THE GYNAECOLOGIST AND BREAST CANCER

The truth is that your gynaecologist may very likely be the first of your medical care-givers to pick up your breast lump.
Traditionally, breast cancer has been the responsibility of surgeons and oncologists.

This has changed.

A growing awareness of cancer prevention and continuing new research into cancer genetics now means that breast checks and mammograms are performed and requested as part of a routine well woman check up by the gynaecologist.

For some women, their gynaecologist may be their only contact with the health system so their gynaecologist becomes their main resource for information about the disease and its prevention.
It does not end there. Once a diagnosis of breast cancer is made, your gynaecologist may be invaluable in helping you deal with immediate and long term side effects of treatment.

So what can you learn from your gynaecologist and how can your gynaecologist help you if you are diagnosed with breast cancer…

Read on.

BREAST CANCER: 5 AREAS YOUR GYNAECOLOGIST CAN HELP WITH :

1.Early detection and screening

Your gynaecologist can show you and should teach you how to do a self breast examination. The trick is to get to know your breasts and any lump or new bump needs to further investigated.
When to start with mammograms and ultrasounds are important considerations and some women at high risk will be advised to start earlier then the recommended general age of 40 years.
Your gynaecologist can also help to communicate these test results to you and plan when to redo tests as necessary. Feel free to discuss the relevance and value of breast thermography to your particular situation.
Your gynaecologist should also be able to point you in the right direction with regards to useful articles on the subject.

Questions and comments I often get are :
How safe is my mammogram for me?
Is the radiation not harmful?
I heard that mammograms are painful so I am reluctant to have one.

2.Reducing your risk factors

Your gynaecologist can advise you about ways to reduce your own personal risk factors to developing breast cancer. This may include
• Limiting alcohol intake
• Not smoking
• Maintaining a healthy weight for you
• Breastfeeding each of your children for at least a year if possible
• Having a first pregnancy early in life

3.Making sense of your family genetics

About 5% of breast cancers have a genetic link. Your gynaecologist can help analyse your family history and refer you to genetic counseling and for further genetic tests if necessary.
The following history should raise a red flag:
For women who are not of Ashkanazi descent:
• Two first degree relatives (mother, daughter or sister)diagnosed with breast cancer especially at age 50 or younger
• three or more first degree or second degree relatives(grandmother or aunt) diagnosed with breast cancer at any age
• a combination of first and second degree relatives diagnosed with breast cancer and ovarian cancer
• a first degree relative with cancer diagnosed in both breasts
• a first or second degree relative diagnosed with ovarian cancer at any age
• a first or second degree relative diagnosed with both breast and ovarian cancer at any age
• breast cancer diagnosed in a male relative

For women of Ashkanazi Jewish descent:
• any first degree relative diagnosed with breast or ovarian cancer
• two second degree relatives on the same side of the family diagnosed with breast or ovarian cancer

4.Managing side effects of your cancer treatment

Treatments that target breast cancer can often induce menopause. In fact , in many patients this is part of the treatment strategy. This is more so especially if a cancer is estrogen and/ or progesterone sensitive. As a result, patients can struggle with hot flushes, mood swings, depression, insomnia and palpitations. Vaginal dryness and painful intercourse are also common problems.
Then there are the general health problems that are not immediately apparent. Low estrogen from menopause is associated with raising cholesterol levels and a consequent increase in the risk of a cardiovascular event.
Memory and concentration can also become a problem .
Loss of bone density and the resulting risk of osteoporosis also can show up.
Your gynaecologist is aware of all these problems that can arise and can guide you in your treatment plan.

Patients on Tamoxifen need special counselling and monitoring. When on this drug, oncologists will recommend at least an annual gynaecological examination with a transvaginal ultrasound. This is because Tamoxifen increases the risk of a uterine cancer. Your gynaecologist will be able to look for this and do appropriate tests as needed.

5.Managing your fertility

It is particularly tragic when a young woman gets diagnosed with breast cancer. Cancer treatment, even at this early stage in life, can permanently affect her ability to have children later when the cancer goes into remission.
This is where your gynaecologist can discuss and plan your future with you. Egg preservation is a reality today and is offered in most major cities in South Africa. While the process is expensive and highly specialized, it offers hope to young breast cancer survivors who dream of starting a family someday. Eggs can be harvested and frozen before treatment begins. They are stored for later use with an assisted procedure when the patient is well enough to consider a pregnancy.

Managing fertility also involves providing the correct solutions for patients who are still at risk of falling pregnant whilst on cancer treatment. Even after successful treatment, contraception may still be required. Read my article in the previous issue of Buddies For Life magazine. It is an in depth discussion on the subject.