I'm a breast cancer surgeon. AMAZING

[Gincision]

What the thread title says. I've been a consultant for nearly 2 years. Open for questions...

Do you have a view on what goes wrong with diagnosis in this country? Do people not go to the GP early enough, or are their fears dismissed, or do they not get the full suite of tests early enough?

@witchmountain the short answer is I don't know. Certainly I don't think that people don't do to their GP enough. The breast awareness campaign has been a victim of it's own success and has resulted in a vast increase of women in the new patient breast clinics with symptoms that turn out to be nothing. When I started training about 1 in 10 ladies in the clinic would have breast cancer. Now it's more like 1 in 20. I don't want to discourage people from coming as it's often difficult to know who will and won't have something significant but clearly improved education for patients isn't the answer. Everyone gets the full range of tests at the point they come, whether that's during the same appointment or subsequently. There is talk of tightening up the cancer targets in order to get treatment as quickly as possible which may help, but in all honesty these are already very stringent and introducing stricter financial penalties at an earlier stage in the patient pathway is likely to negatively affect units that are already struggling with the volume of referrals. No easy answer and one for someone cleverer than me to address.

I do work with a lot of people from other countries who are frequently taken aback by the ‘wait and see if it goes away’ type approach of GPs
This is actually a really helpful approach. Often breast changes can be cyclical and go after a couple of weeks. Whereas it would be very rare for a breast cancer prognosis to be negatively affected by a couple of weeks delay to diagnosis. There are rare aggressive cancers when this might have an impact but these are so infrequent that I doubt they would be affecting our stats by much at all (hence too why I think tightening up the cancer targets isn't going to have the huge impact people think)

Thanks GIncision that's really helpful. Definitely food for thought!

Gincision I don't have any questions as I have an amazing breast cancer team after being diagnosed last November and surgery in December. I just wanted to say thank you 🙏If you are anything like my consultant you will give people strength at what is a very dark time. I was fortunate that it was caught early and jumped on within 2 weeks. Still suffering some after effects but hey ho much better than the alternative.
Thank you so much for your dedication ❤️

Thanks gincision. The wait and see approach has always made sense to me (generally, I mean, not with breast cancer specifically in mind), but I wondered if that was just what I’d grown up with so it seems normal. Obviously something is making a difference, hopefully we will gradually figure out what. The study was sponsored by the pharmaceutical industry and, predictably, highlighted the role of drugs, but it was the NHS England person who mentioned earlier diagnosis (and radiotherapy and surgery). Perhaps the diagnostic part is more relevant in other cancers.

Thank you @gincision. I know it won't bring her back but I've always wondered. I had a breast cancer scare myself earlier this year but thankfully all ok. It was the same consultant so was hard going!

I have been worrying recently. I wrenched my back and had pain in my breast, which I rationally know was because I’d hurt my shoulder blade and that was where the ache was coming from. Since then, however, I feel hyper aware of my breasts and any changes. But they are really big - I’m a 36GG and my fear is that I wouldn’t be aware of a lump until it had grown a lot due to the size of my breasts. Is it harder to detect lumps in big breasts?

I am becoming increasingly aware that being overweight/obese is going to put my health at much more risk and I have young children. I know obesity raises the risk of cancer - is it that it makes it harder to detect, harder to treat or makes people less healthy so less likely to recover?

Hi Captain it is thought that being obese increases the risks of some cancers
www.cancerresearchuk.org/about-cancer/causes-of-cancer/obesity-weight-and-cancer

My understanding is it can make breast changes harder to spot and that fat can affect hormone levels.

Remember that even modest changes to your weight lead to health benefits. A goal of maintaining weight instead of further increasing is a really good place to start. Weight loss of 5% of your body weight leads to lots of health gains.

www.nhs.uk/common-health-questions/lifestyle/what-are-the-health-benefits-of-losing-weight/

I think because cancer is scary and actually quite common if you look at lifespan risk we look for and worry about causes. Some cancers are thought to be preventable (4/10 according to Cancer Research UK) but some probably aren’t.

We can all do what we can to take care of ourselves so that we feel better physically and in terms of wellbeing. That’s a win win situation whatever the future brings.

Captain - agree its all three, excess weight is a big risk factor due to an increase in oestrogen. I am not overweight but being slim and fit has meant I spotted my cancerous lump at an early stage and then made a very quick recovery from cancer surgery and radiology.

Thanks for doing this thread OP, 2 close relatives have had breast cancer and recovered. I have had a blood spot appear on my breast, not knocked it or anything that I am aware of. Its is quite small and not a lump, is it just an age thing or should I get it looked at?

I have a friend who had pain in her breast and was diagnosed with breast cancer. Is pain usually a sign to look for??

I had breast implants in 2015, stage 4 triple negative breast cancer diagnosed Oct 16. Did the implants cause the cancer? Should I have them removed?
I was diagnosed stage 4 due to heavy lymph involvement in neck, collarbone and chest so was always told surgery not an option.
I’m now clear - I realise this may be brief but as I had no organ spread I’m hoping for the best and doing lots of ‘alternatives ‘ which I know conventional Drs don’t agree with.
I’m just worried I bought this on myself with the implants and should I get them out?
I have zero family history and none of the risk factors applied to me yet I got it very quick and it spread very aggressively before I could get a dr to refer me for a scan - I was turned away with ‘it’s not breast cancer ‘ no less than 5 times.

I had no pain - so its not always something to look out for.

@namechangefriday that sounds awful but I'm glad you are now clear. What alternative options did you do. I'm only just diagnosed with breast cancer. I don't even now what type, level yet. I'm a planning sort of person so if there's anything I can do to help myself ie diet I'm interested.

Thank you for responding.
I've had a mastectomy and all lymph nodes removed. There was cancer in multiple places in the breast and in two of the lymph nodes. Would you expect someone like me to have radio or chemo?
I am hormone + and HER2-. I was offered a choice of radio, chemo or the trial - my choice ....

Thanks for your reply @gincision it's much appreciated. Wishing you all the best xx

Hi OP. Thank you for this thread. I have a moderate risk of breast cancer due to family history. I was having a mammogram every year but now at 50 it will reduce to every three years. Why is this? The cynic in me thinks it's financial!
Also, if I have not yet developed breast csncer, is my daughter at increased risk also?
Thank you

My mum (46) was diagnosed last September with breast cancer was told it was non-aggressive and wouldn’t spread. We started the process of a mastectomy and reconstruction, while going to appointments the consultant said it was hormone receptive and we could try this first to try and shrink it and potentially do a lumpectomy instead.
She started on Exemestastane for about a month but a scan showed she had osteoporosis so she came off it immediately, started treatment for the osteo and went on to Tamoxifen. The first scan after 3 months showed the tumour had shrunk so we carried on. In May another scan showed it had begun to grow so a decision was made to have the mastectomy. She didn’t see the plastic surgeon for nearly 8 weeks, we kept ringing for an appointment but passed from pillar to post. In all this time she had seen oncology twice, they had said she would have monitoring appointments but they never materialised. We saw plastic surgeon, as part of the pre-op scans it showed her lymph nodes were inflamed so she was urgently asked to go in for biopsies. She also had a PET scan which showed it had spread to her bones. It is now secondary and not curable.

Sorry for the essay, we only found out last Tuesday it’s no longer curable. It’s the first time I’ve written it down. I’m so so so angry but I don’t know where to direct it. My question is, why did no one check before this that it hadn’t spread? Can I take this anywhere to get this process changed? It feels like it’s been badly handled by everyone that’s touched it.

Also to add. Oncology have decided to continue with hormone treatment for the BC. I questioned this at the appointment as it has clearly spread on HT already so why even entertain the idea? They’re trying Exemestane again with stronger osteo treatment and trying chemo in tablet form, but they’re not sure she’s eligible having already had Exemestane within the last 18 months. Is this usual?

I had a lump and have been referred to the breast clinic. But the lump has now disappeared! Should I still go to the appointment? Still worried as my mum had invasive breast cancer last year so I'm a bit sensitive about it all...

Is it actually normal to have "lumpy bumpy" breasts that come and go?

I went to the doctors when I started feeling lumps in my breast, and I was referred (VERY quickly, I'm always impressed at how quickly people are referred in possible cancer cases) and told that it was just "lumpy bumpy" breast tissue.

It does come and go and I know this is a "good" sign and indicative of my cycle, but even so, each time it happens I'm frantically touching up my boobs thinking the worst and that they've missed something.

Do you think there is an added element with breast surgery that their shape etc is pretty important to people? Ie a lumpy scar somewhere else is far less significant to patients but with so much soft tissue /fat/ whatever they are and how people feel about them that not making a mess takes up more of your surgeon brain than for other specialties?
Some terrible phrasing there, I couldn’t think of better terms sorry!
And- AMAZING!

There is a string family history of gynaecological cancers including ovarian cancer in my dad's family.
No breast cancer that I'm aware of.
No history in my mum's family.

Are my sister and I at increased risk of ovarian cancer? Are there genes for this in the same way that there are Brca genes?