Thank you Lisa Levy

During the course of last week I received an email from Lisa Levy informing me that she would be celebrating her birthday and wanted to collect funding for the Breast Course for Nurses instead of receiving gifts for herself! It is so special to receive news like this especially in the whirlwind that is the end of the year!

The Breast Course for Nurses relies on sponsorship to continue to grow and educate nurses within South Africa. Next year the Breast Course for Nurses will be expanding to countries within Africa.

Lisa Levy and her friends at Tashas

On Thursday I joined Lisa and all of her friends at Tasha's restaurant at the V&A Waterfront. She had envelopes with the breast cancer ribbon attached to each ready for the donations. The amount we received from these generous donations was far more than expected! 

Thank you to Lisa and all of your generous friends, we really appreciate what you have done for our organisation and for the many nurses that will benefit from doing the course made possible by the money that you have raised!


Soft toys resembling pathogens

I was walking along the corridor in theatre last week and noticed a cot with a cuddly toy left abandoned outside the a theatre.  The toy was well used: a familiar item of comfort for the child who was undergoing an ophthalmological procedure.

Soft toys are often given to patients to comfort them whilst they are in hospital.  A teddy bear with "Good Luck" or "Get well soon" can be purchased easily.  I was horrified to discover that cuddly toys nowadays are designed to resemble a pathogen.

The one that caught my eye was an ebola soft toy.  Yes, you can purchase a toy that resembles the ebola virus.  It is one of a series of microbial toys made by the Giant Company.

Logging onto their website to see what the product looked like, I noticed a dropdown box.  It gave various disease options and I chose "breast cancer".  Sure enough, they make a cuddly toy that resembles a breast cancer cell.  It can be turned inside out and so be "cured".

The 'breast cancer" cell
The "cured" breast cancer

I also came across a "sexy ebola suit" that was being promoted as a Halloween outfit.  How sad is that?  I have never had to dress in a protective outfit but even being scrubbed in a hot theatre can get very hot.  I should imagine working in a full suit is claustrophobic and massively unpleasant.

Personally, I think the toys and dressing up costumes are belittling and the height of bad taste.  Let me know if you agree or if you have actually been tempted to seek out one of the products.


Port Elizabeth Breast course for Nurses: Day 2

Back in the "Friendly City", we started with lectures and moved to a discussion about community programmes.  The session was run by Salome Meyer (Advocate for Breast Cancer or ABC) and Estelle Botha from Reach for Recovery.  The ideas discussed were the role ABC play, the importance of breast cancer NGOs and the importance of knowing who is around locally.

Then the second part of the discussion considered possible community strategies.  Key points were:

1. Campaigns need not be expensive.
2. There are many existing community organisations: use them.  An example came from Anne Gudgeon who spoke at Gatesville Mosque last weekend.  During the session, the Iman spoke.  He reminded the audience that each individual is responsible for looking after their health.
3. When women present to the clinic with problems/for investigations, use the opportunity to examine their breasts.
4. When running breast awareness campaigns, bring up other issues eg Prostate cancer.

I am hoping that there will be some imaginative and successful campaigns run by the participants.

Michelle Norris being bandaged
Sue Serebro ran the last session: lymphoedema management.  Lymphoedema therapists are very few and far between in the Eastern Cape.  She taught the students basic massage techniques and demonstrated bandaging techniques.  She demonstrated the various compression garments and had all the participants doing exercises and self massage.
Sue demonstrating bandaging on Anne Gudgeon

A huge thank you to the faculty: Sr Lieske, Michelle Norris, Dr Anne Gudgeon, Dr Linda Whitelock-Jones, Salome MeyerEstelle Botha and Sue Serebro.
The course is dependent on sponsorship.  We are sincerely grateful to our sponsors.  The course was run in the Netcare Education Centre in Post Elizabeth.  The food and flights were sponsored by Christiaan Barnard Memorial Hospital and we are grateful to Chris Tilney for his generous support. Greenacres Hospital supplied the transport and helped with logistics.    Karen from Baard brought the biopsy needles we used and Dr Linda Whitelock-Jones lent us her expertise and US machine.  We are grateful to Care Cross and DigIt for ongoing and much welcomed support.


Port Elizabeth breast course: day 1

Sr Nonnie (St Francis Hospice)
The Breast Course for Nurses has returned to Port Elizabeth for the second part of the course.  It has been well attended with a mixture of nurses from the public and private sector. Dr Anne Gudgeon, Sr Lieske and Michelle Norris and I travelled for Cape Town.

On the first day, Sr Nonnie (St Francis Hospice) and Dr Linda Whitelock-Jones (breast surgeon) joined us from Port Elizabeth.

Sr Nonnie ran the palliative care session.  She divided the participants into 4 groups and gave them a case to discuss.  After discussing the cases, each group gave their feedback and contributed to a general discussion.  There were 2 points that were emphasised: all patients need to be respected and told the truth.  A family/community cannot begin to support an individual who is dying if there is a barrier to discussion.
Sr Lieske helping Eunice with a biopsy
In the afternoon, Anne and I spent time teaching various biopsy techniques.  All the participants had a chance to practise the procedures themselves.  Linda Whitelock-Jones ran the station on radiological investigations.  The day ended with a discussion about how the manage locally advanced wounds.

It will be a wonderful day when we don't need to have the last session.

Anne Gudgeon teaching about the pitfalls of FNA


Thank you

Every October, CBMH hosts a thank you party for the volunteers who give their time to see all the women who have had breast cancer surgery at CBMH.  Michelle Norris always organises treats for them and they get to enjoy massages and cup cakes. This year was no exception. PLWC and Reach for Recovery had stands.  A big thank you to the sponsors who included Pathcare, Morton and Partners and Well Woman Diagnostics.

Michelle Norris (CBMH), Carol van der Velde (Well Woman Diagnostics); Maryan (Morton&Partners)

I have decided to award a non-pink October prize and the inaugural prize has to go to Well Woman Diagnostics for their cup cakes in the colours of the Breast Course for Nurses.

I spoke about "Celebrities and their cancer stories" but the real celebrities of the day were sitting in the room: all the volunteers and the hospital personnel.

Thanks to all for an enjoyable morning!


October madness

October always brings it's opportunities for pink marketing.  I have seen a number of examples (eg, pink tyre caps) but surely the most bizarre are the pink drills manufactures by Baker Hughes: a company involved with drilling for oil.  They are involved with the controversial buisness of fracking.

They have painted the drills pink to "serve as a reminder of the importance of supporting research, treatment, screening and education to help find the cures for this disease which claims a life every 60 seconds.  I don't understand this at all. The tips of the drills are pink.  Who sees them when they are in the ground? How will pink ends to the drills educate people about breast cancer.  how will it find a cure?

The $100 000 donation to Susan G Kommen is generous but I fail to understand the purpose of painting drills pink.    A blog written in the money section of the Guardian has called Hughes Baker and others like them a "philanthropic hypocrites".  For further comment, check out last Sunday's City Press.

Basil Strathoulis, an Orthopaedic surgeon and photographer in Durban sent me a picture advertising "Set the Tatas free day."  "Free the tatas" is apparently an NPO.  What are they about?  On their Facebook page they claim to be"celebrating a woman's body and all it's beauty regardless of ethnicity, religion or creed".  There is no indication of anything they do other than post bizarre pictures.  Why are they an NPO?

There are many women who have had breast cancer and have had a mastectomy and reconstruction.  If there aim is to celebrate the beauty of all women, why are they assuming that all women need to wear a bra?  Are they excluding those who don't?

 The final bizarre campaign I will comment on was in the October version of "You" magazine.  Several celebrities had themselves photoshopped as being bald to "raise awareness".  Raise awareness of what? Any person who has had chemo will tell you that it is not what you look like that defines you but how you feel.  My husband wrote the following and sent it to the press ombudsman:
The "bald" fact is that the editorial and the front page and the article are "balderdash". Worse, it is ill-judged, ill-considered, insulting, inaccurate and insensitive. Cancer has a stigma, which cannot be removed by "shock" tactics, but by proper non-sensational education. Its not true that celebrities have an unambiguous influence or effect on raising awareness - they have their stories, but they are not the last word. Why is the only actual cancer survivor in the article portrayed with her natural head of hair in full focus, and not with a "photo-shopped" image, didn't the editors see an irony and honesty in that. Why try to glamourise a disease that is not pretty? The massive amount of hard work by support groups, professionals and survivors themselves is not boring, rather it is tired and lazy journalism that looks for cheap ways to find headlines, at the cost of truth. I am disgusted. I can give a hundred better headlines and story ideas that are not the demeaning approach this distasteful issue has come up with.
Apparently, You magazine have issued an apology.  I haven't heard any comment from CANSA who supported the story.

Please share your stories about some of the more bizarre campaigns being run this October.


Goodbye Dr Bell

This evening, I went to the leaving party for Dr Bell.  Peter Bell has been a radiologist at Morton and Partners for 30 years.  I have worked with him for the last 13 years and I will really miss him.

The radiographers put on their skirts and danced. 

I have worked closely with Peter as he does most of the interventional breast work at CBMH.  But that doesn't make him stand out from the crowd.  We are lucky enough to have many competent breast radiologists in in Cape Town from the different radiology practices.  What make Peter stand out is his modesty and his holistic approach to his patients.   Holism is a unique quality amongst radiologists.

However, his most defying characteristic is his kindness.  I am not sure who really said "It is easy to be clever but more important to be kind".  It has been attributed to different people but if Peter was less modest, I am sure he could have said it.

We will miss you.  Lucky Bedworth!


Women's Month celebration at Department of Environmental Affairs

I was asked to speak at a women's month programme presented by the Department of Environmental Affairs. This was at the Peter Stokey Hall at the V&A Waterfront. Ms Lucinda van den Heever led a dialogue on gender equality issues, as well as on women empowerment and gender equality. The question of "What is it to be a woman?" was explored.

Tiny Mdlalose spoke about countering arguments against "Push Her Down" or PHD syndrome. The general consensus was that big programmes do not work, rather, local and workplace support is needed. One suggestion was to have an open door policy for any concerns or queries.

I spoke about the importance of breast self examination, early detection and early referral. Included in this was how we are influenced by the role models around us. A questions and answers session followed where the audience could share their stories and concerns.

Malala Yousafzai was awarded the Nobel Peace prize this week.  When she started speaking out about education, she was a teenager in unimaginably poor circumstances.  She put female teenage education at the top of the international political agenda.

The conclusion of my talk was to say that professional woman in this country are in a privileged position.  There are many women less fortunate than ourselves who are not able to speak out.  It is up to all of us to fight for those who can't, and take responsibility for putting breast cancer management foremost on the agenda of the decision makers of society.


Southern African celebrities and their breast cancer stories

Some years ago, I gave a talk about celebrities who shared their stories about having cancer.  I gave some examples of those who I called heroes and those who I felt were zeroes.  I was asked to repeat the talk this week and changed it to include suitable role models in Southern Africa.

I chose to discuss two Southern African women who have recently shared their stories.  Their stories are very different.

The first is Zoleka Mandela, the grand daughter of Nelson Mandela.

She has written a book called "When Hope Whispers".

The first half of the book is about her battle with drug addiction.  The second half is about her journey with breast cancer.  "This book is Zoleka's story of healing and triumph...Zoleka is a living example of success in spite of overwhelming challenges; she is cancer free and enjoying sobriety"
Zoleka was treated in Johannesburg in private hospitals and was able to have a bilateral mastectomy, reconstruction and chemotherapy in the city she lives in.

For many women living in Southern Africa, that is not a reality.

Blandina on a billboard in Malawi
The second celebrity I talked about was the ex Miss Malawi: Blandina Khondowe.  She was diagnosed with breast cancer whilst feeding her son.  She had a breast lump for 18 months before it was diagnosed and had to travel to India to get radiotherapy as there are no radiotherapy facilities in Malawi. She returned to Malawi to complete her chemotherapy.  She has written a blog and shares some of her thoughts and observations.

In her blog, she notes that the women being treated for breast cancer in India are much older than those in her home country and she asks the question why more is not being done to provide cancer facilities in Malawi.

Since her diagnosis, she has become a breast cancer advocate in her country speaking out about the lack of facilities and campaigning for more equitable access to management.

Well done Blandina!

Have you been inspired by a celebrity's story? Who would you make your celebrity hero?


The re-launch of Reach for Recovery

October has come around again very quickly.  For Sr Lieske, Michelle Norris and I (representing the Breast Course for Nurses), the first event was the re-launch of Reach for Recovery.

Alison Ayres and Elsabe Schlechter acted as MCs.  The relaunch is not just about branding but is about reaffirming what Reach for Recovery offers people who have been diagnosed with breast cancer.

The old logo has been replaced with a more modern logo designed by Greg Booysen from AAA in Cape Town.  The symbol represents the form of a breast and a flower and is gender neutral.  I really like it.  What do you think?

Ann Steyn and Salome Meyer

There were 3 guest speaker: Ann Steyn, Salome Meyer and Bruce Walsh. Anne Steyn (past president) spoke about  the history of RFR and Salome Meyer focused on the topic of advocacy and The Advocates for Breast Cancer (ABC). 

Bruce Walsh, gave an inspirational and motivational talk: "Winners or losers - it's your choice." This was about his life story after losing his legs in the 1998 Planet Hollywood bomb blast.  He reminded us all that in the face of adversity, it is up to us to decide whether we will be a winner or loser.

Alison Ayres with a punnet of pink mushrooms
Reach for Recovery is the only breast cancer support group (in RSA) that offers free breast prosthesis fitting.  This has been launched as The Ditto project.

There are many women who cannot afford a prosthesis and  a local mushroom farmer has agreed to contribute a proportion of funds raised from selling mushrooms during October.  They are packed in a pink punnet and are available from local supermarkets.

This is a really good example of pink cause related marketing.  Please support it.

Mr Mosig and his sons
At the end of the evening, Michelle Coe introduced Mr Mosig who will be leaving this weekend to climb Kilimanjaro in aid of awareness for breast cancer.  He was given a reach for recovery flag with the new logo to put on the summit.  Good luck to him


Well done to reach for Recovery on an excellent new logo and for organising a lovely evening!


Emergency poetry

Last weekend, Tony and I had the pleasure of attending a couple of sessions at the open book festival.  It really is an excellent annual event here in Cape Town.

This year, The British Council supported a performance poet- Francesca Beard.
Francesca Beard
We spent a wonderful hour listening to her involve her audience.  She interspersed her poetry with audience questionnaires. One was about how we would choose to die. Given the 7 options, I found it difficult to choose between being eaten by the lion (I was tempted by the promised rush of adrenaline before the incident) or dying in outer space hoping to be found by George Clooney.

Her poetry was diverse.  The poem that I felt made the most impression was The poem that was really a list.  It is quite a tough poem so don't open the link if you are feeling fragile.

Thanks to the Book Lounge for organizing such a wonderful event. It's wonderful that it boosts networking through the book illustrator and 'poems to go' sessions.

Another poet came to my attention this week and that was the "Emergency Poet",  Deborah Alma.  She drives around the UK in an ambulance administering poemcetamols from the Cold Comfort Pharmacy.

Deborah Alma administering poetry


Have you ever felt the need for an emergency prescription of poetry?


Hormone receptors in breast cancer

This joke has been told many times: a surgeon, physician and pathologist were out on a pheasant shooting trip.  They noticed a particularly interesting bird flying in the air.  The physician said "I wonder if that could be the rare lesser spotted pink crane.  Perhaps it is a juvenile red collared duck.  Do you think we are too far north for it to be a spotted hawk? "
"There's only one way to find out" replied the surgeon.  She aimed her gun and shot the bird dead, then gave it to the pathologist who made the diagnosis -- a pheasant.

We always believe that the pathologists can provide us with the definitive answer.  What I remember from pathology lectures at med school is being presented with picture after picture of pink shapes with a various number of black dots.  Generally, the darker the slide, the worse the diagnosis.  Have things changed since labs have become more automated?

A portion of breast tissue imbedded and waiting to be processed
A couple of weeks ago, I invited myself to the pathology lab at Well Woman diagnostics and looked at how the estrogen receptor (ER) status is assessed.  After the diagnosis of breast cancer is made, it is important to know the prognosis of the cancer and  to predict how it will respond to the various treatment modalities available.  One of the mainstays of breast cancer treatment is endocrine therapy (Tamoxifen, aromatase inhibitors and Goserelin).  The higher the ER, the more likely endocrine therapy is to work.

The process involves many steps of fixing and unfixing and is partially automated.  Tissue can be taken from the tumour using a biopsy needle which gives a core of tissue.  A representative part of the tumour must be biopsied.  When the tumour is placed in formalin, the time must be written on the jar as the formalin MUST be fixed for at least 6 hours.  The tissue is cut up and parts are imbedded in paraffin.

Phumeza Siziba slicing up specimens and preparing slides
Thin slices of tissue are sliced by hand and placed on a slide and then stained.  This allows the basic diagnosis of to be made.

Nahwahl Isaacs processing the tissue for ER testing.
If there is a breast cancer, a representative portion of the tumour is then processed a second time and the ER receptors are tested.  In order to do that, the "bridges" have to be opened up, a stain with an avidity for the receptor attached and another stain to show up the previous stain added.

At the end of the day, the staining is quantified by the pathologist.

Even in a first world lab, there are many steps involved and many possibilities for error to creep in.  My last blog dealt with the issue of diagnosis and management of breast cancer in low income countries.  I didn't deal with the paucity of reliable laboratory services in Southern African countries.  In South Africa, we are lucky to have access to world class facilities. To get serious about improving breast cancer management in low income countries, access to reliable pathology services is as important as access to drugs.

Many thanks to Nicole Morse and Judy Whittaker from Well Woman diagnostics for letting me spend time in their lab.


BIGOSA: the management of breast cancer in low income countries

The 3rd BIGOSA meeting was held on Saturday 30th August.  The day before, on Friday 29th August, we had a preconference meeting sponsored by Novartis.

The meeting welcomed oncologists and surgeons from Namibia, Zambia, Mozambique, Botswana and Zimbabwe.  We discussed the challenges of the management of breast cancer in poorly resourced countries.

We don't have accurate statistics about the incidence and management of breast cancer from Southern Africa so in many cases our management decisions are based on small cohorts of patients or on descriptive statistics.  With or without gaps, the data is important.

The afternoon session at BIGOSA was dedicated to the same topic.  Excellent talks were given by Dr Ines Buccimazza, Prof Lynette Denny and Dr Pillay-Van Wyk.

When it comes to managing cancer in in low income countries, the problems are enormous.  Although there were many points discussed, a few are presented here:

  • We don't have disease registries.  Although we are used to seeing tidy pie charts dividing up the causes of mortality into those due to infectious diseases, trauma and non communicable diseases, the overlap between them is enormous.  To illustrate this, an estimated 40-60% of all cancers in Southern Africa are due to infectious diseases: HPV causing cervical cancer and HIV causing Karposi's sarcoma.
  • South Africa has many more cancer centres (especially in the private sector) relative to neighbouring countries. (Zambia has one).  There are few radiotherapy machines, limited imaging facilities and problems with spare parts and maintenance. Drug supplies are erratic.  Access to medication is limited.  The sparsity of resources and support systems mean women spend many months as inpatients in hospital.  For example, in Mozambique, a woman undergoing routine treatment for breast cancer may occupy a hospital bed for 9 months.  This would be unheard of in USA/UK.
  • There are very few trained cancer specialists.
  • For many women, just getting diagnosed with breast cancer and getting screened may take many months.  (Figures presented from Botswana suggested delays of up to 1 year) 
  • The many social challenges within poorer communities are  compounded by the devastating effects of civil unrest and war.

In her talk Ines asked whether drawing up guidelines for breast cancer care specifically for use in low middle income countries was condoning or perpetuating sub-standard care.  She concluded that whilst guidelines alone are not enough to improve care, following the same protocols used in high income countries is simply not attainable.

If we are to achieve anything about the plight of the thousands of women developing breast cancer in poorer countries, we need to start putting cancer care high on the government's agenda and be creative in our approach.



Yesterday, the 3rd BIGOSA conference was held in Cape Town.  It was well attended with delegates from throughout Southern Africa.

Rro Dr Sylvia Heywang-Kobrunner and
Prof Apffelstaedt
The invited guest speaker was Prof. Dr. Sylvia Heywang-Kobrunner from Munich.  She gave 2 talks: one presented the case for routine mammography screening in Germany and the second talk dealt with the confusing and controversial issue of intermediate lesions found on screening mammography.

The rest of the speakers were from South Africa.  The topic for Dr Judy Whittaker's talk was "Traditional prognostic indicators vs molecular prognostic indicators"  This is a huge subject.  Traditionally, the management of breast cancer has been based on what the tumour looks like microscopically (the grade and the presence of tumour cells in surrounding vessels), the size, the involvement of lymph node and the ER and PR sensitivity.  However, there are many tests available that look at the genetics of the tumour. In time, they may take over from traditional pathology.  Dr Karen Fieggen gave an excellent talk on the impact of Angelina Jolie discussing her decision to have a bilateral mastectomy.  Time will tell whether she has changed the overall pattern of practice.

After the tea break, we had a second talk from Prof Dr Heywang-Kobrunner.  She was followed by
Dr Shane Barker who gave a
Dr Ines Buccimazza and Dr Shane Barker
comprehensive overview of the surgical techniques used by plastic surgeons to re create a nipple after a mastectomy.  He was followed by Dr Rika Pienaar who discussed the management of the side effects of endocrine therapy used to treat breast cancer.  Many women give up taking their cancer drugs because of the side effects.  The onset of menopausal symptoms can be overwhelming.  Her bottom line was that women should be encouraged to exercise, lose weight and modify their diet. Dr Voster gave a presentation on how women with bony metastatses should be managed.

Ann Steyn standing with Dr Baatjes in front of the BIGOSA banner

At the end of the morning, Ann Steyn gave a 15 minute talk on the role of advocacy in developing countries.  It is the first time a breast cancer survivor has been invited to address BIGOSA and I hope she will be the first of many. As always, she gave a succinct presentation outlining the work being done by ABC and the enormous amount that still needs to be done.

The afternoon was spent discussion the management of breast cancer in low income countries and I will write a second blog about that.

Every year, a prize is given by Mrs Stathoulis for the best free paper.  This year's winner was Dr Ettienne Myburgh.  We said good bye and thanks to our president-Prof Apffelstaedt and our secretary Dr Karin Baatjes.  We welcomed out new president-Dr Ines Buccimazza and our new secretary Dr Chas Chacala.
Dr Ettienne Myburgh

Next year's conference will be held in Durban.


Durban course

Last weekend, we had a lovely time conducting the nurses course in Durban.  Dr Ines Buccimaza joined the team for the whole course.  The nurses who attended were mostly from Albert Luthuli and Addingtons Hospitals.  Lindsay v d Linden from OCSA in Johannesburg was also there.

We started on Friday with short lectures, and were then joined for an hour by Sr Michelle from the Highway Hospice.
Sr Michelle receiving flowers from Shrini
She gave a very practical approach to the management of a palliative care patient.  It was wonderful opportunity for the nurses on the course to be able to meet other colleagues involved locally with few such interactions.  Having discussed the possible approaches to the management of some of her patients, we went on to talk about locally advanced wounds.  Unfortunately, all of us see way too many women who present with advanced breast cancer.

Dr Chick demonstrating biopsy techniques
The afternoon was spent doing biopsies on apples and polony.  We were joined by Dr Chick who shared her expertise with us.

I am generally quite organised but for various reasons managed to double book my time on Saturday.  However, the course continued in my absence ably run by Sr Karen Hill and Ines.  The morning session on community programmes was run in conjunction with representatives from the local cancer support groups.  Volunteers from both Reach for Recovery and the Breast Health Foundation gave the time and networked with the nurses.    What emerged in discussion was that it is imperative that NGOs invest their money wisely and ensure that they earn interest on their money.  I wonder how many do.

Sue Serebro, from Johannesburg, flew down to teach the session on lymphoedema management.  As before she gave an excellent presentation and even Ines was doing the bandaging correctly by the end.

The Course was sponsored by Netcare (thanks to both St Augustines and CBMH), Pathcare who donated books to the participants, Bard who supplied the biopsy needles and individual donors who have been generous intheir support.  Thank you to all of you.
Ines Buccimazza talking about cytology


Advocacy Workshop in Cape Town

ABC (Advocates for Breast Cancer) have been running a workshop in Cape Town this week.  The training is being run by Salome Meyer who has been involved with the development of cancer policy guidelines for many years.  It is being attended by PLWC, BHF, RFR, Amabelle Belles and CANSA.

The Cape Town meeting is one of a number that have been held around the country.  Advocacy has been defined in different ways.  Salome has use the definition that it is giving a voice to the voiceless.

The aim of ABC is to lobby the government to write and implement a breast health policy for the country.
The Cape Town meeting is one of a number that have been held around the country. Advocacy has been defined in different ways. Salome has used the definition that it is giving a voice to the voiceless. The aim of ABC is to lobby government to write and implement a breast health policy for the country.
Why do we need a national policy? The aim is to minimize the inequalities in health service delivery in this country.  There are many steps involved:
Identification of the issue
Appointment of the team
Establish policy development
Conduct research
Prepare discussion paper
Consultations stage 1
Prepare draft policy
Consultation stage 2

Government has agreed that we need a breast health policy.  It is imperative that we keep it on the agenda.  Salome ended the day with "Now is the time."

Salome Meyer



Linda Greef
Last Saturday morning, Linda Greef organised a second breakfast for PLWC at the lovely Vineyard Hotel in Cape Town.  Once again, the topic was living with metastatic breast cancer.  There were several speakers.  Dr Marc Maurel (oncologist with GVI) gave an inspiring talk in which he referred to the journey undertaken by a woman with breast cancer.  Sumi Padayachee (Radiologist, Ayra Stana breast and bone centre) presented the guidelines for screening for breast cancer.

Emile Minnie

Before we had breakfast, Emile Minnie entertained us.   He is a well known Capetonian: a songwriter and performer.  Although I hadn't heard of him before, I shall be looking out for any performances he does in the Southern Suburbs.

After breakfast, I talked about the role of surgery in the management of metastatic disease, after a recurrence and after the development of a new breast cancer. I was followed by Prof Kotze who presented some of her research into the role genetics plays in the management of breast cancer.  Emile then took the stage again to entertain us with more songs: Thank you Emile.

Linda, well done on organising a very successful event.  It is so important that we dedicate events to women undergoing treatment for breast cancer and those living with the disease.


Thank you Karen

Thank you to Karen Mclennan and her friends for the donation to the Breast Course for Nurses. 

"I felt enormously privileged to receive the outstanding care I did as your patient, and from the nurses who looked after me at CBMH last year when I had a bilateral mastectomy. So for my birthday I had a tea party for my friends and in lieu of presents asked for donations for your courses. I requested that contributions be put in a plain envelope and dropped in a box on the table, so donations were anonymous.

I was touched by how enthusiastically my friends responded to my suggestion, but not surprised, as they were so wonderfully supportive of me all through my treatment. " 

Later in the year we will be starting some new initiatives and you will be able to see what we are using the money for.  Once again, THANK you.


8th SCCA

Earlier this week, I had the privilege to attend the the 8th SCCA in Namibia.  SCCA stands for Stop Cervical, Breast and Prostate Cancer in Africa.  It was started in 2007 by Princess Nikky Onyeri
Princess Nikky Onyeri
from Nigeria.  15 first ladies from Africa have joined the initiative to promote awareness about cancer in the region and implement policies to deal with the disease burden.

Madame Pohamba, Namibia

On Monday, we heard presentations from the first ladies of Namibia, South Africa, Ghana, Chad, Niger, Swaziland, Nigeria, Mozambique, Uganda and Kenya.

In the afternoon, there were track sessions with a mixed bag of presentations.  I attended a very interesting session on ethnomedicincal plants given by Dr Davis Mumbengegwi, UNAM.  He was followed by a Ms Koegelenberg from CAN (Cancer Association of Namibia) who told us about their
projects.  I was most impressed by the fact they have Acacia House which is open to anyone who needs to stay in Windhoek for cancer treatment. The last 2 presentations from Eunice Garanganga and Celestine Mbangtang were about the hospice movements in Zimbabwe and Botswana.  They demonstrated what can be done with relatively little money and good organisation.

On Tuesday, the Windhoek declaration was signed by all the first ladies.  Amongst other pledges, they agreed to intensify advocacy for HPV vaccinations in an attempt to prevent cervical cancer.  Approximately 250 000 African women a year die from cervical cancer.  HPV vaccination should be offered to every school girl.

Several presentations dealt with tobacco consumption.  Tobacco companies see Africa as the next growth area and are targeting the continent.  At present, there are an estimated 77m smokers in the continent.  With the expected rate of population increase and increased usage, this is expected to rise to 700 million smokers by the end of the century.  Dr Evan Bletcher called for action to be taken urgently.

I would like to thank Novartis for making it possible for me to talk about the nurses course.  It was an excellent chance for me to network with health care providers from Botswana and Namibia.

I sincerely hope that the people with influence and power who were at the conference do not waste the opportunity to make a real change in the lives of people in Southern Africa.


Never Say Goodbye

A few weeks ago, I wrote about meeting Susan Lewis, the author of Never say Goodbye.  Having chatted to her, I have read the book and was most impressed.

The book is about 2 women who live on different sides of a seaside town: Josie and Bel.  Josie develops breast cancer and whilst Bel has never had breast cancer, her twin sister died from it.  Bel is a volunteer for Breast Cancer Care and meets up with Josie.

As the story develops, Josie's journey through the diagnosis and treatment of her disease forms the backbone of the plot.  It was interesting to read about the experience of being seen by the surgeon from the other side of the desk.

The relationship between Josie and Bel is not one way.  Bel does support Josie but she also gets a lot out of the relationship.  This is a common and real phenomenon that many volunteers experience.

Over the years of treating women with breast cancer, I have had the privilege of reading some very personal accounts of their story.  In my opinion, Lewis captures the emotional highs and lows of the journey in her insightful novel.

I was impressed with this accessible novel.  It is factually accurate and am sure that women who are going through the trauma of breast cancer treatment will be able to identify with the very real character, Josie.


Thank you IASSS

The inaugural IASSS conference came to a close on Thursday evening.  The first closing speech was given by Prof Khan (Head of surgery, UCT) who gave a brief history of the UCT surgical students association and recounted a very entertaining story about the pioneering heart surgeon, Christiaan Barnard.

Tinashe Chandauka (the president of the UCT surgical society) then reflected on the conference.  Two words summed up his thoughts: innovation and believing.  He believes that the surgical association should be at the forefront of developing innovative solutions for the health problems faced by the developing world, and believes that it can become the place where surgeons from the developed world will seek for new ideas.

Amongst the awards won, a prize was given for the winner of the debate: "This house believes that medical students in 'developing' countries are better trained than those in 'developed' countries to become surgical pioneers of the 21st century".  Unfortunately, I wasn't there for the debate but I am delighted that the topic was chosen.

As the world becomes more populated and health resources are stretched thinner and thinner, the role of surgery in the management of developing world health problems has received increasing attention.  One of the videos shown at the conference was provided by ICES (International Collaboration for Essential Surgery) and can be viewed online:  www.therighttoheal.org.  Surgery must be made more accessible and be seen as a possible primary health intervention.

For the Breast Course for Nurses, the high point came when when we were given a cheque for R30,000.  This money came from the students attending the conference.  Those who know me will attest that I am rarely lost for words but it took my breath away when we were given such a generous donation.

Once again: well done and THANK YOU to all who were part of IASSS.  Please follow our progress so you know how your money is being used.

Like Kuttschreuter handing over the donation



Last night was the opening night of what promises to be a fascinating conference in Cape Town: the inaugural meeting of the IASSS (International Association of Student Surgical Societies).

The conference started with a golf day followed by a cocktail party.  The Breast Course for Nurses has been nominated as the charity for the event so Sr Lieske and I spent the evening there.

Mr Nicholas Tamela 

After the introductory talk, Prof Klopper (Vice Chancellor UCT) opened the evening.  She sketched a future for medical eduction that will result in less boundaries being drawn between undergraduate and post graduate training.  She said the the days of the undergraduate student being a consumer of knowledge should be behind us: they should become producers of knowledge as well.

The Wits team
We listened to presentations from many of the student surgical associations attending the conference.  They were from SA (UCT, Wits and Stellenbosch), as well as from other coutries: Tanzania, China, Australia, USA and Namibia. It was fascinating to hear about their visions and goals and whilst there were obvious differences, all the speakers impressed me with their confidence and enthusiasm.

 Not only will we be the financial beneficiaries of the conference, we met a lot of dynamic, energetic young medical students who we hope will consider becoming involved with our project.

Guys, well done on an excellent conference and THANK YOU!