Oncology Centre CBMH: Breast Course for Nurses

We have been at the new hospital for 6 months and have run our first Breast Course for Nurses.  The plan is to open an oncology unit which should be ready for chemotherapy in about 2 months and radiotherapy in 5 months.  As part of the process, we have had a Western Cape based BCN for the staff working here, those who will be involved in the new centre and cancer survivors involved in support.

Sr Lieske and Dr Anne Gudgeon
Carol van der Velde and Michelle Norris
The morning started with Dr Dedekind going through changes in the normal breast.  Having discussed clinical evaluation of a woman with breast problems, we had a lecture on investigations of the breast given by Dr Dicker and Carol van der Velde.  Dr Ann Gudgeon gave an overview about breast cancer treatment then Sr Correia shared her vast experience on wound management with us.

Suzi demonstrating lymphedema therapy on Claudine
 In the afternoon, we started with a session on lymphoedema management which was organised by Sr Lieske. We were joined by Kate Brinckmann, Dr Clare Neser (reconstructive surgeon) and Suzi Davey.  Kate gave us an overview, Clare discussed the role of surgery for the management of lymphedema and Suzi discussed the non surgical management.    There are now more than 70 certified therapists in RSA, 2 in Zimbabwe and one in Botswana.  To find a therapist in your area, please go to the loasa website.  (There are lymphedema therapists at both Tygerberg and GSH.)

Maryan Halefe and Dr Britta Dedekind

The day ended with Linda Greef talking about advocacy.  She reminded us that advocating about cancer includes advocating for transport, schooling as well as support for the individuals

There are 4 levels of advocacy
1. Individual advocacy
2. Community advocacy
3. Institutional advocacy
4. Political advocacy

What the day has emphasised is the importance of a multi disciplinary approach to the management of a women with breast cancer.  This doesn't just mean the input from specialists from different areas but input from all manner of medical and non medical professionals. A big thanks to Michelle Norris, Theresa Roux and Chris Tilney.
The redoubtable Linda Greef


Post truth in medicine

Recent political events unfolding in the USA have launched the concept of "post-truth" into many newspaper articles.  It was voted as the Oxford Dictionary "international word of the year".  They defined it as

"adj, Relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief:
‘in this era of post-truth politics, it's easy to cherry-pick data and come to whatever conclusion you desire’"

The adjective is largely used by political commentators.  However, I fear that we are dangerously close to a post -truth era in scientific commentary and debate.   Widespread access to the internet has resulted in many examples of commentators being able to cherry pick "evidence" to support an opinion.

For the purposes of this blog, I asked my ever-patient husband to give me a possible cause of breast cancer to investigate.  "Suntan cream" was the mumbled answer.

My search resulted in nearly 3m results.  On page one (the only one most of us ever take time to read) there were 2 plausible articles.
One was from the Daily Mail suggesting that there may be a link.
The second was from a site called "IFLScience", a site devoted to the lighter side of science, which suggested there was no link between the suntan cream and breast cancer.

Mail online accessed on 12/2/17

IFL Science.com accessed on 12/2/17

I am often asked to talk about breast cancer and inevitably the question of causality is raised. Had this been a topic I wanted to discuss, it would be reasonable for me to have cited either of the articles and come to opposite conclusions.

After doing some considerable research on the subject, I don't think there is a link between suntan creams and breast cancer.  (That is not the purpose of this blog).  We must ensure that as medical practitioners, we guard against  "cherry picking" articles that reinforce our opinion rather than accurately represent the facts.  It takes time and energy.  As an increasing amount of data is published on the internet, working out what is fact and what is fiction will become more difficult and time-consuming. 

However, if we don't do that, medical science will be trumped as well as politics!