Breast Cancer: Hope beyond a battle

After months of feeling unwell and exhausted, a routine visit to the doctor in 2021 led to a life-changing discovery for Eliza van der Merwe, now 66, who found out she had breast cancer.

Initially healthy and active, she was referred for tests where a mammogram and sonar would later reveal a tumour in her breast, just months before her birthday.

“I was scared. I had to undergo a painful and traumatic biopsy, but the doctor was patient and eventually confirmed it was cancer,” the Centurion resident said.

Breast cancer affects one in 26 women in South Africa, according to the 2022 National Cancer Registry.

Every October, Breast Cancer Awareness Month shines a light on the most common cancer among women in South Africa.

On receiving her diagnoses, Van der Merwe said: “So much goes through your head, you wonder, will I die? What are they (doctors) going to do? You have to gather yourself and remember you have to handle it.

Every person handles it differently. You feel like exploding, but I kept my cool.

I realised I must decide what to do.” For Van der Merwe whose late mother had a mastectomy, a surgery to remove a breast, this thought was daunting. She eventually opted to have the tumours removed.

“After the operation I was in so much pain, I could not move my arms.

A friend called and said, ‘Ouma are you doing your exercises?’ She called her people and arranged for me to see a physio.”

Months later she started holistic medicine and said she has been cancer free.

“I used to go for tests every three months and they would come up clean. Now I go every six months.

There is hope, it is a mind thing, be strong in your faith, know God is there he is carrying you through. There are days I feel tired, feel down, then you have to try to be calm and relax. I should not burn out.”

Wadiah Salie has faced two life-changing cancer diagnoses in the past 16 years. In 2008, she was diagnosed with cervical cancer after a routine check-up, leading to a cervical coning procedure.

Three months later, she discovered a small lump in her breast by chance, marking the start of her battle with breast cancer.

Her treatment included a mastectomy, reconstructive surgery, six months chemotherapy and nine months of Herceptin, used to treat breast cancer.

In 2012 Salie was diagnosed with a brain tumour, which fortunately could be largely removed.

“I am constantly reminded that I am strong enough and giving up is never an option and with this my life will be forever changed,” said Salie.

Stellenbosch University, Department of Physiological Sciences, Prof Anna-Mart Engelbrecht explained that breast tumours differ from tumours in other parts of the body in specific ways due to the unique biology and structure of breast tissue.

Tumours are characterised by uncontrolled cell growth, genetic instability, and heterogeneity, meaning they consist of diverse cancer cell populations.

“They also evade the immune system and rely on the tumour microenvironment (TME) for support, which includes interactions with non-cancerous cells like fibroblasts and immune cells.

“The breast is composed of lobules (milk-producing glands) and ducts (channels that carry milk to the nipple), and tumours often arise in these structures.

“The glandular nature of the breast and its susceptibility to hormonal changes makes breast cancer biologically different from cancers in non-glandular tissues, such as bone or muscle,” Engelbrecht said.

“Breast cancer tumours are diverse and classified into types based on where they originate and their molecular characteristics. Common types include ductal carcinoma in situ (DCIS), which is non-invasive, and invasive ductalcarcinoma (IDC), which spreads to nearby tissue and beyond. More aggressive forms include triple-negative breast cancer (TNBC), which lacks hormone- and HER2 receptors, making it harder to treat, and HER2-positive breast cancer, where cells overexpress a growth-promoting protein.

“Hormone receptor-positive cancers rely on oestrogen or progesterone for growth and respond well to hormone therapies.”

Breast cancer is further divided into molecular subtypes like Luminal A, Luminal B, HER2-enriched, and Basal-like. “These subtypes influence treatment and prognosis, with Luminal A being less aggressive, while TNBC (often basal-like) and HER2-positive cancers are more challenging due to rapid growth and fewer treatment options,” said Engelbrecht.

She said personalised medicine transforms cancer treatment by tailoring therapies to each patient's tumour's unique genetic, molecular, and environmental characteristics, unlike the traditional "one-size-fits-all" approach.

In the South African Health Review’s cancer focused edition, delays in diagnosing breast cancer were identified as a significant concern.

Although the national Breast Cancer Prevention and Control Policy recommended a referral time of 21 to 60 days, researchers found that a four-month delay between the first visit and diagnostic biopsy was not uncommon.

Cancer Association of South Africa (Cansa) head of advocacy, Zodwa Sithole said diagnosis delays can have serious consequences for patients, affecting their treatment outcomes and overall health.

“The issue of delayed detection of cancer and strategies for reducing delays need more attention. Campaigns for health education on the importance of early detection screening are also needed.

“The importance of providing cancer training to healthcare professionals, particularly those who work in primary care clinics, can help in the early detection of cancer.

“Inadequate training can cause delays in referring patients to more specialised services, as the majority of patients access the healthcare system through primary care.

“Cansa recommends that screening of cancer should start at the community level, cancer screening should be incorporated into the existing screening tool of the community healthcare workers,” said Sithole.

Cansa urged women to prioritise breast self-examinations and screenings for breast cancer.

The organisation provides affordable clinical breast examinations at its care centres to identify any lumps or irregularities.

Government health clinics offer free clinical breast examinations.

Cape Times