cape Town) based organisation.  I get quite irritated when I see money being raised locally that will be spent either in another province or internationally.  Secondly, it supports people with many different cancers.  It is, after all, November: prostate cancer awareness month.

During October, there were a couple of local schools who ran breast cancer awareness campaigns.  I am not aware of any doing a similar project for prostate cancer.  In the USA, there have been high profile cases of schools taking individuals to court for wearing bracelets considered inappropriate for
school girls.  In Cape Town, the campaigns have been a lot more appropriate.

Should school girls be taught about "breast health" whilst at school?  I would argue that it causes more anxiety than anything else about a disease which is not known to affect women until their late 20s.  If we accept that just as many parents will have had treatment for prostate cancer as for breast cancer, why don't schools do more in November to support prostate awareness month?

There are several reasons for this:
1. There are far more female teachers than male teachers so more of the school's community are likely to have been affected by breast cancer than prostate cancer
2. If a member of the school community (either mother or teacher) is having chemotherapy for breast cancer, the baldness is obvious: in males it is less so.
3. Women are more likely to be upfront about their illness than men.
4. Community initiatives are often lead by the girls in the class.
5. A staggering nearly 50% of South African school children have an absent father
6. In South African schools, November is exam month.

What do you feel about promoting breast awareness in schools?  Please comment on your thoughts or your experience.


Vincent Pallotti Oncology Centre

Last week, the new oncology centre at Vincent Pallotti Hospital opened.  There are a number of oncologists and breast specialists working there: Dr Gudgeon, Dr Boeddinghaus, Dr de Villiers and Dr Jacqui Hall.  They are to be joined by others at a later date.

Shortly, the new radiotherapy machine will be working.  One of the major challenges of treating with radiation is to minimise the damage to the surrounding healthy tissues.  The new machine will allow treatment to be administered more precisely.   I see a number of women who have had their radiotherapy in neighbouring African countries where there are only old machines.  It serves as a constant reminder of how lucky we are to have several modern oncology centres in the Western Cape.

The chemotherapy room has been open for sometime.  It is light and airy.  What caught my attention were the quotes on the walls.  In the chemo room, there was a quote from Mother Theresa:

Life is life, fight for it
Life is beautiful, admire it
Life is a challenge, meet it

Outside the chemo room are a series of blocks. Different women have added their pictures or their thoughts.  Dr Anne Gudgeon (who is a breast cancer survivor) has written the following:

"Life is not about weathering the storm.  It is about learning to dance in the rain."

What inspirational quotes helped you get through your treatment?

The last word has to go to Nelson Mandela:


Tops and Flops

Over the last month, there have been a number of interesting initiatives. I thought it would be good to compile a tops and flops list.  You may not agree with my list but here are my thoughts:

One prize goes to Cancer Alliance for their blog.  They have posted a blog every day through the month of October and are going to continue the project which is excellent.  It is a combination of individual stories and features which cover many aspects of breast cancer management.   The topics covered are ones bought up frequently by my patients: fear of recurrence, the impact on partners and children, weight issues and dealing with anger and fear.  It is not only doom and gloom and there are some excellent photos!  Well done to them

One of my gripes about October is that the issues discussed are not confined to one month of the year.  They are ongoing issues and my next heroes are the ever consistent local Reach to Recovery group who will visit any woman in Cape Town who has had breast cancer and are always available to discuss fears or share thoughts.  October has meant I have had more contact with them and I know they will continue to be there for the other 11 months of the year.  A big thank you.

The PLWC photo exhibition was excellent.  Sure, it did not give us facts and figures about issues facing women with breast problems in this country but it is a start.  We must gather more information about the challenges of the silent majority of women in this country with breast cancer problems if we are to make a change.

Lastly, my flop has to go to the group of women trying to popularise "mamming".  In my opinion it is a bunch of people trying to invent something for the sake of it and not doing anything to improve the lot of survivors/imrove breast care.

Who are your tops and flops for the month?


Is pink awareness enough to change breast cancer care in Southern Africa?

Last Friday, CBMH hosted it's annual Breast Cancer Awareness event.  I gave a talk entitled "Is pink awareness enough to change breast cancer care in Southern Africa".  The talk was well attended and we were privileged to have Dr Mutebi with us.  She is a surgeon from Kenya and is in Cape Town doing a fellowship in breast surgery.

The pink ribbon is worth a fortune.  I tried to find out how much it is worth but failed to get a reliable estimate.  Looking at figures of nearly $500 000 000 in the Susan G Kommen's financial statement gives an impression that it must be worth billions of Dollars. How much of that money trickles down?

In 2009, American Express launched a campaign: "The partnership between American Express and Breast Cancer Campaign, enables participating card members to redeem their points into entitlements for a cash reward which will benefit the charity." Julie Dennis-Litinger, Membership Rewards Partnerships, American Express

The reality: the card has to be used 100 x in one month to raise $1 for a cause (Pink Ribbons Inc)

In the USA, much of the money raised may not be used appropriately.  What about the situation here?  Over October, we have tried to follow up leads to see where the "pink drive" money is going.  We have traced a few and the ones we have answers for seem to have money being channelled into recognised NGOs.  I have not been able to find out what percentage.

We cannot, however, use the campaigns from the the developed world to think we will make a difference to the majority of women with breast problems in this country.

There are few statistics about the stage of presentation of women with breast cancer in South Africa.  I used figures from 2001, Joburg and compared them to SEER data (USA) and came up with the following pie charts.  (Interestingly, both sets of data were presented as "white women" and "non white women": the difference in the 2 groups probably has more to do with access to treatment rather than race).

In this series, nearly 80% of non white women in S Africa present with stage 3 and 4 breast cancer.I accept that the data is old and the situation may have improved.  The fact remains that we see too many women with locally advanced breast cancer presenting to our clinics.  We need to think of new and innovative ways to create awareness about breast cancer in this and other developing countries an we must encourage companies to be transparent about their cause related marketing campaigns.  They should stipulate what percentage of their profits are going to the cause and exactly which "cause" it is going to.



A picture paints a thousand words

Last Wednesday, I went to the official start of the PLWC photographic  exhibition.  Opening remarks were from the MEC for Health Theunis Botha.  He drew inspiration from stories of determination that made up the moving display.  Linda Greef followed with warm thanks for the many people who were involved in bringing the project to the public.

The installation reveals women's journeys through the diagnosis and treatment for breast cancer.  It uses both photos and words in an easy to follow succinct manner.

The stories come from different angles.  Women talking about the lateness of diagnosis, the inaccessibility of treatment and the financial impact of the illness.  Each story is inspiring.  Many deal with acceptance.

The exhibition gives a voice to those whose stories are not generally heard.  The organisers, in my view, have illustrated how it is important to go beyond awareness, to make a difference to the outcome of breast cancer survivors in this country,

On Friday, 25th October, Christiaan Barrnard Memorial Hosital is hosting a talk at 12.30.  I will discuss the question "Is pink awareness enough to change the situation for women with breast cancer in this country".  Please feel free to join the debate.  Contact Michelle Norris at CBMH.

On Friday 18th October, the Mail and Guardian ran an article about mammography screening.  It was written by Dr Martinique Stilwell.  She has done an enormous amount of research and has written an excellent piece.  There are a number of other excellent articles that I have seen this month (please go to "worth a read page").

Let me know if you have come across other articles.


October again!

I have conflicted feelings about the value to the reading public of designating October as Breast Cancer awareness month.  Having said that, there are a number of collaborative ventures that have launched this month.  If we are to do anything about improving the resources available to women with breast problems in this country, we need a strong, clear collective voice from the diverse NGOs involved.

Cancer Alliance started a blog featuring daily breast cancer posts through the month of October.  

Reach for Recovery spent yesterday afternoon in the wind and rain decorating the trees along Adderley Street and Company Gardens.  The initiative comes from Pink trees for Pauline which started in the Eastern Cape.  Thursday 17/10/13, at 1300 there is an event at the entrance to Company Gardens.  Anyone interested in going should contact Elsabe Schlecter.  It is a great example of a collaberative venture by local NGOs, as any money raised will go to the Hospice, Reach for Recovery and Pink Ribbon. 

Company Gardens in October
Please let me know what you think about the pink!



October.  Breast cancer awareness month.   Is it appropriate to South Africa?

It's inital aim was to get women to go for a mammogram.October

It was started in 1985 by the Amercican Cancer society and the pharmaceutical company that is now known as Asta Zeneca. The story of the pink ribbon is a long one but the main players in establishing it as a world wide symbol are the Susan G Komen foundation and Estée Lauder.  It is probably one of the most successful examples of cause related marketing.

According to the financial times, cause related marketing is defined as "a form of marketing in which a company and a charity team up together to tackle a social or environmental problem and create business value for the company at the same time.  Typically, in cause-related marketing campaigns, a brand is affilated with a cause and a portion of the proceeds from the sales of the brand is donated to the cause."

Where do the funds generated by objects decorated with a pink ribbon go to? Are any of the funds directed to South African groups?  Please let me know what objects you have seen with the pink ribbon on and, if possible, tell me where the money raised is going.


BIGOSA Conference

Last week we had our second BIGOSA conference in Johannesburg.  It was attended by about 45 breast specialists: the majority were from South Africa.  Our guest was Prof David Cameron from Edinburgh.  He gave 2 talks.  The first was on the controversial issue of breast cancer screening in the UK.   He was one of the contributors to the Marmot report and discussed the pros and cons of a mass screening programme.  The report is summarised in the Lancet.

I will highlight a couple of facts that illustrate the dilemma of whether mass screening is the way to go:
If 10 000 women, in the UK, between the age of 50-70 are screened for 20 years 43 cancer deaths will be prevented but 129 women will get treated for a cancer that would not have killed them: they would have died of something else first. Simply put, one cancer death will be prevented for every 3 women who are treated for a screen detected breast cancer.

His second talk looked at the cost of new cancer drugs.  He posed the question "Can we afford to use new (expensive) drugs to treat breast cancer?  Can we afford not to use them?"  His talk highlighted the cost to society of a women with breast cancer.  It is a cost that government forgets when they are deciding on health policy.

Both are difficult debates.

The conference is a mixture of invited speakers and specialists talking about their research.  There is a prize for the best paper and that was won by Dr Murugan from Chris Hani Baragwanath Hospital.  Her paper was entitled: "Can breast cancer in our public sector be downstaged in the pre screening era.  Experiences from CHB hospital"  Congratulations to the breast team at CHBH for their excellent presentations.



10 days ago, we started our second breast course for nurses.  We went to Baragwanath Hospital in Soweto.  It was a fun day!  Dr Herbert Cubash is the head of breast surgery there and he made us feel very welcome.  He is ably assisted by Nelly and Maureen.  We were privileged to have 48 nurses and health care workers from 8 different hospitals and 2 NGOs (CANSA and Pink Drive).  Time was given to networking.
Although 4 of us went up as faculty, we all felt as though we learnt a tremendous amount. We heard from health providers about the different facilities they have.  It reinforced my belief that we need to share our experiences more if we are to improve breast care in this country.
Doing the course away from Cape Town made me very aware of the importance of sponsors.  We want this project to be sustainable and for that to happen, we need to be realistic about the costs incurred.  Care CrossAbbVieNetcare and Bluespier have been incredibly generous.  I have also been humbled by the kindness of individuals who have donated money.
The next course will be starting in Durban in January.  If you want any information about the breast courses, please contact me.  The web site will be up and running shortly.


Can words heal?

Last weekend, Cape Town was treated to the Open Book Festival.  What a remarkable occasion.  The event has many sponsors but is largely organized by the Book Lounge.  I went to several sessions and, amongst others,  thoroughly enjoyed the engaging presentations of Ian Rankin, Marianne Tham, Damien Brown, Helen Zille, Mamphela Ramphele and her son.

The first event, chaired by Dawn Garrisch, had the title "Poetica: pen as a sword: can poetry be used to bring about social change".  On the panel was Malika Ndlovu, Adrian van Wyk and Clinton Osbourne.  Between them, they have been involved in many projects.

Malika's personal mantra is "healing through creativity".  She is a performanace poet and gave extraordinary renditions of some of her work. We are all Spirits having a bodily experience, not bodies having a spiritual one, she said. Adrian van Wyk is involved in the Stellenbosch University literary project.  I wished I had taken my boys to listen to his rap poetry.  Clinton Osbourne is involved with a project encouraging prisoners to express themselves through creative writing, and in the creative writing find some inner release.

Dawn Garrisch is a GP and based  in Cape Town.  She has published novels, books about the body and poetry.  She believes the power of writing can be used to restore/maintain mental health.

Many women are using creativity to come to terms with their diagnosis of breast cancer.  Some have painted (and given me lovely pictures), some have written blogs/diaries. Bev Rycroft, wrote a book of poems called "Missing" about her journey through the diagnosis and treatment of breast cancer.
Having had breast cancer, did you write creatively about your experience?  Did it help you with the healing process?  Please share your stories and poems with us, your metaphor as medicine.


Personalised medicine for breast cancer treatment. A Reality?

Personalised medicine:a reality?

Once a year, I give a talk for the local branch of Reach for Recovery. It was my pleasure to be there last Thursday. Many of you will know that Cape Town hosted a very successful international Reach to Recovery Conference last year. I decided to give a talk based on the one I gave there. The title was 'New developments in the management of breast cancer'.  The essence of my talk was that we will go away from Evidence Based Medicine and start practising Personalised Medicine.

What does that mean?

Evidence based medicine is defined as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." The decisions we make are based on population studies. By this we mean research done on a number of people with a similar disease/disease state. For example, if we want to know if a medication works for breast cancer, we will give 1000 women with a particular disease profile the drug being tested and then give either standard therapy/no therapy to a matched group of women and see which is best. It is the principle behind all medical trials.

In reality, we tend to over treat a number of women with early breast cancer in the hope of not under treating the few that would benefit from extra treatment. (Conversely, we under treat a number of women as well.)

There has been a massive increase in the field of genetics. We can look at the individuals' genetic make up as well as the the genetics of the breast cancer.  (There is no doubt that more research will come out in this area.)  As a result, the cancer's behaviour will be more accurately predicted and so we should be able to individualise our recommendations for treatment.

What do you think? Do you believe we will be able to be so certain of a cancer's behaviour that we will be able to omit surgery/radiation/chemotherapy and guarantee that it is safe? Let me know.


Every Wednesday morning the southern suburbs oncology group meet at Vincent Pallotti Hospital in Cape Town.  There are between 10-15 of us (surgeons, radiologists, pathologists, oncologists and radiotherapists). We discuss all the new breast cancer patients we have seen during the week and patients who are known to have breast cancer but need a new treatment plan.  It is a business meeting rather than an academic meeting.  However, the discussion often covers debatable issues and when we need to discuss them in more detail, we have a separate evening meeting to discuss specific topics.

10 days ago, we met at the Wild Fig Restaurant and discussed what staging investigations a woman should have when she has been diagnosed with breast cancer. (The stage of the disease is how far the cancer has spread).  Most women with early breast cancer are sent for a chest XRay (CXR) and liver ultrasound but is that more than we should be doing?  Are we just exposing women to unnecessary radiation or should everyone go for a CTScan of the chest, abdomen and pelvis? If the CTScan is normal, should they then have a bone scan?

We reviewed the current literature and the consensus was that women with very early breast cancer probably shouldn't have any staging investigations.  If the cancer has spread to the lymph nodes in the armpit then at least a CXR and liver US should be done.

Let me know what happens in your centre.  Did you find that having a CXR and liver sonar made you feel better?  Please share your thoughts.



The radiographers from Morton and Partners requested a session with me, and it  took place a great location yesterday.  We talked about a variety of issues but the first hour was devoted to discussing the concept of holistic breast imaging.

I am based CBMH, a venerable institution, but there are plans afoot for the construction and design of  a brand new "state-of-the art" hospital.  Although the equipment in the radiology department is up to date, the layout is dated.  Cue the plans for the new hospital.

To begin with, we did a small survey whereby we asked patients to give us feedback about their experiences of having a mammogram. Sixty people completed the question and they were remarkably complimentary.  What became very clear was that the attitude of the person doing the mammogram was the most important factor in the experience of satisfaction.  The radiographers at CBMH were perceived as being the very best, certainly at the top of their game.

Doing the research for my talk, I read various blog sites about women's experiences of having mammograms.  There's no doubt that the procedure itself has become far less painful, with newer technology but, inevitably, there are still aspects that can be uncomfortable.  One women remarked on feeling how demeaning it was to walk around the department without a bra on.

We need fresh ideas. Your ideas. So, if it was you designing a new radiology department, what features  would you add to make the experience of having a mammogram more acceptable?  Please share your thoughts. I'm going to read all of them, and this is real chance to help me make inputs into the final design of the new generation of breast imaging setup.


Last week, a colleague who is premenopausal and in her late 40s complained about aching breasts and asked me what she could do about them.  It is a question that I am commonly asked.

There is no satisfactory explanation for mastalgia (aching breasts) and it is definitely something associated with normal breasts and particularly in women in their 40s.

Breast change with age.  During your 20s, your breasts are in the proliferative (busy) stage of development.  As you get older, the breasts start to age and by the time you get to your late 40s, your breasts have increased in size, may have undergone fibrocystic changes (dense tissue with small cysts), become fattier and so lost a lot of inbuilt support.  As a result, women in their 40s have breasts that tend to move around a lot more and may feel very lumpy and tender.

The question is what to do about it.  If you are over 40 and haven't had a mammogram for a year, you should have a screening mammogram to ensure the tissue looks normal.  After that, the best plan is to go to a specialist bra shop for a bra fitting (40% of women over the age of 40 wear the wrong size bra). Leave things for a month and if they are still uncomfortable, try a NSAID cream (available over the counter).  I think some women do get relief from Evening Primrose Oil but when it has been subjected to large trials, it hasn't been found to be useful.

No other dietary manipulation/drugs have been shown to work when they have been compared to sugar pills but please share your experience.  Let us know what worked for you.

In Cape Town, there are a number of good bra shops.  Two that consistently seem to give a good service are Inner Secrets and Storm in a G cup.


Last Saturday, it was my pleasure to be a speaker at a breakfast on metastatic cancer hosted by PLWC. The essence of my talk was that whilst metastatic breast cancer is incurable, it is not untreatable. It is important to remember that Diabetes is also incurable but is very treatable. In 2001, I had the pleasure of attending the ABC conference in Lisbon. It was a meeting aimed at drawing up guidelines dealing with the management of metastatic breast cancer. Many points came out of the meeting. One important point was from Musa Meyer who stressed the need for research into the area and emphasised that success of treatment should not be judged purely by survival but in quality of life survival.
Afer I spoke, we heard from 2 women who are living with their disease. Both had extraordinary stories to tell. Raychan Cassiem inspired all of us as she told us about her success in the Two Oceans marathon. Janet Grobler talked about the need to reinvent oneself as the disease affected her in different ways.
 In true Cape Town style, we had an excellent breakfast and then heard from Dr Rika Pienaar (oncologist) who talked about the importance of treating a breast cancer survivor holistically and with wisdom. Ms Frieda Loubser finished off the morning with a talk about the genetics of breast cancer. 
Over the last 20 years, survival after the diagnosis of stage 4 disease has increased so more and more women are living with their disease.

There is no doubt that further workshops addressing the needs of this particular group of breast cancer survivors will be necessary and I am certainly looking forward to the next one. Well done to Linda Greef for organising such an excellent morning.


The Breast Course for Nurses

The Breast Course for Nurses

On Friday this week, we started our new Breast Course for Nurses. What an excellent day!

We have run education programmes for nurses before but in March this year, I met up with Professor Dave Woods from the PEP Trust and we used a workshop with like minds, to put together ideas on how a Breast Course could be run for nurses.  The course aims to familiarise nurses with the practical assessment and effective management of common breast problems.  The course is designed for nurses working in primary and secondary clinics.

After listening to the input from those who had attended previous courses and then applying Prof Woods' considerable experience in these matters, we have redesigned our course.  The emphasis is on LEARNING not TEACHING and the course is a combination of lectures, practicals and self study modules.  We all met up on the 19th of July 2013 at CBMH, Cape Town City Centre and launched into a day-long discussion on the philosophy of the course, the logistics to make it happen and then started the first modules: the normal breast and how to do a clinical assessment of a woman with breast problems.  The next time we all meet up will be in November.  Between now and then, all the participants will have received the material for self study.

It was a real VIP course - truely a formidable group. The nurses who attended all had masses of expertise. We had some good looking male models for the examination section, as you can see. The best part is that we are planning to take the course on the road so that it can bring direct benefits to different parts of the country.  If you are interested in being involved in the course, please contact Karen Hill: Karen.Hill@netcare.co.za
Prof Woods teaching a small group
The course participants


Weight loss and breast cancer

Did you know that 75 % of women who have been diagnosed with breast cancer put on weight.
How can you stop yourselves becoming one of them?
How did you manage to loose weight after your diagnosis?
Why does it matter?  Not only does it make you feel miserable but we know that for some women, it may make affect their out come.
Here is an article that may help

There is no magic way to lose weight.  Exercising is important.  However, in order to lose weight remember that the most crucial thing is to cut down on the number of calories.  Not easy!  80% of your weight is due to your intake.  20% is due to exercise.
There are loads of books on the market.  Have a look at Dr Luc Evanepoel's book: Lose the weight and keep it off.
Increase your exercise: if you have had breast cancer, Curves (gym) will waive your joining up fee.

Get exercising and share your stories.  Let us know what is happening in your area. Please use this space.