Gynaecologist – first port of call

The truth is that your gynaecologist may very likely be the first of your medical caregivers to pick up your breast lump. With that said, we look at the role of the gynae in breast cancer.

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 check-ups and mammograms are performed and requested as part of a routine well-woman check-up by the gynae.

For some women, their gynae may be their only contact with the health system, so their gyane becomes their main resource for information about the disease and its prevention. It doesn’t end there. Once a diagnosis of breast cancer is made, your gynae may be invaluable in helping you deal with immediate and long-term side effects of treatment. So what can you learn from your gynae and how can he/she help you if you’re diagnosed with breast cancer?

Early detection and screening

Your gynae:

• Should teach you how to do a breast self-examination. The trick is to get to know your breasts; any lump or new bump needs to be investigated.

• Should inform you when to start having mammograms and ultrasounds. Some women at high risk will be advised to start earlier then the recommended general age of 40 years.

• Can also help explain 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.

• 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:

1- How safe is a mammogram for me?

2 – Is the radiation not harmful?

3- I am reluctant to have a mammogram as I heard it is painful.

Reducing your risk factors

Your gynae can advise on ways to reduce your personal risk factors. This may include:

• Limiting alcohol intake.

• Not smoking.

• Maintaining a healthy weight.

• Breastfeeding each of your children, for at least a year if possible.

• Having a first pregnancy early in life.

Making sense of your family genetics 

About 5% of breast cancers have a genetic link. Your gynae can help analyse your family history and refer you to a genetic counsellor for further genetic tests, if necessary.

Managing side effects of your treatment

Treatments that target breast cancer can often induce menopause. In fact, in many patients this is part of the treatment strategy, especially if a cancer  is oestrogen 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 aren’t immediately apparent – low oestrogen 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, while loss of bone density and the resulting risk of osteoporosis can also show up. Your gynae should be 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. This risk is two to three times higher in women taking tamoxifen than in women who are not. Your gynae will be able to look for this and do appropriate tests as needed.

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 gynae 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 specialised, 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 Which contraception can I use?, it is an in depth discussion on the subject

MEET THE EXPERT

Dr Sumayya Ebrahim is a gynaecologist in private practice in Johannesburg. She is also a blogger. Check out her blog “vaginations by Dr E” on www.vaginations.co.za

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