Dedicated to the care of breast cancer and all breast conditions
Dr Sarah Rayne is no longer practising in
Johannesburg and this practice is closed.

These pages are for information only,
and current only until 2018
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Managing breast cancer  
If you, or someone you know has been diagnosed with breast cancer, you can be plunged into a place where people talk about different treatments and problems and it is often hard to know where to start. There are many great resources available to help you (links to some are found here) but having a good multi-disciplinary team specialised in dealing with breast cancer is essential. Make sure you get all the opinions you need to make the right choices.

In breast cancer management, surgery will take place at some point through the treatment path. Surgery can take place at more than one time, either for diagnosis, treatment or reconstruction. Breast surgery for cancer is detailed here

Before or after surgery other cancer treatments will take place. These include

Local treatments to the breast:

Whole body treatments to find any cancer that has spread in the body:
Target-dependant treatments (hormonal and immunological)
Radiation treatment
Radiation (or radiotherapy) works to kill rapidly dividing cells such as breast cancer cells. Unlike chemotherapy, it works locally in the breast and under the arm. A beam made up of thousands of X-rays attack any cells that may be cancer and reduce the risk of cancer returning after surgery, especially if the cancer was large or the lymph nodes were involved. In addition radiation helps reduce the risk of the cancer coming back if breast tissue is left behind (after a lumpectomy or wide local excision) making these choices as safe as a mastectomy.
Chemotherapy uses medicines to kill any cancer cells in the body. It can be given before or after surgery through an IV drip or in a tablet (sometimes both). Chemotherapy attacks cells which are rapidly dividing like cancer cells, but can also kill rapidly dividing healthly cells such as those of the gut, blood, nails and hair. When these cells die it can leave the body with side effects such as hair loss, nail changes or gut symptoms like nausea and vomiting. Despite the side effects, the use of chemotherapy for breast cancer has changed it from a disease where most people died, to a disease where most people are cured or live a long time. Whether or not you need chemotherapy depends on the stage of the breast cancer and its ‘personality’or behaviour. New methods of testing for the risk of recurrence in cancer, such as Oncotype DX, use genomic characteristics of the cancer to determine whether chemotherapy will be of benefit. These testare expensive at present but authorised by some medical aids. They will hopefully help us best tailor treatment to the individual patient and their individual cancer.
Target-dependant treatment
The behaviour of every breast cancer is different: how it interacts with the normal cells of the body. The way breast cancer interacts with the cells of the body is through hormones and growth factors that need to join with receptor on the surface in order to be accepted into the cell. If a breast cancer cell has a receptor, then that hormone can act to influence the cell to grow and divide. By blocking the receptor we can stop the breast cancer cell growing and dividing. The common receptors we can block are:
Oestrogen receptors(ER) and Progesterone receptors (PR)
If a cancer has oestrogen receptors (ER+) or progesterone receptors (PR+) medicine can be used to block these receptors and prevent growth or even shrink tumours. Giving blockers and inhibitors long-term after treatment for 5-10 years dramatically reduces recurrence.The most common medicines are Tamoxifen and blockers called Aromatase Inhibitors.
Her2/neu receptor over-expression
The HER2 receptor accepts and uses growth factors to encourage growth. A cancer with many of these receptors (HER2 +) are often aggressive and fast-growing, particularly if ER/PR negative. New treatments such as Trastuzamab, specifically target these receptors and dramatically reduce the risk of recurrence or spread of the breast cancer.

Most recently chemotherapies have been linked to the anti-HER2 treatments to guide chemotherapy to specifically destroy breast cancer cells.

At present anti-HER2 medications are not available to most patients in South Africa, they cannot be afforded by government hospitals and many medical aids also refuse to pay for full treatment (one year). The best way to access these medicines if you are HER2 positive is through a clinical trial. You can ask your doctor to find out if any are available.

Much of the research into breast cancer care is around finding more receptors so that more medicines can be developed to block them. Often new treatments are being tried out in current cancer patients, and patients can take part in a trial of a new treatment.