August 8, 2022
With the advancements made in breast surgery, there is hope whether your breast cancer has been detected early or late.
There are few things more devastating than hearing a diagnosis of cancer. The immediate questions a patient usually asks, surrounds late stage cancers and how much time they have left to live.
Dr. Phumudzo Ndwambi is a special breast surgeon at Busamed Modderfontein Private Hospital in Gauteng. She works extensively with breast cancer patients. Dr. Ndwambi is big on breast conserving surgery – the process of conserving as much of the natural breast as possible (you can read her article on this topic here) when surgery is needed.
Dr. Ndwambi says there are many patients who have been caught up in a narrative of fear and anxiety when it comes to a breast cancer diagnosis. For the past 20 years, the message has been that early detection saves lives. While this statement remains true, many members of the public have misconstrued the sentiment to mean that only early detection saves lives. Dr. Ndwambi says, in 2022, this is simply not true.
“We have a lot of people branching out into clinical research and studying surgery and the impact of treatments at end stage or mid stage. We have information that allows us to delve into the science of cancer, psychosocial aspects of treatment, social narratives, genetic risk and so on. Here in the medical world, we’re very optimistic about reaching a cure for cancer, but what we’ve also learned is that while we are absorbing this material, our patients are not reading our texts where the hope is there in black and white. And even if they are reading this material, of course, all the jargon contained within can be confusing and maybe even scarier than the normal. So, the information isn’t penetrating our patients’ anxiety and fear and so I think the next step in breast cancer innovation is actually working on changing that narrative of fear.”
Dr. Ndwambi says medical professionals will always uphold that early detection saves lives, but you’ll hear nowadays that “any detection… just knowing that something is different with your breast, should leave the patient with hope that whether they detected the cancer early or late, there are options for them.”
“When patients ask me, “Doctor, what stage am I?”, I always answer by asking them what does a stage mean to them because we’re filled with media hype and misinformation regarding cancer stages. The narrative out there is that ‘Stage 4’ means imminent death while ‘Stage 1’ means we create your patient file and you’ve got time. This is not necessarily the case. If you come to me at ‘Stage 3’ and I do the right operation and give you the right treatment, we can give you the same sort of life expectancy as someone who came in earlier than you.”
She adds that innovative procedures and treatments have changed the game.
Dr. Ndwambi says cancer treatment has advanced to such a degree that there is a chance “a cancer patient receiving treatment might actually outlive their neighbour who doesn’t even have cancer.”
This is by no means an invitation to ignore symptoms. Early detection will always have a place in cancer treatment. In fact, many of Dr. Ndwambi’s patients seek her assistance when they experience breast pain. “For women, breast pain could be a result of hormones, a menstrual cycle, pregnancy and even breast feeding. But when a patient comes in for this pain, we conduct ‘opportunistic screening’ to rule out any lumps or abnormalities. For women over 35, a mammogram will be ordered because even though I can examine them and feel like there is nothing in the breast, a mammogram will reveal even a tiny little spot of cancer that no one would have ever felt with a physical exam.”
She says other reasons for getting your breasts checked out is if there is some form of a calcification or some a premalignant lesion. Dr. Ndwambi says not all breast lumps are made equal. “There are some that are more sinister than others, but it is another common reason why someone would come to see me. Any woman over 30 must have a breast lump investigated. If it is in younger women, mainly teenagers to around 25 years old, then I’m less likely to do very invasive investigation.”
Another reason people should visit their doctor is if there is a discharge from the nipple. “Now, again, not all discharge means something bad. Some of it is just physiological. It’s part of what your hormones are doing at the time. It can be milky, it can be from an infection, so it can be more purulent like puss. But if it is the bloodier type of discharge, that is more concerning especially if the discharge is coming only from one breast and not from both. Usually if the two breasts are doing the same thing it is less likely – not unlikely – but less likely that there’s something sinister like a cancer, and more likely that it’s something physiological or maybe an infection of some sort.”
Skin changes around the breast or the nipple area, or a noticeable change in the size and shape of one or both breasts also warrants an examination by your doctor, especially is there is a history of breast cancer in your family tree.
Dr. Ndwambi is optimistic about the eventual cure for cancer. She says breast cancer is a deeply researched cancer globally and the strides being made to understand factors that lead to malignant cancers should leave everyone feeling hopeful that treatment might help them recover.
Dr. Phumudzo Ndwambi
Specialist breast surgeon
November 22, 2023
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