Breast cancer awareness — a personal journey through early detection and treatment

11 Nov 2024

From a casual observer to a cancer campaigner, Diane Coetzer shares her insights on the physical and emotional challenges of the disease.

“Early detection saves lives.”

How many times had I seen those four words as yet another October rolled around and the annual Breast Cancer Awareness Month got under way.

And how many times had I vaguely thought to myself “that sounds about right”, even as I got mildly irritated by the pink ribbons and pink-themed events and pink paraphernalia that came with the month, while simultaneously congratulating myself on remembering to go for my bi-annual mammogram.

But this year the words took on a resonance that was at once overwhelmingly reassuring, and also terrifyingly real because I found myself contemplating them from deep inside the chemotherapy chair, watching a bag of freshly prepared Paclitaxel with my name on it drip, drip, drip its way into my arm.

As I have written previously, in April I was diagnosed with breast cancer, falling directly into this category: “Approximately half of breast cancers develop in women who have no identifiable breast cancer risk factor other than gender (female) and age (over 40 years).”

And, as I wrote at that time too, the relief I felt at hearing the words “your cancer is early stage” was short-lived when the results from the MammaPrint genomic test were shared with me by my oncology team a few weeks after my breast conserving operation (or lumpectomy).

Serious medical diagnosis

When most of us receive a serious medical diagnosis, there is much that’s new to confront and I’d never really understood what genomic testing meant until the surgeon who removed my tumour said it would help guide the next phase of my treatment, following the course of radiation that accompanies surgery.

Since then I have read extensively about the MammaPrint test that my tumour was put through. I visualised the cluster of cells — an ominous, out-of-the-way gathering, deep in my breast, that I would never have known was there but for a routine mammogram — being measured against 70 specific genes in breast cancer tumours to determine its aggressiveness, or, more specifically, the likelihood of metastases.

“I am so sorry,” the nurse specialist said when she showed me the results of the test on the computer screen in her office. Under “MammaPrint Risk-of-Recurrence Result” it said — in caps — HIGH RISK.

“You’re going to need adjuvant chemotherapy,” added the oncologist when he arrived a minute later, showing me the risk of metastatic recurrence in 10 years if I didn’t have the treatment. It was not something you’d want to take a bet on.

Nearly five months on, there is still no starker illustration for me of just how early detection can save lives than those MammaPrint results.

I retrieve them from my inbox when another chemo infusion has me unable to eat or lift myself off the couch. I look at them again when I need a reminder of why — as a now immunocompromised person — I have spent much of this year in semi-isolation because I depend on public transport to get anywhere outside of the town where I live (if Covid-19 did anything, it imprinted in me the hazards — unseen, ever-present — on buses, trains, aeroplanes and other spaces that are teeming with people).

Those who have been through it know that nothing really prepares you for the infusion of powerful chemicals into your body, but the experience of those who have sat in the chair before you helps a great deal.

Helena, Tracy, Elena, Dee and Michelle all generously shared what they had been through and remedies for side-effects — including short walks and apple and ginger shots to help with the nausea; hot water bottles for bone pain — and offered a listening ear should I ever need one.

‘Sometimes you just want to scream or shout or cry’

They all agreed that, while being positive is vital, sometimes you just want to scream or shout or cry. I have mostly done my crying in the shower because it’s often with the water streaming on to my bare skull, stripped of hair just a handful of weeks into my treatment, that I am overcome with feelings of why? Why, why, why? In this state of mind, I find myself unable to watch movies or even an episode of a television series that hints at a bad or uncertain ending.

I started my chemotherapy with a combination of cyclofosfamide and doxorubicine.

Doxorubicine — which damages the DNA inside cancer cells and so renders them unable to divide — is not new but is one of the most powerful chemotherapy drugs available.

It wasn’t a surprise, then, to learn that it has earned the nickname “the red devil” for its literal red colour and its devilishly harsh side-effects. A headache that felt like a leaden object had landed on my head but that had also invaded it from the inside, rendering me unable to do the things you would very much like to do in the post-infusion period like read, watch and listen.

A discombobulating dislocation from my body, like I was a little drunk but with none of the fun. A scrambling of the insides of my stomach that made it hostile to most food and also coffee — coffee! — and other warm drinks (but, thanks to significantly improved medicine to deal with side effects, frequent nausea never developing into me bolting for the toilet as has been a staple in depictions of chemotherapy treatment in movies and television shows for decades).

But I managed to get through the red devil and its companion — with the help of a loving partner, my children, family and friends — and I am now halfway through a regime of Paclitaxel (also called Taxol) which, while still delivering nausea, fatigue and new and sometimes starting side effects (What is that red rash that has just appeared on my face? Is the bone pain now in my jaw?) is a few degrees less harsh than cyclofosfamide and doxorubicine.

This round, I am also taking part in a medical study that aims to establish if icing hands and feet before, during and after the infusion helps with the neuropathy that Paclitaxel can bring.

This means that my hands and feet are wrapped and cooled, making the usual chemo chair activities — reading, phone scrolling, sipping juice — impossible. But if it means that I won’t get nerve damage and can help science too, I am up for it.

Aside from the times when family — my wonderful family — sits with me and we talk, the two hours of my Paclitaxel infusion and the icing gives me time to reflect on what early detection saves lives really means.

Scientists. Chemists. Researchers. Doctors. Nurses. All those women with breast cancer who came before me. And, Henrietta Lacks, whose cells — taken without her knowledge in 1951 — became one of the most important tools in medicine, and whose life is captured in the riveting The Immortal Life of Henrietta Lacks.

I give thanks to them all when the Paclitaxel starts slowly descending from its position on the drip stand above my shoulder.

I sometimes wonder, too, what made botanist Arthur S. Barclay — then working for the US Department of Agriculture — and his trio of university student field assistants choose the Pacific Yew to collect bark, twigs, leaves, and fruit from in 1962.

After all, Taxus brevifolia is a slow-growing evergreen and so would probably not have been a sure-bet choice for plant samples that were collected by the botanists, destined for America’s National Cancer Institute as part of its quest to find natural products that might treat cancer.

What if it actually worked? How would demand be met?

As this article explains, in the end, it was the bark of the Taxus brevifolia that contained the chemical that was found to damage the structure that supports cancer cells, which then stops the cells from growing and dividing.

But it took much more research and time to move from killing a whole Pacific Yew to get all the bark needed for the extraction, to producing the Taxol that is infused into me each week using precursor chemicals found in the needles of a related tree, Taxus baccata, or by culturing plant cells.

Growing and dividing. That’s what the cancer cells in my body were doing when I walked — surrounded by spring blossoms pushing their way through the winter mulch — to the mobile clinic where I had the routine mammogram that set in motion an unwanted, unexpected medical journey.

Anthems to Blast Cancer Collective

I still walk that path on days when I have enough energy because it’s an outing, it’s fresh air, and it always feels healing, especially when I put on my headphones and listen to the Anthems to Blast Cancer (ABC) Collective playlist.

My partner started it as a way of keeping me uplifted and in the embrace of my wider family who regularly contribute songs, always with a short write-up in the accompanying WhatsApp group that reflects on their choice and its relationship to me. (A recent entry by my youngest child, Emmylou, to accompany her selection of Ethiopia’s Mulatu Astatke’s “Tezeta (Nostalgia)” reads, in part: “As it’s starting to get cold and dark again, I hope this can bring my mama some happy nostalgic feelings. Astatke, an incredible multi-instrumentalist, plays piano and organ in this piece. I love his piano solo, and the steady percussion, guitar and upright bass in the background. As I go back to my last assignment — which interestingly is about cancer — I hope my mum goes into relaxation mode this Friday afternoon.”)

My walk is now framed by a picture perfect Autumn scene and I hold on to it as I observe the trees arcing downwards, coming ever closer to the water as winter approaches, and the rich red, golden yellow, and burnished orange leaves tumbling down.

This season makes me feel closer to something that keeps me going forward: the notion that the disintegration of parts of my body is part of the deal I have made to give it the best chance to no longer provide a place where cancer cells can grow and divide.

Maybe the tinnitus will linger and I worry about my thumping heart because breast cancer chemotherapy can cause damage to this organ.

My hair, my eyebrows, my eyelashes, my taste buds and my appetite will return in the new year, and I will soon be back in the world

But my hair, my eyebrows, my eyelashes, my taste buds and my appetite will return in the new year, and I will soon be back in the world, always grateful for the science that keeps me there. That keeps all its beneficiaries here.

One last thought. I am lucky enough to work for an organisation that supports me as I go through this demanding journey. I am still working but when I need to recover from the latest infusion, or the queasiness and diminished appetite leave me unable to be part of an online team meeting, I am able to rest without worry.

It’s not this way for everyone and I am especially thinking of domestic workers in South Africa and what a treatment journey like mine might mean when you have no choice but to use public transport to get to and from the hospital (and are not lucky enough to be collected in a taxi paid for by National Health Insurance, as I am).

And what if your employer doesn’t keep paying you while you go through chemo? How do you cope with the effects of the treatment while worrying about paying rent or buying food?

Every year 2.3 million breast cancer cases are diagnosed, according to the World Health Organization, making it the most common cancer globally.

In South Africa, apart from non-melanoma skin cancer, breast cancer is the most common cancer in women of all races, with a lifetime risk of one in 26 in South Africa, according to the 2022 National Cancer Registry. Providing structural support for women in these unprotected financial situations is more than urgent. It’s a human right. DM

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South Africa

Serious medical diagnosis

‘Sometimes you just want to scream or shout or cry’

Anthems to Blast Cancer Collective