When surgeon’s scalpel can’t dislodge a painless monster

I recently saw Jessica*, who is her late forties. She has no child and has uterine fibroids. She has heard about breast cancer and interacted with breast cancer survivors.

For a year, Jessica has had a lump in her breast, but has postponed seeing a doctor, citing a busy schedule. Moreover, it has been a painless lump and has not disfigured her skin. It couldn’t possibly be cancer; she repeatedly reassured herself.

Other than not having children, she had no other risk factor for breast cancer, so I was shocked midway through the examination when I found a deep-seated five-centimetre lump in her left breast. In her armpit, I felt enlarged lymph nodes.

I recommended an ultrasound scan and biopsy, and she put on a brave face as she came down from the examination table.

After numbing her breast with a local anaesthetic, I took nine stabs at different points on the lump. Every time I sunk the biopsy needle into her breast, she grimaced, even though she felt no pain. A week later, we got the pathology report. It was what we had feared. Jessica had an aggressive form of cancer.

We stared at each other for what seemed like eternity, then she broke down into a torrent of tears followed by an inconsolable wail.

The chest scan results were even more depressing. The cancer had spread to her lungs, meaning I could not address the cancer by the tip of a surgeon’s scalpel.

We are now considering a combination of medicine and radiation to control Jessica’s disease. I have referred her to a medical oncologist for review.

RISK FACTORS

I have had a difficult time trying to comfort her. She needs to stop blaming herself for having waited for this long. But the truth is, may be nine or so months earlier, we may have caught the disease at the armpit. Such is amenable to surgery.

As October, the month when the world marks 31 days of breast cancer awareness., comes to a close, let’s keep the momentum up. Attention and awareness towards early detection and treatment or palliation of breast cancer has been raised, but we must keep doing our part, like doing self breast exams every month, and seeking medical help as soon as a lump or other abnormality is found.

Anyone can be affected, personally or through a close family friend. It is time to take a walk to the clinic for that ignored lump. Even if it is painless. Especially if it is painless! The greatest tragedy in the fight against cancer is that majority of the cancers are painless.

The latest World Health Organisation (WHO) report indicates that cancer cases are on the rise. Kenyan statistics indicate the food pipe and the stomach are more affected than the breast (story for another day).

Risk factors for breast cancer include female gender, increasing age, personal and family history of breast or ovarian cancer, inherited changes in one’s breast cancer related genes, previous radiation to the chest and neck, among others.

Breast cancer will mostly start as a lump although majority of breast lumps are actually harmless. It is difficult to tell a patient what a cancerous lump will feel like at the start without a doctor examining it. Perhaps the best approach is to have everyone assume the worst-case scenario every time they have a lump, have the doctor examine it and rule out cancer.  Looking at the latest trends though, I would rather see a hundred harmless lumps to pick one cancer early, because then it is curable.

As we start a new month (and every month thereafter), touch your breasts (or your partner’s). Feel anything abnormal? Please rush to the doctor. They will examine you in detail and reassure you. That is better than letting a painless monster grow under your watch, just because you gave it the benefit of the doubt.

*Not her real name

Dr Aruyaru is a general surgeon in Nyeri