I was told I had an unknown genetic link with my mother due to our young age at diagnosis. Breast cancer campaigns from government supported free breast screening for 50-to-74-year-olds, and non-government fundraisers have successfully brought the high incidence of breast cancer to the public’s attention – the pink ribbon is a successful marketing image, and has come to stand for breast cancer.
So too have famous actors or comedians receiving the diagnosis. After Angelina Jolie’s piece appeared in The New York Times about her decision to remove her breasts, there was an increase among women with BRCA genes doing the same. My antennae tuned in to the debate about women having prophylactic mastectomies, but what interested me more were those who had cancer, not those who feared its likely occurrence. However, I applauded Angelina Jolie bringing the BRCA genes’ existence to the public’s attention.
Jennifer Saunders had triple-positive breast cancer, like me. However, she chose to keep her breast after a lumpectomy. She too sank into a depression caused by her sudden loss of a sense of youth, and taking the (anti) hormonal pill Tamoxifen. She combated her slide into the underworld with ‘a little pill’ that ‘opened the curtains again’. When the chemo and radiotherapy finished, her hair returned, all over. She took a magnifying glass and pair of tweezers to herself.
Olivia Newton-John went a step further than writing about her experience. She lent her fame as a singer and actor and her cancer story to a flagship public hospital in Melbourne. The Olivia Newton-John Cancer Wellness and Research Centre focusses on the integration of first-rate medical science with the design of person-centred care – for example, having medical labs metres away from wards so that there is a true bench-to-bedside focus in delivering medical care. Alternative treatments such as herbal remedies and meditation are part of the program also.
Twenty-five years after Newton-John’s first cancer diagnosis, it metastasised to her sacrum. You are never cured in cancer, or safe from recurrence. The sword of Damocles is with every cancer patient: every survivor.
What’s not often discussed in the media is that breast cancer is not one-size-fits-many. There are different kinds. It can stay dormant in the duct and lobule without breaking out into surrounding tissue, meaning you’re fairly safe to leave it there. This is termed DCIS and LCIS: ductal carcinoma in situ and lobular carcinoma in situ. Or it punches through the walls of the ducts and lobules to invade surrounding tissue, like what happened to my mother and me.
Paget’s disease of the nipple is a rare breast cancer that forms in the nipple and areola. It’s associated with invasive cancer somewhere else in the breast, and often confused with eczema due to its scaly brick-red appearance. Another invasive kind of breast cancer affects the lymphatic vessels, leaving the breast red and inflamed.
These are types of breast cancer, but that doesn’t speak to their genetic make-up. In this arena there are multiple combinations. For those with a BRCA gene mutation their hormones may not play the major role in developing the disease. For my mother and me our cancers fed on oestrogen (ER+) and progesterone (PR+) to grow, with mine having the extra HER2 protein. One in five cases of breast cancer is HER2 positive. It’s considered more aggressive. But you can have different levels of cancer sensitivity to your hormones. Some cancers, like mine, are highly positive to oestrogen and progesterone. Others are not. You can also develop triple-negative breast cancer (negative to hormones and the HER2 protein).
If you have a BRCA1 or 2 mutation, you have a higher chance of developing breast and ovarian cancer than the normal population. Around five to ten per cent of breast cancers have a BRCA mutation. We all have BRCA genes, but those (mainly) women who develop breast cancer from their BRCA1 mutation are more likely to test as triple negative. Those with BRCA2 mutations are more likely to have ER+ breast cancer.
But when did breast cancer first develop in the world?
From ancient times our breasts have had the ability to develop the disease. Egyptians wrote on their papyri of bulging tumours with no cure. The father of Western medicine, Hippocrates, in 460 BC described cancer as black bile, one of the body’s four humours: blood, phlegm, yellow and black bile. Dutch physician Franciscus Sylvius challenged that theory in the 17th century. He said the problem was a chemical process that transformed lymphatic fluids to acidic base. Bernardino Ramazzini, the father of occupational medicine, hypothesised that a high frequency of the disease among nuns was due to a lack of sex. No sexual activity for reproductive organs meant they could decay and develop cancers. On the contrary, researcher Friedrich Hoffmann of Prussia believed sexually active women who developed the disease were having sex too vigorously, leading to lymphatic blockage. Many theories abounded from here on in about the source of women’s breast disease: mental disorders, curdled milk, childlessness and a sedentary lifestyle.
The famous 17th-century painting by Rembrandt of his long-time love Hendrickje Stoffels enacting Bathsheba, King David’s wife, naked at her bath, was an icon of breast cancer publicity in the 1980s. The blue-tinged dimpling on her left breast was regarded as an early visual record of the disease. Dutch scientists from the University of Twente, working on the properties of human tissue, simulated the firing of millions of photons at a tumour. They concluded it was highly unlikely the painting was a depiction of breast cancer based on discolouration, and that the eye would only pick up a blue tinge caused by breast tumours if they were located one to three millimetres under the skin. As most tumours are much deeper than this, it diminished Bathsheba’s usefulness as an iconic image. Though dimpling in a breast can mean cancer’s present.
The 18th-century French physician Henri Le Dran said that removal of the tumour and infected lymph nodes in the armpit helped treat breast cancer. A
