Heatherís life-changing decision

The fear of a return of breast cancer has prompted a local woman to have a healthy breast surgically removed. Catherine Kalamis met Heather West to find out why she felt compelled to make this significant decision.

FIVE years ago Heather West, then 37, felt a pea-sized lump above her breast. The consequences of that discovery – which led to a diagnosis of cancer and a mastectomy – continue to affect her life. She has spent the past few years reeling from the shock of cancer, a mastectomy and major reconstruction surgery, with the last cosmetic stage completed only in January. These experiences have led Heather to a remarkable conclusion. She has decided to have her remaining, healthy breast removed in an attempt to reduce the risk of cancer returning. Heather, who is down-to-earth with a very positive frame of mind, has thought long and hard about what to do. In fact the decision has taken months to achieve. But it has been made entirely on her own, apart from advice from a surgeon, because she did not want anyone else’s opinions to muddy her thoughts.

The procedure is called an elective, or prophylactic, mastectomy. Doctors have said that although it would reduce the risk of breast cancer significantly, it will not remove the risk completely, as small amounts of breast tissue will remain. There have been several factors in the decision – but the most significant is that Heather wants to do all she can to stay healthy and alive for her sons, aged 10 and 12. ‘My children are young and need me and I want to be around when they are older. I have a child with special needs who is not going to grow up and leave home when older. I have to be around for him,’ explained Heather. ‘As much as I don’t want to go through the operation, I feel it is a positive decision, much less traumatic than finding another cancer and having to go through chemotherapy again. ‘I was lucky and did find it (cancer) last time – but if I had not found it, where would I be now?’ Heather continued: ‘I owe it to my family to be around for as long as I can. ‘It is a huge decision and it has taken me most of this year to decide to do this. I did not discuss it with anyone apart from the surgeon, as I did not feel I wanted anyone else’s attitudes or pressure put upon me, such as “why are you putting yourself through this?” ‘They say they cannot take the risk away. They say they cannot get every tiny bit of breast tissue. But they can take a huge part of it away and that is going to give me peace of mind to get on with life, without having to think about cancer each day.’

Heather, who is deputy manager at a residential home, said that although she might have a generally happy disposition, she privately dwells on her experience of the past five years and feared a return of breast cancer. She has had some scares since her original diagnosis of cancer and there is a nagging fear that it will return in her other breast. ‘I do worry about it and that gives me a lot of stress.’ There have been other factors to consider. Last year she received another shock, when her mother was diagnosed with breast cancer – albeit a different form – and also underwent a mastectomy. And Heather has just finished taking Tamoxifen, the antibreast- cancer drug which doctors recommend should not be taken for longer than five years. As a result she is concerned that her oestrogen levels will rise which could be a risk factor for the development of any cancer that feeds off oestrogen (as her original breast cancer did).

On the plus side, she has already had successful breast reconstruction – so knows that she will still be able to have a completely natural look after surgery. The result has been so good that she wants reconstruction as soon as possible after her healthy breast is removed. Although there is no sensation in the new breast, she said: ‘It is so good that some women go topless on the beach after reconstruction and no one knows.’ Heather is aware of what she faces: recovery from the elective mastectomy to be followed by a seven-hour operation to rebuild a new breast. Last time around there were complications, although nothing she could not cope with, she said. Heather has had the support of two surgeons – one in the UK and one in Guernsey. ‘My surgeon said that it was my decision and that he supported it – he said he would write to my surgeon in the UK to go ahead with it. He did explain that it would not take away all the risk, but he understood that it would give me peace of mind.’ She said she had talked to another woman who had made a similar choice. ‘She is now so much more relaxed about breast cancer.’ Heather has had to think of other factors. She accepts that the removal of a woman’s breasts can take some sense of femininity away. ‘But equally I think the reconstruction looks good, so that I can undress and still look the same. Although I am taking away, I am gaining in other ways.’

Heather’s road to recovery
 Heather discovered breast cancer after feeling a small lump above her breast, following a shower. Her GP said it was probably nothing to worry about but that it would be worth getting checked out at the breast-screening unit. But Heather – with some of the fortitude that she has displayed in the decision to have an elective mastectomy – knew she wanted the lump removed, whatever the outcome. Her breast specialist agreed, so just three days later, after an ultrasound scan and mammogram, but no firm diagnosis, Heather had an operation to remove the growth. One week on, it was confirmed as breast cancer. The blow rocked Heather’s life. After diagnosis came the news that her surgeon recommended a mastectomy because the cancer was found to be particularly aggressive. She then had four exhausting sessions of chemotherapy at the Royal Marsden Hospital’s breast unit in London, which involved leaving her young family every three weeks for intravenous infusions of a powerful anticancer treatment.

Heather’s thoughts after diagnosis went immediately to her family – her sons who were then just seven and four. Her children and their future still, naturally, remain at the forefront of her mind. ‘After the diagnosis I was numb, totally numb.’ Prior to the mastectomy operation she went through a frantic stage of organising everything because, she said, she worried she was not going to get through it. Then the reality of cancer hit home. ‘I realised that I had had cancer and that it could come back.’ She was dealt a particularly hard blow because that summer people had commented upon how well she looked. The chemotherapy was particular intensive and involved intravenous administration through a fixed Hickman line. Even that was not straightforward: she suffered blood poisoning and became very ill, although prompt treatment saved her life. Losing her breast to cancer affected her confidence. She found that coping with prostheses was not for her although she accepts that other women do like them. ‘I’d go out sometimes and forget to put one in.’ It took her more than a year to feel strong enough to go through the major operation and recovery that breast reconstruction entails, but is now pleased she did. Recovery took a while and there was bruising and swelling. ‘But even so I would recommend to anyone having it done – it gave me my confidence back.’

Cancer is life-changing
Heather said that having cancer changed your life. It helps those who are diagnosed to recognise what is really important in life – and that can be a positive part of the disease. ‘It affects you in ways that you would never imagine. It helps you make decisions in life that you probably would not have time for before you had cancer.’ The disease can strengthen bonds of friendship. She realised how lucky she was to have wonderful supportive friends, one of whom accompanied her to London for treatment, she said. Her mother also spent eight months in Guernsey looking after her. Heather is one of the Pink Ladies, a group of women who have had breast cancer and who offer support to others. They meet regularly, organise lunches, invite guests and raise funds – their recent purchases have included some modern wigs complete with highlights.

Prophylactic mastectomies

SEVERAL local women have chosen to have a healthy breast removed after suffering cancer. And a very small number, although they have not contracted the disease, have decided to have prophylactic mastectomies because breast cancer is in the family. This decision is made only after screening has identified these women carry a genetic risk of developing the disease and after professional, and often intense, counselling. The reason, in both cases, is to prevent the onset of breast cancer – a disease that has successfully entered the public consciousness as a major health worry and which now affects one in nine women. Breast surgeon Roger Allsopp said: ‘As long as there are no contra indications, we would try to do what someone would want.’ He said many women who had had breast cancer worried about its return in the second breast. ‘Some people cannot cope and prefer to have it done – sometimes it is not totally logical, but you cannot make everything logical,’ he said. Even after opting for this drastic course, the threat of the disease is not eradicated. ‘We cannot say that this will completely eliminate the risk – but it could reduce it by as much as 98%.’ Even after having an elective mastectomy, a woman will still be offered clinical examinations and support afterwards. Women with breast cancer, or at risk from the disease, need lots of support and time to make such decisions. ‘It is a very legitimate decision to take, as long as the woman has had all the help available with counselling and has had information and knows exactly what risks there are,’ said Mr Allsopp ‘We have to make sure the patient has thought about it and had time to do so. There is usually plenty of time to make these decisions,’ he added.

What next?
Reconstruction is an option available to women who have had mastectomies – and it is a procedure available under the Medical Specialist Group scheme. The operations cannot be performed in Guernsey but links have been established with centres in the UK. It is possible to have immediate reconstruction after a mastectomy and a new link may be forged soon with a UK hospital for these cases. ‘Things are changing; it has become much more specialised,’ said Mr Allsopp. In the past a woman might be seen by a breast cancer surgeon and a plastic surgeon. Now a new breed of surgeon is being trained up who will specialise in breast surgery and reconstruction. ‘The advantage is that it is one surgeon taking charge of the whole aspect of that patient’s treatment.’

Are you at risk?
You could be offered genetic counselling and screening if you have two ‘first degree’ relatives who have developed breast cancer before the menopause. Mammography is offered to women under 50 if a first degree relative developed breast cancer before the menopause. A genetic screening can determine whether you are at an increased risk. A prophylactic mastectomy would be available only to a woman who has not suffered breast cancer if it was decided she carried a serious risk of developing the disease. And it would be considered only after that woman had had complex counselling and screening. Many women have a first-degree relative who has developed breast cancer after the menopause and these women are not considered to be at greater risk of the disease, unless a genetic link has been shown.  

(Reproduced courtesy Guernsey Press and Star)
Article dated 10 October 2002



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