DAWOOD: The woman who used battle with cancer to better her life

I have often said in this column before that cancer of the breast is the commonest in women worldwide, including Kenya. Therefore, I feel very frustrated and disappointed when I see advanced cases of this disease, especially in public hospitals. I can only attribute it to lack of breast cancer awareness and the fact that the commonest manifestation of breast cancer is a painless lump.

Breast surgeons all over the world  pray every day that breast cancer lumps become excruciatingly painful like a kidney colic so that patients are driven to doctors and hospitals earlier. The other strategy, we employ is the establishment of Breast Clinics in every hospital and health centres. Most centres of excellence have implemented our recommendation. The purpose of these specialised clinics is not only to treat breast diseases but also to regularly examine “normal” breasts and pick up dormant disease lurking there and pre-empt it. In addition, it works to create breast cancer awareness and teaches women self-breast examination (SBE) - and pick up painless lumps without delay.

In 1979, I went to Karolinska Institute in Stockholm, Sweden, to refresh my knowledge of breast cancer and learn the modus operandi of breast clinics, of which Sweden was a pioneer. On my return, I established the first Breast Clinic in Nairobi and it was replicated in various hospitals, public and private. Unlike breast clinics in the developed world, those in Kenya do not have one-stop clinics with a package deal. This means consultations and investigations don’t reside under one roof and take place at different locations, at different times and the “patient” is charged item-wise, making it an inconvenient and expensive exercise. My regret is that before I retired from surgical practice, I could not correct the system and hope that those who have followed me will complete my “unfinished business”.

To create breast awareness, I talked to various women groups and my mantra was. “I don’t care who examines your breast, you, your husband or your boyfriend; the important thing is to examine the breast at least once a month.”

This is the story of a woman whose breast lump was discovered in my Breast Clinic after one such meeting and who then surprised me by treating the challenge it entailed into an opportunity. As she sat in front of me, my opening remark was. “I remember you because you put me through my paces, when I opened the meeting to questions at the end of my talk.”

“Your talk was a wake-up call for me when you mentioned heredity as one of the risk factors,” she replied. “Both my mother and grandmother died of breast cancer and at the age of 40, I thought it was high time I had my breast check-up.”

As she said all this, I noticed that she looked overweight and since this is also a risk factor, not only in breast cancer but also in cancer in general, diabetes, hypertension, heart attacks and arthritis, I made a note of it on the Breast Clinic form she had filled before my secretary sent her to see me. I had devised the form after my return from Sweden because I had seen it being used there and saved the surgeon from asking the same questions of all who attended the Breast Clinic. Before she lay on the couch for examination, I asked her to go on my weighing scale. When I recorded her weight as 11 stone and one pound which I jotted on her file, she remarked. “When I was studying in Edinburgh for my accountancy degree, they called me ‘bonny’.”

WELL-PADDED

“That is the Scottish way of politely saying that you are well padded, which you are at a height of five feet three inches,” I said.

I proceeded to examine Vicky and as I was concluding my negative examination, ready to give her good news, my fingers hit a lump. It was hard, small and very mobile, thus escaping my initial superficial palpation.

“Your visit is very timely,” I said, “thirty to 40 is the age-group, we advise our ladies to go for their routine checks because breast cancer commonly occurs in that decade in our setting; also nearer the menopause, hormonal changes occur in the female body, making it more vulnerable to breast cancer.”

“But I still get my periods every month,” argued Vicky.

“We have realised that menopause is a process,” I explained, “which starts long before cessation of period. It is also timely because I have found a lump in your right breast.” As I saw her face wilt, I added. “It is very mobile and likely to be benign but certainly needs to be checked with a mammogram, ultra-sound and needle biopsy.”

“I am very glad I attended your talk and came to see you,” Vicky remarked as I filled three request forms. I was equally pleased because her remark indicated to me that she was a “positive” person.

The results of the investigations proved me wrong. Mammogram and ultra-sound were suspicious and needle biopsy showed malignant cells. As arranged, Vicky came to see me soon after the reports arrived and I greeted her with the hackneyed statement. “I have got good news and bad news for you. The lump in your breast has been proven to be malignant but we can get away with lumpectomy and you don’t have to lose your breast.” As I saw a strange mixture of sadness and relief on her face, I quietly slipped the corollary in. “This means that you will need chemo, radio and hormone therapy after surgery.”

“Will I lose the extra tyres around my waist and butt as a result of these?” she asked. “I understand that chemotherapy makes you sick and you lose your appetite.” Her question was another evidence of her positive outlook.

WEIGHT ISSUE

“No such luck,” I clarified. “To combat the worst ill effects of chemotherapy, we give steroids and they help the body to retain water and gain weight.”

“What about radiotherapy and hormonal treatment?” Vicky asked.

“To my knowledge, irradiation does not affect the weight one way or other,” I replied. “As for hormone tablets, we give them for five years only if the tumour is oestrogen positive, which improves the prognosis. But because it induces premature menopause, it piles up the middle-age weight.”

True enough at the end of her treatment, which included five years of hormone tablets, Vicky found herself aged 45, with an old fashioned matronly figure, weighing 13 stone and one pound. Then something happened which shocked her into reality. On one of her follow-up visits she did not look as cheerful as she always did, so after checking her medically, I point-blank asked her. “Usually your visit here is a tonic but today you seem to be in the dumps yourself. Do you wish to tell me why?”

“The reason is personal and I don’t want to burden you with it.”

“You know the saying that a problem shared is a problem halved,” I coaxed her. “Besides, I take a holistic view of my patient’s problem, not only the physical but also the psycho-somatic side as well.”

That encouraging statement did the trick and Vicky promptly replied. “It’s about my husband; he has left me. With my breast slightly mutilated from surgery and me putting on weight, he told me he doesn’t find me attractive any more. In fact, he said he finds me repulsive.”

NORMAL APPEARANCE

To comfort her I informed her. “There is a new specialty sprung up known as ‘oncoplasty’, which deals with rectifying mutilations left behind after cancer surgery.

“This allows the primary surgeon to excise the growth radically and clear the borders without worrying about the cosmetic result because the oncoplastic surgeon will restore the normal appearance of the organ as far as possible.”

“Thank you for the information,” Vicky clarified, “but I suspect his repugnance is more related to me being overweight.”

“Surely there are many other fishes in the sea,” I suggested.

“There are but I want to convert this challenge into an opportunity,” Vicky replied with determination. “I have decided on a plan to reduce my weight and make myself attractive again, so that after a year, Andrew will be knocking my door, begging me to take him back,” her face was filled with fury of a woman spurned.

Over the next year as she came to see me every quarter for a check-up, she kept her word and her weight disappeared like the mist on the twin peak of Mount Kenya at the first appearance of the sun. She also groomed herself with attractive wigs and frequent facials and visits to her hair-dresser. I asked her how she reduced her weight so that I could give her formula to my other patients suffering from excessive weight gain.  

“Simple arithmetic which I learnt with my accountancy,” she replied. “Cut down the calories intake by dieting and spend them generously at the gym.” As I waited for elaboration, it came. “I didn’t go hungry but simply changed my diet by cutting out ugali, bread, butter, pasta and sugar. Instead, I concentrate on soups, salads, meat, vegetables and maziwa-lala.”

“And the result?”

In reply, she stood on the weighing scale and said “I have gone from 13 stone and one pound to nine stone and five pounds, considerably lighter than when I came to see you for the first time.”

Then with a vengeful look, she added. “And Andrew is back where he belongs.”

“And after all that, you took him back?”

“After all, he created the challenge,” Vicky replied. “Besides, the devil you know is better than the one you don’t!”