Strong bond of love and affection helps sisters survive breast cancer

The two were always together and it could be this unbreakable, rocklike bond that has kept them disease free for the 10 years I have followed them. ILLUSTRATION| JOHN NYAGAH

What you need to know:

  • As I examined, I obtained snippets of her history and when I asked how many children she had, she replied: “I am not married; I am a free lancer!”
  • As I was laughing at her funny reply, I had to suddenly stop because my palpating fingers hit a suspicious lump in her left breast. “Do you feel a lump?” she asked. “You have suddenly turned glum.”
  • “Yes, I do,” I replied. “It needs investigations, including a biopsy.”

As Salome and Winifred sat in front of me, the former giving her medical history, I could see the special chemistry between the two sisters. As they entered my consulting room, Salome asked, “Can my sister come in with me?”

“Okay with me,” I replied. “As long as we can freely discuss your diagnosis and treatment in front of her.” That was an important proviso because, according to Salome’s doctor who had rung me earlier, his patient had a lump in her breast, which had proved malignant with the various investigations he had carried out on her.

“No problem,” Salome assured me.” We have no secrets between us. In fact,” she went on, “we have been very close since we were at school and after I got married and raised my own family, we have continued to be best friends.”

“Right,” I asked Salome, getting down to the business in hand.” How long have you had this lump?”

“Maybe about a month; I talked to Eliza and she took me straightaway to see my doctor.”

“Good, so you didn’t waste any time,” I complemented the two sisters.

“No,” replied Salome. “With all the hype in the media, we were adequately warned. As soon as my doctor saw me, he suspected malignancy and sent me for urgent mammogram and ultrasound,” Salome added, reflecting her doctor’s note. “When they both were reported suspicious, he arranged a core biopsy, which confirmed malignancy.”

“And then?”

“He said I needed surgery,” replied Salome, “and asked me if I had any preferences about a surgeon.”

Winifred came in now and added: “I had heard about you from a colleague at work, gave him your name and he rang your office straightaway. Your secretary gave an appointment for today. As he was waiting to be connected with her, he said that he had the same name in mind and would have referred Sally to you if we had not expressed a preference.”

“Thank you very much.” I said in appreciation.

I completed my history taking, examined Salome and saw her mammogram films, ultra-sound images, biopsy report and gave my opinion. “Reporting as soon as you felt the lump has paid dividends. The lump is malignant but we can get away with a lumpectomy and spare your breast.” As I saw obvious relief on both faces, I went the whole hog.” That means you will need radiotherapy, chemotherapy and very likely hormonal therapy after I have removed the lump.” When I noticed that they needed further elaboration, I added: “Breast cancer is a multifocal disease, which means that there may be foci of disease in the breast as well as other parts of the body, not obvious clinically or with our current investigations. Radiotherapy takes care of the malignancy in the breast while chemotherapy destroys it in the rest of the body. As for hormonal therapy, some tumours are hormone dependent and will benefit from anti-hormone tablets. The hormone dependency can only be confirmed when the lump undergoes elaborate histology.” 

After giving this lesson, I needed a pause, after which I gave them further reassurance: “All this is based on hard evidence gathered over the years.”

“What I dread most is chemotherapy, because of what I have been told by friends who have had it,” Salome mildly raised her concern.

“But it is worth it, if it is the price you have to pay for keeping your breast,” Winifred took the cudgels on my behalf.

Salome had all the modalities of treatment, constantly goaded and supported by her sister.

At the end of a year, having done exhaustive tests, including tumour markers, I said to her. “You can count yourself clear of the disease. You only need to see me once a year for me to check that the disease has remained under control.”

“Thank you,” said Salome.

“We both are relieved and very happy,” Winifred added.

She accompanied her sister at every follow-up visit, once driving me to tease her: “You obviously don’t trust Salome with me!”

On one of those visits, after I had examined Salome and had given her the “all clear” opinion, Winifred said: “Do you mind examining me while I am here, please? In the bathroom today, I noticed a lump in my left breast.” And then looking sheepishly at me, she added: “It might be nothing and I might be wasting your precious time.”

“No problem,” I said looking at my watch, aware that I had found my waiting room full on entering my office because I had been delayed by an emergency. “You can’t be too careful with these things. Hop on the couch.”

As I examined, I obtained snippets of her history and when I asked how many children she had, she replied: “I am not married; I am a free lancer!”

As I was laughing at her funny reply, I had to suddenly stop because my palpating fingers hit a suspicious lump in her left breast. “Do you feel a lump?” she asked. “You have suddenly turned glum.”

“Yes, I do,” I replied. “It needs investigations, including a biopsy.”

The biopsy report was short and pithy. It simply said: Lobular carcinoma. Anything in the right breast?

To simplify the matter and knowing the intelligence level of both sisters, I handed the report to them. Winifred asked after reading the report: “My lump is on the left side, so why is the pathologist interested in my right breast?”

I grinned at the Winifred’s wordings and explained: “Lobular carcinoma is often bilateral and if it is not so at the time of its initial presentation, it occurs on the other side a few years later. In fact, at my preliminary examination, I carefully examined your right breast, as I always do, and found no lump there. But in view of the pointed question, let’s do it again.”

Winifred took off her blouse and bra and lay on the couch for me to repeat my examination. I found no abnormality on the right side and told her so. We then discussed her treatment. “For lobular carcinoma, we take a more radical approach. I am sorry, no lumpectomy for you as we did in the case of your sister. It will have to be a mastectomy. I might as well tell you, since lobular malignancy appears in the other breast occasionally, some surgeons advise bilateral mastectomy.”

“What do you advise?” asked Winifred.

“I am an optimist. I watch the patient regularly and do mastectomy when a malignancy appears in the remaining breast.” Then to explain why I had talked about bilateral mastectomy, I added: “I only mentioned it because so many patients go online. I thought that if you do, you might find it mentioned there.”

“I think I will go by your advice,” Winifred said after pondering on the matter for a while. Then turning to her sister sitting next to her, she asked. “What do you think, Sally?”

Sally took a little time thinking and replied. “I would have the other breast off. If I kept it, I would constantly worry what it was brewing.”

There was another pause, during which time I saw the two sisters deep in thought. I let them because their decision was important. To help them though, I went on. “Whether we remove one breast or both, we will carry out breast construction for you. With the new technique, we do so using your own tissues, without resorting to silicone prosthesis. But let that not influence your decision. We would advise reconstruction, whatever decision you make.”

“I think I will go for the bilateral option, as Sally said. I won’t sleep wondering what my right breast is up to. Furthermore, when we know that malignancy can arise on the right breast, why not remove the soil?”  

“Good reason and good decision.” I said as my closing remark.

Accordingly, my colleague in reconstructive surgery and I carried out mastectomy and reconstruction of the breast in two stages, he assisting me at mastectomy and me reciprocating in the reconstruction. In the latter procedure, we carried out a tummy tuck with Winifred’s prior consent. While giving her consent, she remarked in her characteristic manner of seeing the positive side of things. “Now that I have reconstructed boobs, my boyfriend can admire my thin waistline!”

When Salome, the plastic surgeon, and I looked at Winifred at the end of her surgery and chemotherapy, she looked smashing and I told her so.

This was important for me to say because in view of her lobular type, Winifred needed more toxic chemotherapy drugs than we had given to Salome. Consequently, she had severe side effects and at one stage even considered not taking the next course. I had to invoke Salome’s help because I had discovered that while the shoe was on the other foot, Salome had reciprocated fully. She had extended the same support which she had received from Winifred and much more.

To end this story of sisterly love and affection, they both are being regularly followed up by me, Winifred more frequently than Salome because of the nature of her tumour. But she is always accompanied by her sister. So much so that I am more than convinced that it is their unbreakable rocklike sibling bond that has kept them disease free for the 10 years I have followed them together. Long may it last!