Breast cancer: just words, not a sentence
Valerie’s story
Valerie was just 40, and was looking forward to a long and happy life ahead with her husband, an officer in the defence forces, and three children—when the sky fell in.
‘I had just had a shower and was getting dressed, when I saw what seemed to be a dimple on top of my left breast. I can’t say when it actually appeared, it seemed to just be there all of a sudden,’ Valerie said.
‘I said to my husband, this isn’t right. He felt under my breast and said that he felt a thickening under the skin. I was frightened: I think even then I knew what it was.’
Being diagnosed
Things moved quickly after that. Two days later Valerie saw her GP, a friend of the family, who told her that he was ’95 per cent sure it’s cancer’. The breast cancer specialist she saw later that day confirmed the diagnosis.
‘It’s funny how you deal with the big things, but sometimes it’s the little things that set you off. Not long after the diagnosis, I was given a surprise birthday party. I had just given up smoking and a friend who didn’t know about my cancer, gave me a poster that showed a person in a coffin surrounded by cigarette butts with the slogan ‘Smoking Kills’—I burst into tears.’
Facing surgery
Valerie was diagnosed on a Thursday. The following Tuesday she was admitted to hospital, scheduled for further tests on Wednesday and then surgery on Thursday.
‘I discussed options with the surgeon and he gave me 2 choices. Once on the operating table, they could do a biopsy, see what the test results showed, discuss the results with me and go back in later if necessary, or check while I was still under anaesthetic and remove or leave the breast, depending on the test results. I told him the latter—I wanted it done then and there.
‘I came out of anaesthetic and apparently said to the sister, "excuse me, do I still have my breast?". She told me that she pulled down the sheet to show me and said, "no darling, it’s all gone". I said "thank you", and went back to sleep.
‘When I was conscious again, I must have remembered the conversation—it must have sunk in. I suppose the brain said, "breast gone, now get on with living". There wasn’t a lot of pain: I felt different though.
‘They told me later that the cancer had spread; they took my left breast and lymph glands—a total mastectomy.
‘It had all moved so quickly, and then after the operation I received news that my grandmother had died. Well, at least it took my mind off the surgery. I know I must have cried, but the only time I remember crying was on the Saturday after the operation when they shortened my drainage tubes. It was a combination of a lot of things — the surgery, some pain, my grandmother dying — I guess it all got a bit too much.’
A lighter moment
But it appears there were some brighter moments. Valerie is very proud of the fact that one week after her surgery, the hospital ‘evicted’ her for being disruptive.
‘The hospital was apparently a bit short of room, so I was put into the nuns’ ward—it was a Catholic hospital. The nuns there were recuperating for various reasons and we used to meet in the sunroom for morning tea. One of the nuns was on a diet and we would discuss endless plans to escape and raid the local cake shop. There was just too much laughing, I guess.
‘But the nuns were wonderful. They insisted on praying for me, reading me passages from the Bible and giving me crosses to hold—even though I’m Presbyterian,’ Valerie added with a grin.
‘It was a strange time, they wrapped me in cotton wool and were all so caring, but it helped.’
Getting on with life
Valerie said that the shock of the diagnosis and the surgery was lessened a bit because of all the other things that were happening at the same time.
‘I had to look after a husband and 3 children, aged 17, 13 and 10. I wanted the children to see what had happened, to be aware of what breast cancer can do, and for the girls, to make sure that they had checks later on. Their reactions were unusual, but probably, predictable.
Girl: ‘How awful you had to have that done.’
Girl: ‘How do you feel?’
Boy: ‘Wow, how many stitches? Can I count them?’
Dealing with reactions
‘The day I went home, I went to the hairdresser (where I passed out, by the way) and was in a receiving line for a Christmas cocktail party the following night. Most of the people on the Defence base knew about the surgery and were understanding and diplomatic about it.
‘But when I went to shake hands with one man, he looked straight at my breast and not into my eyes—I could have smacked him in the mouth!
‘But my husband, Les, has been wonderfully supportive. There were a few times in the night that I used to wake up and weep, but he was always there to comfort me. He has great awareness and understanding, and I don’t feel that has lessened.’
A supportive carer
According to Les, at times like this, there is a very strong requirement for a supportive carer. ‘It comes as a big shock when you are told about cancer. Even in a strong partnership such as ours, it’s the most horrible and hurtful thing. You think about the consequences, but the initial thought is, "am I going to lose my partner?".
‘When I saw the dimple on her breast, I insisted she go to the doctor. You have to be strong: a lot of women put off going to the doctor and that’s the danger zone,’ he said.
‘But yes, seeing what is there after the breast has gone is difficult. You cuddle into a part of your wife that you expect to be there, and it’s not there. But we were lucky, there’s a strong bond, we have always loved each other.
‘There’s shock, the breast was gone, there was just a layer of skin covering bone—Val looked totally emaciated. What’s there, or isn’t there, is hurtful to you, but you don’t worry about the look: your partner must get well.
‘What helped me, I suppose, was that following the surgery, we were posted to another city and were in a motel for 2 weeks. Being in close quarters, I came to terms with it.
‘The most difficult part, the hardest to communicate to Valerie, was that the missing breast was not a prime concern—that the major concern was that she was here and alive.
‘We had a good chance; the doctor said the cancer had been caught early enough. But even though it was only small, it had already spread—there’s that danger,’ he added.
Facing the treatment
Valerie continued: ‘After just losing my grandmother, 2 weeks after the surgery, my father died from thyroid cancer, but you have to cope and move on.
‘Eight weeks after the surgery, I began radiotherapy treatment at Sydney’s Prince of Wales Hospital.
‘The radiotherapy would last for 6 weeks, then there would be chemotherapy every month for 18 months.
‘One particular staff member there was very matter-of-fact on coping with side effects from chemotherapy. She gave me practical advice, such as, if you vomit, don’t go to bed on an empty stomach, have some dry toast and tea.
‘So I used to get up from the table after dinner, go and vomit, wait a little, then have tea and dry toast—it helped.
‘The radiotherapy burned the skin and looked like a bad case of sunburn. But then the top layer of skin wasn’t there one day and underneath was a mess. It looked horrible and smelled worse.
‘I had to wear loose clothing and use lots of burn medications. I couldn’t wear perfume or use soap—I could only use salt water,’ said Valerie.
When speaking with Les and Valerie, you get the impression that although things were tough—probably a lot tougher for them than they like to talk about—Valerie is still able to produce a funny story that lightens the mood.
‘We had just moved into our new married quarters. Les was cleaning up the yard when he fell into a hole and broke his ankle. With plaster, his leg became very smelly. Then when my flesh broke down following radiotherapy, it was also very smelly, and in bed when the sheet moved—whew!’
Prosthesis and surgery
While Valerie was undergoing chemotherapy, she couldn’t have reconstructive surgery, so she used an external prosthesis to take the place of the missing breast.
‘I must admit that I did have great fun with the external prosthesis. We went to a friend’s for dinner and they were asking about it, so I took it out and slapped it on the dinner table. They were very interested, poked and prodded it and asked lots of questions.
‘At the time I was also going to Weight Watchers and one week I hadn’t lost any weight and I’d really been good, so I went to the loo and took out the prosthesis (all 340 grams of it) and got re-weighed. They commented that I really must have needed to go to the toilet as I had lost weight! I had to be really careful every week after that,’ Valerie added.
It was to be 3-and-a-half years before Valerie would have a breast reconstruction.
‘They reconstructed the breast shape only. Some women do expect too much and are then disappointed. The surgeon impressed the difference on me before surgery, as he wanted people to face up to it.'
More surgery
But unfortunately, 6 years ago, the lifesaving radiotherapy that Valerie had undergone revealed another side effect.
‘The radiotherapy had apparently damaged my left lung and possibly my main arteries. I found out later that this had happened to other women who had undergone this form of treatment. But it meant that I had to undergo open-heart surgery,’ said Valerie.
‘It was while I was in hospital waiting for the surgery, that I was told that my mother had died.
The future for Valerie
‘But there was never a time when I thought that I wouldn’t make it. I went for checks every year for 16 years. I went to the Prince of Wales Hospital in Sydney every year until 5 years ago. I’ve had mammograms and bone scans; they have been very thorough and I still have a mammogram each year.'
According to Valerie’s husband, what they have been through has made their bond stronger.
‘I can’t understand why some husbands can’t help and support their wives. We’re lucky—it’s been 22-and-a-half years now, there have been for checks every 12 months until the last 5 years and, yes, there was still that fear leading up to each check but the cancer didn’t progress,’ Les said.
And for Valerie? ‘Yes, there was fear when I first found out about the breast cancer, then grief and acceptance, but now overwhelming gratitude that I have survived.
Medical treatment today
About 20 years ago, says Professor John Boyages, Executive Director of the NSW Breast Cancer Institute, the accepted treatment for breast cancer which had spread to the lymph glands following a total mastectomy was a course of radiotherapy followed by at least 12 months of chemotherapy. Decisions were often made ‘on the spot’ using the frozen section technique. Patients would wake up not knowing if they had a breast under their dressings.
‘Today we are keen to obtain a pre-operative diagnosis and spend time with the patient going through various choices. After objective discussion, 60-70 per cent of women choose breast conservation and the remainder choose a mastectomy. All of our patients are offered an immediate reconstruction following a mastectomy,’ Professor Boyages said.
‘When radiotherapy is recommended, we are cognisant of avoiding heart and lung complications. Most centres undertake the treatment of choice involving CT scan planning to avoid as much heart and lung involvement as possible. Three-dimensional planning is also available and some departments have their own CT scanners.
‘Chemotherapy is given for shorter durations, usually for only 4 courses given at 3 weekly intervals. We now have access to a wider and varied range of medications, which are carefully selected based on factors such as grade, hormone receptor status and other newer markers.’
Remember
Early detection of breast cancer can reduce the risk of dying from breast cancer by 30 per cent for women over the age of 50.
If you are over the age of 40, have your free mammogram. Call 13 20 50.
Last Reviewed: 14 May 2001
