Margaret's Story

I decided to go for a routine mammogram. I am still not sure why. I couldn't feel any lumps. Maybe I was listening to my body. Perhaps outside influences were at work. Probably, I was just plain lucky.

My mother died of breast cancer when she was in her 70’s. I had just turned sixty. My younger sister was having problems with breast lumps and so had I at her age. I was staying with my sister, Pat and her family at Longreach and one day she told me about her recent trip to a Brisbane breast clinic. They had asked her, as we had similar histories, what my last mammogram had shown.

"What did your last mammogram show, Peg?"

I could not remember when I had my last mammogram. It had been clear though, and I was to "come back in two years". But when was that?

At that time (about eight or ten years ago, I calculated) my breast lumps were of great concern to me. The moment I felt a little thickening I would rush to the doctor and live in fear until I got the results of the mammogram. Although I am very religious with my breast examinations, it is somewhat difficult to determine the presence of lumps as my breasts are quite fibrous. I settled down to a routine of self examinations, periodic examinations by my doctor and a yearly mammogram.

About the time of my last mammogram my husband had become dreadfully ill. I was overcome, first with worry about him as he fought bravely to overcome his foe and then with grief after he died. I kept up the regular self examination of my breasts and asked my doctor to confirm the ‘all clear’ twice a year, but I did not go for a yearly, routine mammogram.

People had begun to question the worth and the reliability of mammograms. Were they all they were cracked up to be? Was it wise to have one – radiation by any name, etc? I guess I really felt there was no need for it. I had gone through a stage, but I was OK.

My sister thought I was silly for becoming so complacent and extracted a promise that I would have a mammogram as soon as I returned home. When I asked my doctor for the referral he asked, alarmed, "You haven’t got a lump, have you?"

I told him the story and he agreed it was indeed time. He was surprised it had been so long since my last routine mammogram. One cannot expect a busy GP to keep reminding ohis patients about things like that. A woman has to be responsible for her own body.

When I got the referral, I had to ring the clinic at Penrith and make an appointment. Talk about complacent! I let it sit on the telephone table for weeks. Friends visited and went. One left an afternoon paper with an article on mammograms – for and against. It showed a diagram with four sizes of lumps. Two small ones which could be picked up with a mammogram before being obvious to external examination and two bigger ones which were the usual size when the awful discovery was made by most women. I knew I did not have the last two, but I looked at the diagram and thought, "Is this trying to give me a message?" I made the appointment.

"Few diseases can present themselves in so obvious a site as breast cancer" (Prof A O Langlands, 1988).

I simply could not believe it when the result showed ‘an opacity with slight irregularities … in the mid superior quadrant of the right breast’. A LUMP! At almost the centre top of my right breast! I could not feel it and neither could my doctor. I freaked!

I was in a dream. My world had gone crazy. Here I was in my dear family doctor’s rooms talking about cancer in my breast. He did not say that it was cancer – he couldn’t, but I knew as soon as I saw the small ‘malignant’ shadow. What was I going to do?

"Where do you want to go?" he asked.

"What?" I spoke in a dream – NO, nightmare state.

"Where do you want to have your operation?" he explained.

"WHAT ARE THEY GOING TO DO TO ME?" my brain screamed.

I cried for three days and I kept my dreadful secret with me. I couldn’t cope. Why should I, who had suffered so much, have to suffer more?

Then I dried my eyes and told my family and friends. Looking for sympathy? Of course. And it was the best thing I could have done.

I was amazed at the love and attention. And the advice! Advice from everyone, including people who had had breast surgery. All had positive suggestions but the biggest moral booster of the lot was that they cared! I was no longer a widow living alone with that most frightening anxiety, that terrifying fear, that the thought of removal of the breast can cause. Help and understanding were at hand. I had found that a lot of men were wonderfully understanding of these fears, for they said that if they had to have their testicles cut off they would feel the same dread. It is irrational! It should not make any difference to the person, the soul, but it seems that those two so very different external appendages which pronounce us as either male or female really do unite the psyche of the gender.

Varied and plentiful as the advice was, it was practical in that I had to make a choice! I was the one in charge of my body. Bouyed by moral support, I descended on the medical profession with a thousand questions. One of the doctors who had looked after my husband during his illness (and a close personal friend) gave me some articles from his medical magazines. He rightly thought that they would help me.

"Can a specialist in one form of treatment describe the choices available in such a way that the patient is not unduly influenced?" (Prof A O Langlands, 1988).

I found myself quizzing doctors on what THEY felt was the best way to treat breast cancer, Radical or Conservative? I was not going to have a Radical and I was not going to surrender my right of choice. The bad old days when the lump was discovered one day and the breast removed – without question – the next, seemed to be over.

I decided to have the operation at my local hospital. The surgeon was kind and helpful and consented when I asked if I could have a second opinion. At last I found myself in the Radiation Oncology Department at Westmead Hospital. Here I found what I had been searching for.

They praised the mammogram for its excellent quality and the doctor for his diagnosis. The lump was really very small. A rare case indeed.

There are many reasons for breast lumps and cancer is only one. Yet cancer occurs in one in eleven women. I feel that the fear of Radical surgery has stopped many women from even thinking of the possibility of developing cancer. One doctor told me that for a long time now the doctors of France have preferred Conservation to Radical treatment for breast cancer and their figures on survival are equal to anywhere else. "They would rather cut off their right arm than a woman’s breast", he told me. Bless ‘em!

With all the information they gave me at the Clinic, I made my choice. I would have a lumpectomy followed by Radiotherapy, if it proved cancerous. I had my Radiotherapy sessions booked before I had my operation and I cannot describe the feeling of ease and relief this gave me. I could have just had a lumpectomy only and lived with the threat that cancer may return as it does in 40 percent of cases. Not I!

It was a tiny lump, but the thought of hospital worried me. I was not sick and I lacked the gratitude sick people have when they go to hospital. I knew I would soon feel worse, not better.

As the lump was non palpable, the surgeon suggested a needle localisation before surgery. This would enable him to localise the lump more accurately and therefore remove only the affected area. The lump was once more located on the mammogram machine. An extremely fine needle was placed in my breast. A knob on the needle shaft was turned so that the needle was curved around the lump. Now it looked like a fish hook that cradled the lump in its curve. All this was explained to me before hand. I thought it would hurt like hell but made up my mind to be as relaxed as possible. Both the doctor and assistant were wonderful and I can honestly say that it did not hurt at all. Once in, the needle had to stay until cut out during the operation the next day. I felt no more than slight discomfort – certainly not pain.

I was in hospital for only a couple of days and when the surgeon rang to say "it was cancer" I was quite composed. I had it removed and my radiotherapy was to begin in the New Year.

I will be finishing my treatment soon which has not given me any trouble. Two weeks after my lumpectomy – when the scar had healed – I had my planning session. I had to lie on a ‘simulator’ (without moving, for over an hour); the simulator is similar to the machine on which I would have my treatment. Everyone around me was busy-busy, taking measurements, talking and checking pictures and marking ‘the area’ with purple ink and tattoos. The tattoos remain, but the ink comes off – often on one’s clothes!

Some radiographers have complained that on the one night of the week they want to go out, purple ink covers their fingers.

The computer puts all the facts together and comes up with a dosage unique and compatible. A small price to pay for one’s very own, brand new, designer dose!

There are some rules. I am allowed to shower but not use soap, talc, perfume or deodorant in ‘the area’. This is because these things contain metals which react to the radiation treatment. It is also recommended that I do not wear a bra and that I stay out of the sun. It is easy in Sydney’s hot humid weather to stick to the ‘loose cotton’ clothing suggestion. I have found that in the heat, some lemon juice and a little cornflour used on my underarm to be soothing and cleansing. The time of treatment – 33 days – is slowly coming to an end. I was surprised when I heard that some people decide against Radiotherapy because of the time involved!

We are quite a close-knit little circle at Radiation Oncology. As we sit, garbed in our little white gowns awaiting our ‘turn’ on our allotted machine, we chat. We swap notes on our treatment and discuss our cancers – and we have very positive outlooks – because we are there!

One gets to know one’s ‘neighbours’ on the machine. A lovely woman of Japanese birth gave me a folded paper ‘good luck’ charm which I cherish. Her cancer was the same type as mine only slightly larger and had unfortunately invaded the lymph nodes. She looks wonderfully well and has a marvellous attitude.

Another found her lump ‘by accident'. She was also a regular self examiner. However, she was feeling uneasy because she had neglected her Pap smear tests for some time. One day, just out of the blue, she decided to have one. Her doctor also examined her breasts and found her lump – again a similar type to my cancer. She wondered if perhaps somewhere in our subconscious something was at work protecting us.

"What is it," she mused, "that leads us on the path to these discoveries?"

I have been lucky. My lump was very small. In fact, I couldn’t feel it. It came to light on the mammogram. Because of this my lumpectomy was a minor operation. I recovered quickly. My ‘designer’ dose is very easy on me. Luck has extended this too. The machine is serviced every second Friday and my treatment has covered more Fridays "off" than usual with the result that I have recovery time in between and little reaction.

This is my story. I feel that such good luck should be shared. Maybe it will help some women to make up their minds to have a mammogram every 2 years. I hope it will make all realise the control they have over their bodies and ask the questions they want to have answered. People in the medical profession want to help but each case is different and YOU should find the right advice to suit YOUR case.

Langlands, A O. "Choice in the treatment of breast cancer", Modern Medicine of Australia, May 1988.

PS March 1988

It is now seven years since I discovered my cancer and had treatment. Every year I have a mammogram and a check up at the Radiation Oncology Department at Westmead Hospital (NSW Breast Cancer Institute). Do I think or worry about it? Yes and no. I consider I am so well-cared for that it is most unlikely I will have another breast cancer, but cancer elsewhere can happen to anyone and it is up to me to try to outwit it. That I won’t live forever (and who wants to?) is something I accept. With a good diet, exercise and a healthy mental attitude I hope I will one day die gently of old age.