By the 19th and 20th centuries, with the development of better medical care, like antiseptics, anaesthesia and blood transfusions, people survived surgery in far greater numbers. William Halsted introduced the en bloc radical mastectomy into surgical practice. His method was to remove the breast, axillary nodes in the armpit, and the chest muscle. This became the go-to response to breast cancer for 100 years. The radical mastectomy remained common practice four decades into the 20th century.
The development of a systemic theory took over when ovaries and then adrenal glands were removed by surgeons once the discovery that reducing oestrogen in the bloodstream reduced tumour size.
In 1976 Bernard Fisher began a study that would show that breast cancer patients had the same survival rate whether they underwent a radical mastectomy or less invasive surgery followed by radiation and chemotherapy. Dr Fisher, a former specialist in liver regeneration and transplantation, joined I.S. Ravdin’s National Surgical Adjuvant Breast and Bowel Project. Dr Fisher’s decades of clinical trials and laboratory research into tumour metastasis led to a surgical shift away from Halsted’s radical mastectomy.
Modern medicine has seen huge leaps in novel therapies for breast cancer, like hormone treatments, and better surgical and biological therapies. Mammograms and ultrasounds have been developed for early detection. Genes have been isolated that cause breast cancer: BRCA1, BRCA2 and ATM. The ATM (ataxia-telangiectasia mutated) gene helps control the rate at which cells divide and grow. Scientists are finding or have found many other gene mutations, as in the HER2-amplified breast cancer I had, that play a role in causing tumours to grow.
The new way in breast cancer and its treatment is in the arena of personalised medicine and gene therapy. I can imagine a day when ‘good cells’ are used, by extracting, medically tweaking and then returning them to the body, to attack and kill cancer cells instead of chemotherapy. When this happens cancer patients can live a life while going through treatment without extreme ill health and hair loss. My fingers are crossed, big time, for this to become standard treatment in my lifetime.
I live with cancer every day. I choose to do this, as a reminder that my future death wants me to live well now. The bodily truth of its one-time existence is writ large: I see it in the shower and in the mirror – my portacath peekaboo scar atop my left breast. When the breast surgeon removed nine lymph nodes from my armpit, one of them a nugget of cancer, I developed cording. It’s like a thin rope pulled taut under my flesh, my skin forming a tent along its raised seam, from the breast, to the armpit and down the arm. I have this tugging at my flesh every day.
Seven years of taking Arimidex atrophied my vagina. With such low levels of oestrogen floating around I shot into my 60s, it seemed. Now I looked at women over 60, in their 70s, and officially old in their 80s, and saw the unspoken. The first national study, Sex, Age & Me: A National Study of Sex and Relationships Among Australians Aged 60+, showed a mild movement in the media about acknowledging ageism around ‘old age’ people having a sexual life. I was 42, but felt a projected kinship. I never heard mention of penetrative intercourse being a part of that life. Did most women, years into menopause, have vaginal walls so thin that penetration could hurt like a razor blade?
The Women’s Wellness Research Program, run out of Griffith University and affiliated with the Queensland University of Technology, has developed a 12-step intervention called the Women’s Wellness After Cancer Program, which addresses some of these issues. The program has shown significant results for women’s sense of happiness, measured in terms of reducing weight and improved sexual self-efficacy. I did casual work for this program as a research assistant on the dataset results.
In moments of contentment I’m the original Amazonian who cut off her right breast to shoot straighter. I did everything to live for myself and for my son. Bereaved spouses find other partners after the death of their significant others. B would find another mate – my son would no longer have his mother if I died early.
With the return of a new normal, some of the rapidly made decisions leading into my first lot of surgeries came back to haunt me a little. I attended the 43rd Clinical Oncology Society of Australia’s joint conference with the Breast Cancer Trials group to take part in advocacy training around improving clinical-trial participation in Australia. The current knowledge and work in the breast cancer space is on neoadjuvant therapy, meaning if you get a breast cancer diagnosis now you can go straight into more refined chemotherapy regimens and, depending on your tumour type, you may not require such invasive surgery. You might preserve your breasts with the same survival rates as mastectomy. Of course this depends on your particular brand of cancer.
My double mastectomy I have no qualms about, nor my chemotherapy regimen, administered under a clinical trial where I took a particularly toxic form of drug, one of the taxanes, which can leave you permanently bald and with reduced heart function. One choice stirred regrets when I reached 42. I had been asked if I wanted to preserve my eggs before undergoing chemotherapy. I refused. When my period returned soon after finishing chemotherapy I was told I needed to shut my ovaries down due to them pumping out the very hormone that triggered my cancer. I chose to remove my womb, ovaries, fallopian tubes and cervix. Would it have been possible to have another child post–cancer treatment if I’d left myself intact?
I’ll never know.
I’d wanted more children. The grief around this came back – not in full blaring
