Zest for life

Even though our Super Survivors developed a new primary breast cancer, years after their first breast cancer diagnosis, all three are stilling living their lives to the fullest.

Passionate ballroom dancer

Zest for lifeZest for life
Astrid Quiterio (58) lives in Florida, JHB. She is divorced and has two sons and four grandchildren.
First diagnosis: 2007 – HER2 (left breast)
Second diagnosis: 2010 – triple-negative (right breast) 

The mother of two was diagnosed with HER2 breast cancer, at the age of 49, after discovering a lump in her left breast while bathing.

She recalls the way the news was conveyed to her being cold and insensitive – after the biopsy, she heard the words, ‘I don’t know if doctor wants to do surgery first or chemo’; this was moments after she saw the screen immediately turned black when her left breast was examined. “I thought these are such big words, I don’t understand,” Astrid explained. A few days later, she received a phone call saying, “Please come in on Monday, it is very serious, but enjoy your weekend.” Being the woman she is – a passionate ballroom dancer – that is exactly what she did – she danced, partied, had a ball of a time, and would face whatever she had to on Monday.

That Monday, it was finally communicated to her that she had breast cancer. She had  a left mastectomy on the Thursday. She explained she didn’t have time to be nervous. The next morning, the shock hit her when she saw ‘the dent with all the staples.’

Her treatment plan consisted of 18 months of chemotherapy, and radiation which would have commenced six months into her chemo. But after hearing her lungs and skin could be burnt, that she could have a heart attack and would never be able to have reconstruction, she became petrified. “This was the first time I cried since receiving my diagnosis…because this news made me fearful,” she said.

After meeting with her surgeons, she was informed that if they recut her margins, she wouldn’t have to undergo radiation; this was done along with lat flap reconstruction and    the outcome was “beautiful”.

After making a wonderful recovery and thinking she had conquered the biggest battle of her life, she started to experience nausea in 2010. After countless sonar scans and mammograms, three triple-negative tumours were found in her ‘healthy’ breast. “I was devastated as I knew what I was going to go through. The second time was definitely worse than the first…it was more difficult,” Astrid explained.

She immediately had a mastectomy where  an expander was put in to make the cavity big enough to place the prosthesis in at a later stage. Her six months of cyclophosphamide, methotrexate and fluorouracil (CFM) chemo commenced, both intravenous and tablet form. Reconstruction, including nipple, was done at a later stage. Astrid has the same opinion of the outcome as the first – beautiful!

She was, however, concerned that because a piece of her right nipple, which was healthy at that stage, was used to reconstruct her left nipple but now had also turned out to be ‘unhealthy’ that it would also become cancerous. However, the doctors reassured her the piece of the right nipple that was used was not cancerous.

When asked is she fears getting cancer for a third time, she replied, “No, if I get cancer again, I’ll just deal with it. My life is a new journey now, before cancer I would just drive to work, but now I drive to work and notice and appreciate the beautiful Jacarandas.” With that said, she admits she would not have gotten through it all, if it was not for her son, Edward. “He was my pillar of strength with his endless patience and incredible support throughout.”

Quality of life, according to Astrid, is exactly what she has now “to wake up in the morning, to feel healthy, to still be able to walk…I come to work and do the things that I used to before, but I do them with more appreciation now.”

And she certainly never lost her love for dancing, the only concern she had, when she was in the treatment phase, was that her wig would fall off while sweeping gracefully across the polished floor. Today, she doesn’t have that worry as she has a full head of hair and dances like no one is watching!

Vivacious actress

Zest for lifeZest for life

Lillian Dube (71) lives in Randburg, JHB. She is a divorcee and has one son and two grandchildren.
First diagnosis: 2007 – triple-negative (right breast)
Second diagnosis: 2015 – HER2 (right breast)

If you’ve ever had the opportunity to meet Lillian, you’ll know that she is jovial, full of jokes and extremely fun to be around. Today, she is still that, just amplified, even though she has recently completed Herceptin treatment.

Since she played the role of Sister Berttina in Soul City from 1994-2004, Lillian went for annual breast check-ups and knew the importance of self-examination. That is why, at the age of 63, after noticing her one breast was larger than the other and feeling a lump the size of a peanut, she went for a mammogram. When she heard that she had triple-negative breast cancer, all she thought was ‘I am going to die’. “The worst was thinking that I was going to leave my grandchildren behind,” expressed Lillian.

Sue Grant-Pam, a friend and fellow actress, gave Lillian some hope as she too had breast cancer but was still alive. “I thought well she is younger than me, maybe she had a better chance.”

A prayer session was held for Lillian by Soul City, Muvhango and Word of Mouth Productions. They prayed for a successful surgery and fast recovery. This heartfelt support increased Lillian’s hope and being a woman of God, she too then started praying for herself, and believed she would survive.

She added that witnessing the passion her team of doctors had, gave her the utmost confidence that she was going to live.

In 2008, she had a lumpectomy  then underwent chemotherapy and radiation. She found the side effects very hard to endure but explained that being part of Bosom Buddies, where support and advice were offered,  eased her discomfort. She especially appreciated the guidance regarding her having Type 2 diabetes.

“People who have gone through what you have, are the best advisors, even better than doctors,” Lillian said. And, always seeing the funny side of life, Lillian joked that losing her pubic hair wasn’t that bad as she saw it as free waxing.

Then last year, just before Lillian turned 70, she felt unusual sensations in the same breast, and knew something was not right. “My fears were confirmed but I was told that it was good that it wasn’t the same cancer, that it had mutated, but this meant nothing to me,” Lillian explained. She phoned Louise Turner, CEO of the Breast Health Foundation, who explained it like this: “You are lucky it is a new boyfriend. If it was the old boyfriend, it means the cancer had spread and you would be gone.” This came as a relief to the actress and she knew she stood a chance of survival again.

“I wasn’t afraid. I remember with my first diagnosis when they were marking me and putting me in those round machines, I thought they were sending me to heaven or turning me into Mark Shuttleworth, but this time I was used to the routine and nothing was frightening, like before,” she said.

Reconstruction was off the table for Lillian as it meant she would need more operations after her right mastectomy and more time to recover, and being the active go-getter she is, she didn’t want that. She currently wears an external breast prosthesis or even sometimes puts a pair of socks in the bra cup or doesn’t put anything in at all. “It doesn’t bother me and it also creates awareness,” she said.

Her second treatment plan included 17 sessions of Herceptin, every 21 days, and tamoxifen, which she will take for the next five years. Her last Herceptin infusion took place on 10 November.

“I don’t live with fear (of cancer reoccurring). I celebrate and make the most of everyday and even if it does, I know I will be able to deal with it. Even with death… eventually, I’ve made peace with it, with everything. Having cancer takes away all the nonsense, you forgive everyone and are just happy to be alive.”

Lillian sees quality of life as attitude – being happy, no matter what your circumstances are. And if anyone has the right attitude, it is definitely this vibrant grandmother, who is immensely thankful that she got to see her grandchildren turn a year older this year.

Earth mother, mentor and clinical sexologist

Zest for LifeZest for life
Professor Elna McIntosh (58) lives in Hurlingham Manor, JHB. She has one adult son and is divorced.
First diagnosis: 1994 – ductal (left breast)
Second diagnosis: 2006 – lobular (left breast)

After Elna had a radical mastectomy after being diagnosed with ductal breast cancer, at the age of 36, she became a ‘hurried woman’. “It was like I wanted to pack everything into life just in case I died – I ran the comrades, I did the Dusi, I went back to uni and got a PhD, and I desperately wanted to be 40 because by then I would have gotten my son, Garth, through school,” Elna explained.

Even though Elna had medical knowledge, and understood early detection meant long-term survivorship, she admitted that her human character took over, erasing that insight and replacing it with fear.

Twelve years later, a few days after having her ‘religious’ routine check-up, she received a phone call, while sitting in a hairdressing salon, with the news that she once again had cancer in the same breast, but this time it was lobular breast cancer. She couldn’t believe that she had to go through this ordeal for a second time.

She underwent surgery to remove the cancer and had lap flat reconstruction, then went for radiation.

This time Elna had a different approach, she didn’t ask questions nor made any attempt to understand her new breast cancer. “By this time, there were new words and new drugs…I didn’t want to know anything about breast cancer. Whatever my doctors told me to do, I just did,” Elna said.

The biggest lesson Elna learned, the second time around, was to accept support when it was offered. “I am used to helping people, not people helping me and I didn’t want to inconvenience people by coming with me to radiation – the drive there was longer then the actual radiation. But people won’t offer, if they don’t mean it…and it that lonely time, when you just sit there, you rekindle friendships.”

It fascinated Elna that there was a fertility clinic just above the radiation centre, “We were all nearing death and dying on the ground floor but yet upstairs they were making life,” she said.

Elna planned to take part in this year’s Everest Base Camp 2016: One Step at a Time summit but unfortunately had to pull out a few months before due to a kidney stone. However, during training she became extremely close with Nqobile Mazibuko. She found this friendship cathartic as she saw Nqobile celebrating breast cancer whereas she never knew if she should mention it or how to talk about when she is invited to give a talk. Nqobile gave her a different perspective on being a breast cancer survivor.

Elna does fear getting cancer again but explained that at the end of the day, she is alive and gets to spend time and travel with friends. This December, they will explore Singapore. To her quality of life is having a small group of close friends, spending time with her mom and son, whom she loves dearly, and her earth children, which includes a 10-year-old boy, Mandla. “He is like my grandson and I see life through his eyes,” and that life is magnificent! Elna added that Garth is her reason for wanting to grow old, so she can see her real grandchildren.

What is the likelihood of women developing two different breast cancers?

Prof Benn (specialist breast surgeon): Very uncommon, about a 1-2% chance per annum (not accumulative) of developing a new primary.

Dr Moodley (oncologist): It does occur in patients, al be it not commonly. The prognosis from breast cancer is always governed by the index case i.e. the breast cancer you have and not by another new primary breast cancer lesion. These Super Survivors all presented with a breast cancer initially, and the therapy for the initial cancer has been very successful hence they’re still clear with no evidence of recurrence of this first cancer. However, what they have now is another new breast cancer arising from another part of the breast. Remember that no matter what operation is done the breast tissue can never be completely irradiated and hence the chance that this type of problem can always occur.

Dr Edge (specialist surgeon): This is a question I am often asked. Sometimes, the original breast cancer can recur. Other times, a second primary may form. The second cancer can occur in the same breast or in the opposite breast.  Unfortunately, we don’t have figures for SA. However, some of the best follow-up data comes from the USA; they calculate the risk of a second breast cancer as being 6% in 10 years. That means for every 100 women who have a breast cancer, six of them will represent with another breast cancer in the next 10 years. It is more likely to occur in women who have a strong family history of breast cancer or in women who are very young at the time of diagnosis of their first breast cancer.

Dr Edge explains how to reduce the risk?

1. By doing a bilateral mastectomy at the time of diagnosis. This approach has become popular as reconstructive options have improved but it is still a radical approach and certainly should not be offered to everyone.

2. By taking endocrine therapy (tamoxifen or an aromatase inhibitor (AI). Many years ago, women who were at a high risk of developing breast cancer were given tamoxifen and it was found that the rate of developing a new cancer reduced by 50%.

Having seen a number of women who are unfortunate enough to develop a second cancer, I have come to realise that it is not the same the second time round. It is certainly not easier. I wish Elna, Astrid and Lillian all the best.

Written by Laurelle Williams