More than 2500 new cases of breast cancer are expected this year and more than 600 women will die from the disease.
One in nine New Zealand women will be diagnosed with breast cancer in their lifetime. The figures are scary but breast cancer does not have to mean a death sentence. Early detection through mammograms and by being "breast aware" can make all the difference.
• Importance of screening
BreastScreen Aotearoa health promoter Jo Kingi says screening mammograms are important as they show changes in the breast before they can be seen or felt.
"Breast cancer can be detected early, which means there is a very good chance of successful treatment."
Robyn Tourell (61) can vouch for this. She was diagnosed with breast cancer three years ago after a lump was discovered during a routine mammogram.
"It was the size of a 10c piece," she said. She was quickly called back for a needle biopsy.
"I had been called back before when they needed to recheck something, so I didn't think anything of it." This time, however, the results showed cancer in her left breast.
"I didn't believe it, really. I thought it might be a cyst. Then they called me to go see a surgeon - it's not good news when they come into it."
Robyn had pre-tests and was scheduled for surgery to remove part of her left breast.
"There's disbelief it's actually happened to you," she said.
Adding to her stress, her surgery coincided with a radiographers' strike and had to be cancelled.
"Luckily, I was strong and could speak for myself. Others went home and had no-one to talk too," she said.
"I went private in the end. It was the same surgeon."
Naturally, Robyn advocates screening.
"It might hurt for a few minutes but you're mad if you don't have it done. Act on it straight away. Don't leave it. It may only be a cyst. If you do a self-examination and you find a lump, go and see someone about it. Don't leave it," she repeats.
• Being breast aware
As well as having routine mammograms, being breast aware is important. This means knowing what is normal with your breasts and knowing what changes to look and feel for.
For example, any lumps or thickening; a change in breast shape or size; any unusual pain; puckering, reddening or dimpling of the skin; or any changes to nipples.
A self-examination two years ago led Jill Palmer (45) to an unwelcome discovery.
"I was watching the late news and they were talking about self-examination. I did it, and found a lump. It was there again the next day. My reaction was definitely to get it checked."
Jill went to her GP and was then sent for a needle biopsy.
"It's not painful but not pleasant. You do it," she said. She was retested and booked for surgery.
"It was all very quick. It was like a bad movie playing out. That word cancer - you immediately think the worst." As well as the lump in her right breast they also found cancer in the left.
"It didn't sound good at the beginning. I had bilateral surgery to remove both breasts."
Jill decided to leave reconstruction till later.
"I decided to let my body have some time off. I had a friend who got it done at the same time. It was important to her. She had her surgery on a Friday last July and was out the following Sunday. She took only a week off work.
"It was better to go to work, surrounded by positive and supportive people. I didn't like to be home by myself. I took it day by day."
While it is not clear what causes cancer there are some key risk factors, including:
Age: More than 70% of new cases are among women 50 or older.
Family history: Women who have a family history have a greater chance of developing breast cancer, but it is not as high as you may think.
According to BreastScreen Aotearoa, about 4% of women will have a moderately increased risk if they have a mother, daughter, sister or father who developed breast cancer before 50; 90-95% of women diagnosed have no family history.
Weight: Being overweight has been linked to an increased risk of cancer. New Zealand Breast Cancer Foundation figures showed that 5% of all cancers among post-menopausal women in the United Kingdom were attributable to being overweight or obese.
Lifestyle: Even low to moderate alcohol consumption increases the risk of certain cancers. The risk rises rapidly the more you drink.
The good news? Other factors such as having a healthy weight, exercising regularly, having children and breast-feeding are said to be protective factors.
Robyn was in the at-risk age group and had a family history of cancer. She had been having regular mammograms since the age of 45.
For Jill it was different. "It's not in my family. I didn't smoke. I was a one-drink type of person. I didn't fit the bill. A girlfriend asked `Why you?' Why not me? It doesn't discriminate."
• Life after surgery
Robyn was surprised at some of the emotions that surfaced after surgery.
"You feel lost. I didn't think I'd cry, but you think you've lost part of you," she says.
"The surgery took a great chunk out from underneath my left breast. It was only reconstructed this year, because I needed to get back into the public system. I just got on with it. Lived with it. I wore a bra that fitted on one side and not the other."
After surgery Robyn began a six-week course of radiation therapy, at least three times a week.
"Some days I had double doses - I'd go in the morning and back in the afternoon. Radiation doesn't hurt, it just makes you very tired. And your skin gets burnt like a sunburn."
She says it helped being a positive person.
"I came through it quite well. I could have lost a whole breast, I lost only part. I could have lost both. Or worse. I don't let myself think like that. They got it early. I am very, very lucky."
Robyn's reconstruction made a big difference.
"I can wear pretty bras now," she smiles.
For Jill the hardest part was her course of chemotherapy. She had eight sessions over six months - every 21 days.
"Some ladies can go back to work, others don't have that experience. I could go for treatment and pick up my son from school.
"He would ask `How was chemo today, mum?' I welcomed it, because it was like sending the army in."
Jill had total hair loss including her eyebrows.
"I shaved it when it first stated falling out and wore scarves. People looked at me with sympathy - the `poor wench' look. That was OK. After chemo, she had radiation for five weeks every day except the weekend.
"You set yourself goals to tick off. Having hair back is a big one. I have my hair and eyebrows back now. I had my first haircut and I'll need another one soon."
Dealing with the emotions was also difficult for her.
"I was wondering `how am I meant to feel?' You have dark thoughts, but every day you get a step further away from it. I tried to fight the dark days.
"You see your family upset and that's hard. They're living it as well. You need to be realistic and prepare for the worst, but you don't focus on it," she says.
"There was an ad on TV, a mother in bed watching her son playing football. I thought `Let me be her'."
Jill says screening and self-examination gives you "peace of mind".
"If you're scared to go for yourself, then go for your husband and kids. Do it for yourself and your family."
Both women credit support from family and friends for helping get them through.
"I had a supportive husband and kids who rallied around," said Robyn.
"One friend fed us for the first while," said Jill.
"You appreciate who's there for you.
"Don't be afraid to offer help," she adds.
"I'm sure it will be gratefully received."
• Life after cancer
Believe it or not, cancer has had its positives for Robyn and Jill.
"Once the cancer was cut out and they said it was gone . . . you view life differently," said Robyn.
"Life is worth living. Why put all those blocks up and get frustrated and angry? I don't take things on board so much. Colours seem brighter," she laughs.
"I love travelling. Before I thought `Wait till later, or when I retire'. Now I think, `do it now'. Life - you only get one chance at it."
Jill agrees. "It's given me more than it's taken," she says.
"Now I don't sweat the small stuff. I'm in a privileged position. It's intense. You don't take anything for granted, but it's so much more than that. It's the simple things. I'd like to think I had my priorities right before, but now it's to a better degree. I always watched the children play sport, but now I just love it."
"It still seems surreal that it happened to me," she said.
"I have a close friend who has been through it as well, and we say we're not lucky, we're blessed".
• How you can help
Today is the annual Pink Ribbon appeal day. Keep an eye out for collectors and the colour pink.
Dunedin area appeal co-ordinator Sonya Bartlett said Dunedin raised $250,000 last year.
"We're hoping to match or better that. Our biggest concern is the weather," she said.
Collectors will be in Dunedin, Green Island and Mosgiel, and she urges people to contribute.
Jill will be collecting at the Dunedin Hospital, while her father, Kevin McLaughlan, will be covering the airport.
Robyn is part of the Zonta Club of Metropolitan Dunedin which will collect at the Meridian Mall.
• Demystifying mammograms
What is a mammogram? A mammogram is a low-dose X-ray of the breast tissue. It is used to detect abnormalities.
Screening mammograms, to search for any sign of cancer, are carried out routinely on women with no symptoms.
Diagnostic mammograms are done on women who have signs or symptoms that need further investigation.
How effective are they?
Mammograms can detect lumps that are too small to be felt or seen, which means cancer can be detected and treated early, thus reducing the risk of dying.
According to the New Zealand Breast Cancer Foundation, mammograms are 85%-90% effective in detecting cancer in women over 50 and 75% effective in women under 50.
Women who have not been through menopause or who are on hormone replacement therapy (HRT) have denser breast tissue, which can make it easier to miss something or give false positive results (where an abnormal area turns out not to be cancer).
Combining mammograms with self-examinations and GP checks gives you the greatest protection.
What should I expect?
During a mammogram, a medical radiation technologist (MRT) will place the breast between two plates, gently compressing the breast so that anything abnormal can later be seen by the radiologist from the images.
This can be an uncomfortable procedure but very few women find it unbearable. The procedure take only a few minutes.
Where do I go?
If you are aged between 45 and 69 and have no symptoms of breast cancer you can register with BreastScreen Aotearoa for a free mammogram every two years.
As well as having clinics in the community or public hospitals they also have mobile screening units for rural areas.
For more information or to register with BreastScreen Aotearoa call 0800 270 200.
If you have any signs of cancer or are in the at-risk category, talk to your GP, who will refer you to a specialist or outpatient service for diagnosis.
How often should I have a mammogram?
The foundation recommends screening every year for women aged 45-49 and every two years from 50 onwards.
If you notice any changes between visits consult your doctor. Sometimes something is missed or a cancer may develop quickly.
Is it safe?
The radiation level from a mammogram is very low and the benefits of early detection outweigh any risk from the radiation for women over 50, the foundation says.
The risk for women under 50 developing cancers from X-ray radiation is greater. The risk increases the earlier a woman starts mammography.
Do I need to do anything?
Avoid wearing powder or deodorant on the day of the screening, as this can affect the reading.
Wear a shirt or blouse as you will be asked to undress from the waist up, and bring reading glasses if you need them, as well as any previous mammograms you have had, for comparison.
What happens if they find something?
If something irregular shows up on a screening mammogram, you will be called in again for further assessment.
This does not mean you have cancer, as only one in 10 women recalled will actually have it. Further testing could include a clinical breast examination, more mammograms, an ultrasound scan or a needle biopsy (to remove breast cells for testing).
If the results are normal you will return to screening every two years. If cancer is diagnosed, you will be referred to your doctor to discuss treatment. Remember, nine out of 10 breast lumps are not cancerous.
Events
BreastScreen HealthCare promotion events for breast screening awareness month:
Women's Lifestyle Expo: October 10-11, Dunedin.
Breast and cervical screening promotion:
Whanau Ora health evening: October 13, Murihiku Marae, 7pm-9pm, Invercargill; Tokomairiro Waiora, October 30, Milton.
Giveaway
We have 10 Healtheries Pink ribbon gift packs valued at $50 each to give away to Otago Daily Times readers. To enter the draw email playtime@odt.co.nz including your name, address and daytime phone number, with "pink" in the subject line.