BREAST CANCER sURGERY
BREAST CANCER SURGERY
Most women (and men) with breast cancer have some sort of surgery as part of their treatment. Most, not all.
Surgery differs depending upon what type of breast cancer you have. For example, surgery could be for:
- Removing as much of the cancer as possible (a lumpectomy, or a mastectomy).
- A biopsy to find out whether the cancer has spread.
- To restore the breast’s shape after the cancer is removed as in a reconstruction.
- To relieve symptoms of advanced cancer
Decisions are based upon your overall health and not just the state of your breast. Your breast cancer, medical history and your current overall health come as one package when it comes to making a medical assessment.
Make sure you know your options so you can talk about them with your doctor and make the choice that is right for you.
SURGERY FOR REMOVING BREAST CANCER
There are two main types of surgery.
- A LUMPECTOMY means they’re able to save the breast by removing parts of the breast tissue that contain the cancer – plus a bit more around the edges to be sure they have rid you of all the cancer cells. How much breast they remove depends on where and how big the tumor is – not to mention other health factors. Remember, each surgery is unique to the particular person – you!
- A MASTECTOMY is a surgery in which the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues. There are several different types of mastectomies. Some women may also get a double mastectomy, in which both breasts are removed.
I know as black women that many of us are petrified of this kind of operation. I know it’s often the fear of this that causes delay in being diagnosed in the first place.
YOU MAY WELL DIE DUE TO DELAY WITH BOTH BREASTS STILL SAFELY APART OF YOU?
If you want to know what happens to your body when you delay going to the doctor for a potential breast cancer diagnosis, check out: NAKED TRUTHS.
A LUMPECTOMY OR A MASCECTOMY?
Many women with early-stage cancers can choose between a lumpectomy i.e. breast-conserving surgery (BCS), and a mastectomy.
- The main advantage of BCS is that most of the breast is saved. But in most cases, radiation will still be needed.
- Women who have mastectomy for early-stage cancers are less likely to need radiation.
Your decision should be based not on an emotional attachment to your breasts but rather on your ability to live a healthy life.
As a woman, can you imagine yourself as a full human being without your breasts, or do your breasts ultimately determine who you are?
Discuss your choices with your doctor and make a MEDICAL DECISION and NOT an emotional one. In time, your emotions will change.
ON THE OTHER HAND
Some women especially in the West, are having mastectomies unnecessarily because of the worry that having a less extensive surgery will see the cancer return eventually. With great ease, some women are saying, ‘just take them both off now!’
But some studies show that when BCS is done with radiation, survival is the same as having a mastectomy in people who are candidates for both types of surgery. Admittedly, these studies are based on western, and Caribbean women, not indigenous African populations.
SURGERY FOR REMOVING LYMPH NODES
When breast cancer spreads, the cancerous cells travel incognito (under cover) through the lymph nodes. Think of lymph nodes as the drainage system for our entire body and the cancerous cells are trying to escape like criminals in the dark, wading through wet tunnels while looking for other places to wreak havoc. Cancer cells like to be in charge, and they do that by tossing the place once they arrive – that would be your body.
To find out if breast cancer has spread to your armpits (underarm), some lymph nodes are removed for examination. I had 14 removed from there (I didn’t know I had that many), and I’m fine. You know how nature has natural contours in the earth, well that’s kind of repeated in our bodies. Don’t ask me how, but the drainage system finds alternative routes once those lymph nodes have been removed.
Anyway, an examination of the lymph nodes allows the doctors to get a measure of how serious the breast cancer is. Lymph nodes may be removed either as part of the surgery to remove the breast cancer, or as a separate operation.
THERE ARE TWO TYPES OF SURGERY FOR LYMPH NODES:
- Sentinel lymph node biopsy (SLNB) is where the surgeon removes only the lymph node(s) under the arm where the cancer’s likely to spread first. Removing only one or a few lymph nodes lowers the risk of side effects from the surgery, such as arm swelling, known as lymphedema.
- Axillary lymph node dissection (ALND) happens when the surgeon removes many (usually less than 20) underarm lymph nodes. ALND is not done as often as it was in the past, but it might still be the best way to look at the lymph nodes in some situations.
BREAST RECONSTRUCTION
Breast reconstruction is sometimes an option for women. A woman having a mastectomy might want to consider having the breast mound rebuilt to restore the breast’s appearance after surgery.
In some breast-conserving surgeries, a woman may consider having fat grafted into the affected breast to correct any dimples left from the surgery. The options will depend on each woman’s situation.
This is really popular for many women of African heritage including the Caribbean where cosmetic surgery is highly valued. I didn’t have to consider it, but had I had to, I definitely would’ve done.
YOUR BREASTS,
YOUR BODY,
YOUR CHOICE.
If you are thinking about having reconstructive surgery, tell your breast surgeon and a plastic surgeon BEFORE your mastectomy or your BCS. Give them a chance to plan your treatment and keep your options open – especially is you’re going to take reconstruction surgery.
ADVANCED BREAST CANCER AND SURGERY
Advanced is another way of saying the cancer has spread to other parts of the body. Surgery here is mostly about either
- Trying to slow the cancer down or,
- Relieving the symptoms
Surgery normally cannot cure advanced breast cancer, but it can be used:
- To reduce small numbers of tumors that have spread elsewhere in the body.
- To relieve an open wound in the breast (or chest).
- To reduce pressure on the spinal cord
- To minimise a blockage in the liver
- To relieve pain
If your doctor recommends surgery for advanced breast cancer, make sure you absolutely understand what the aims are in very precise terms.
YOU HAVE TO MANAGE YOUR EXPECTATIONS.
AFRICA AND SURGERY
Surgical intervention is the primary focus of treatment in Africa. At least in part, this is because therapy choice is determined by the local availability of resources.
- Surgery represents the most popular option when access to chemotherapy and radiotherapy is limited.
- Honestly, we need much more information about that.
- The rates of surgical treatment vary greatly across the different countries in Africa, ranging from only 35.2 per cent of women in NIGERIA have surgery for breast cancer compared to nearly 100 per cent in CAMEROON.
- The majority of countries report surgical rates between 48 and 75 per cent.
- This divergence in surgical treatment popularity seems to be dependent on both patient preference and country-specific resources.
In NIGERIA, for example, the comparatively low breast cancer surgery rate was attributable to:
- Inoperable advanced tumors,
- An inability to pay for treatment, and
- Patients’ unwillingness to have a mastectomy.
In ERITREA, surgical intervention was often their only treatment because there are no chemotherapy or radiotherapy options available nationally.
Another CAMEROON study showed, 93 per cent had some form of surgery, despite the majority of patients presenting with stage 3 (advanced) disease.
- 79 per cent of patients received (early initial) chemotherapy to downstage tumors and therefore enabled surgery afterwards.
- Notably, very few women in ERITREA and CAMEROON are refusing mastectomies in comparison with their counterparts in NIGERIA.
IT’S REALLY ABOUT THE BURDEN OF COST
- The treatment divide between African countries is more a reflection of healthcare systems than anything else.
- In NAMIBIA, where cancer treatment is FREE, almost ALL WOMEN attending their cancer care hospital were willing to be treated.
- In contrast, in UGANDA and NIGERIA, where cancer care costs are paid by the patients themselves (and relatives and friends), that changes significantly.
- One in six patients at UGANDA’S major referral hospital and one in three patients at two regional settings in NIGERIA had not initiated any type of cancer treatment within 1 year of diagnosis.
THE WORLD HEALTH ORGANISATION (WHO)
The WHO argued the following in one of their studies (IARC Evidence Summary Brief No. 1 – March, 2021), that involved African counties: ZAMBIA, UGANDA, NIGERIA, SOUTH AFRICA AND NAMBIA. It said,
- Women were vulnerable to being diagnosed with advanced breast cancer NOT BECAUSE THEY DID NOT NOTICE CHANGES IN THEIR BREAST; they did notice changes and did seek help, but they experienced LONG DELAYS to diagnosis.
- Notably, one third of Black SOUTH AFRICAN women, one half of ZAMBIAN and NAMIBIAN women, and three quarters of UGANDAN women reported having had symptoms of a breast problem for more than six months.
- MOST WOMEN WERE PROACTIVE IN SEEKING HELP for the changes in their breast, but they experienced considerable delays between their first contact with the health system and the eventual diagnosis.
- Therefore, the suspicions much publicised about African women and surgery in relation to mastectomies, must not be overstated without placing those concerns in the wider socio-economic context.
THE CARIBBEAN AND SURGERY
Among BAHAMIAN breast cancer patients, surgery was the preferred method of treatment (later confirmed by a report of 79% of breast cancer participants who had a surgical mastectomy, with modified radical mastectomy (both breasts removed) being the top choice, in contrast to radiation used only in 6.5% of patients.
FRENCH GUIANA breast cancer patients typically require specialized care that is covered outside of French Guiana in either France or Martinique (other French territories). One study observed that 96 per cent of women benefitted from treatment within eight weeks of diagnosis in the form of surgery (84 per cent curable), followed by chemotherapy (54 per cent), and to much lesser extent radiotherapy (8 per cent) and/or hormone therapy (9 per cent).
In SURINAME, surgery was the primary form of treatment for invasive breast cancer with 87 per cent for mastectomy and 13 per cent for lumpectomy. This combined with adjuvant (early initial) chemotherapy in 20 per cent of cases and radiotherapy in 14 per cent of cases.
In TRINIDAD & TOBAGO, surgical procedures tended to be the most common approach used for breast cancer management. Patients who had surgery also had chemotherapy, radiotherapy, and hormone therapy in various combinations, with the combination of surgery and chemotherapy being the most common. The most frequent surgical procedure was unilateral (one breast) mastectomy which, in some cases, was combined with lymph node removal.
A recent 2021 Caribbean study published by Cureus reported the following findings:
Surgery was by far the main treatment for breast cancer in the six (out of the 31) Caribbean countries that provided their information. These countries included:
- The Bahamas
- Cuba
- French Guiana
- Haiti
- Jamaica
- St Vincent and Grenadines
- Trinidad and Tobago
- Five countries, except HAITI, relied on some form of radiation, chemotherapy, or hormone treatment together with surgery, or in place of surgery.
- These approaches may be a result of the stage at diagnosis and not necessarily the availability of treatment options.
- Publications from HAITI showed the expensive cost of radiation and chemotherapy medication/drugs as a hindrance in the treatment of breast cancer.
- JAMAICA and TRINIDAD & TOBAGO showed the patient-driven use of medicinal plants for the treatment of breast cancer.
