Sarah is 36 years old, married, with two children aged 11 and 12.
Two and a half years ago, she was relaxing after a bath when she felt a lump in the upper part of her breast. Although she was not very concerned about it, she went to see her doctor the following day. Sarah’s G.P agreed that the lump was probably nothing to worry about, and was likely to be related to the fact that her period was soon due. She suggested Sarah return a week later. As the lump was still there the following week, Sarah was referred to a consultant.
There was some delay in arranging an appointment with the consultant, and Sarah was eventually seen by a hospital doctor about 4 weeks later. The doctor did a needle biopsy to remove some cells from the lump, and Sarah returned the following week for the results of this test. Unfortunately, the biopsy had failed to provide any conclusive evidence about the nature of the lump, apart from indicating that it was not a cyst and contained no fluid. Another needle biopsy was done and another appointment made for the following week. This time she saw the consultant, who told her that the second needle biopsy had also failed to provide any useful information. He then did a Tru-Cut biopsy to remove a piece of tissue from the lump. Sarah was due to return to the hospital to receive the results of this biopsy a week later, but in the meantime the consultant rang her to suggest that she should take a suitcase with her to her next appointment as, whatever the results of the biopsy, he felt that the lump should be removed.
It was only then that Sarah began to feel concerned about the possibility that the lump could be cancer.
At her next clinic visit, Sarah and her husband learned that the tissue biopsy had revealed cancer, and the consultant asked if she would like to go home for a few days to consider whether she would prefer to have a lumpectomy or a mastectomy. He himself was in favour of a mastectomy, and they all agreed that she should have this operation the following day.
The breast care nurse took Sarah and her husband to the ward and explained to them what was going to happen.
The next morning, Sarah’s breast was removed, together with several lymph glands from under her arm. The lump was between 2 and 3 cm in width (about 1 inch). She was in hospital for about 4 days, and before she left she was fitted by the breast care nurse with a temporary soft prosthesis to put in her bra. While she was in hospital, a physiotherapist also showed her how to do some exercises to help her regain the movement in her arm.
She felt shocked and exhausted for the first few days she was at home. Her wound was quite painful for several days, but regular painkillers helped. She was given sleeping tablets which she took for the next 10 nights, while awaiting her follow-up appointment with the consultant. When she returned to the clinic, she was told there had been no evidence of spread of the cancer beyond her breast, and she would not need to have further treatment.
About 10 days after her operation, the stitches were removed from Sarah’s wound at her local health centre, and 4 weeks after her mastectomy, she was fitted with a permanent external silicone prosthesis.
A few weeks later, having watched a television programme about cancer, Sarah developed a fear of her breast cancer recurring. During the next few months she had a bone scan after developing back ache and headaches, as well as a variety of other tests to investigate the causes of various aches and pains. About 3 months after her operation, she started having dizzy spells and her doctor, who felt that anxiety could be the cause of some of Sarah’s problems, started her on anti-depressants. She continued taking the anti-depressants for about a year, gradually stopping when she felt better able to cope.
Sarah had a great deal of support from her breast care nurse, as well as from her GP and consultant, all of whom took her worries seriously. She also saw a counselor for a while when her anxiety was becoming difficult for her to deal with. However, for 18 months after her operation, every ache or pain Sarah suffered added to her terror of the cancer returning. She feels that it has taken her about two and a half years to recover completely psychologically, although it was only about 4 to 6 weeks before she had recovered physically from the operation. She now feels able to live her life without constantly thinking about what she will do if the cancer recurs, and has decided to face any problems if and when they arise.
Her breast care nurse arranged for pockets to be sewn into her bras (and her swimsuit) following an embarrassing experience at her daughter’s sports day. She did try an adhesive prosthesis, but found the strips that stick to the skin, and to which the prosthesis itself attaches, uncomfortable.
Sarah returned to her consultant for check-ups every 3 months to begin with, and then every 6 and she will now see him once a year. She wishes that there was some test that could be done so that she could be told categorically that there is no more cancer in her body, but realizes that this is not possible. Since her operation, she examines herself regularly to check for any breast abnormality.
Sarah and her husband have not told their children that she has had breast cancer, only that she had to have a lump removed from her breast. They will do so when they feel their daughters are old enough to cope with this knowledge.
*71/39/5*
