For years Anastasia Stylianou had learned to live with her partial mastectomy, but then she went to Germany for reconstructive surgery. The operation transformed her life and highlights yet again the need for a specialised breast unit in Cyprus
ANASTASIA Stylianou was diagnosed with breast cancer almost 10 years ago. As part of her treatment she was given a partial mastectomy, followed by six courses of chemotherapy and 33 of radiotherapy. Two months ago she flew to Germany where she underwent 10 hour breast reconstruction surgery.
Although the mother of two does not complain about how her case was handled by local doctors, her experience drives home the message of the importance of specialised surgeons and the need for a specialist breast unit in Cyprus.
“It was 1999, around the eve of my wedding anniversary. I was lying in bed when I felt a lump in my right breast. I asked my husband to feel it and he told me it was nothing,” she said.
That night Anastasia couldn’t sleep. A friend of hers had been diagnosed with breast cancer just a few weeks ago after finding a similar lump in her own breast.
“I’d been to my gynaecologist two months earlier and he’d found nothing so I decided to go and see a surgeon directly. He advised me to have an ultrasound to determine whether I might simply have a cyst,” she said.
But the ultrasound results were inconclusive and it was recommended that she have a mammogram to be on the safe side.
“The mammogram showed nothing. I took the results to the surgeon and he told me to go home and forget about it and to come back in six months for another check up,” she said.
Instead of waiting, she asked a family friend, who was an oncologist, to examine her.
“She said it was probably nothing but contacted the surgeon and asked him to operate because it was something that wouldn’t go away and it was best to investigate it,” she said.
Prior to the procedure her surgeon did not discuss what he planned to do. Nor did she receive any information about what to possibly expect when she woke up.
“I remember the last thing I heard the doctor telling me minutes before wheeling me into theatre and putting me under general anaesthetic was that if it was malignant he’d remove my lymph nodes. Up until that point he’d told me it was likely nothing and now he was saying he was maybe going to remove my lymph nodes.”
When she woke up, Anastasia said she reached over and touched under right armpit to see if the lymph nodes been removed.
“I thought if I didn’t feel anything I’d know if it was bad news or not.”
Her doctor informed her that he’d performed a partial mastectomy and removed 11 lymph nodes.
“It was a huge shock. I suddenly had virtually no breast left… He said 99 per cent I was better and that it was up to me to keep a positive attitude.”
Anastasia spoke to her surgeon a few days later to discuss the results of the biopsy on her tumour.
“He said I didn’t need to do chemotherapy and I was thrilled.”
When she next went to see him, he apologetically informed her that he’d made a mistake.
“Oh no Anastasia I’m sorry. I’d been looking at the wrong results. You do need chemotherapy.”
Knowing what chemotherapy entailed and its side effects, Anastasia became frightened.
Her fears were soon laid to rest when she met with her oncologist at the Bank of Cyprus Oncology Centre.
“He immediately gained my trust,” she said.
During her treatment she flew to the UK for a second opinion where she was told the treatment she was receiving in Cyprus was the right one.
“It was an exhausting time. As well as the treatment, I had a lot on at work and I didn’t want to show anyone I was sick and tired and so they gave me even more duties which I didn’t turn down.”
Over the next year or two, Anastasia would look at other women and envy that they had a pair of breasts. At no time was she advised to undergo breast reconstruction surgery. When she brought it up one doctor actually asked her what a woman of her age wanted reconstruction for and was it because she planned on finding herself a boyfriend.
“As the years went by I got used to it and didn’t think about it. I had special bras and bikinis so it didn’t bother me too much. Then about a year ago a friend of mine urged me to look into having reconstruction done.”
The problem was that having had a partial mastectomy meant reconstruction was more complicated. Although local doctors later fitted her with a silicone breast implant, it never fitted properly.
“The Health Ministry recommended I undergo reconstruction at a specialist breast clinic in Germany because the procedure I needed to undergo was so specialised and not something that could be done here.”
Anastasia said she nearly got cold feet and cancelled the 10 hour procedure.
Today she is glad she didn’t and is grateful to her plastic surgeon at the general hospital who recommended the clinic to her.
“It was an amazing experience. To go somewhere that is specialised and that they get the job done right from start to finish. The plastic surgeon’s role there is not cosmetic surgery. He said he only did reconstruction to fix a breast that had had a partial or total mastectomy,” she said.
“The doctors there co-operate with each other. The surgeon and plastic surgeon talk about their cases and patients’ diagnosis and treatment options are discussed.”
Her experience has taught her that a specialist breast unit is desperately needed here.
Today Anastasia said that having cancer taught her to love life.
“God gave me this disease to teach me to love myself and to look after myself. Before I gave all of myself to others and I tried to do everything myself. Now I’ve learned to ask for help and to develop my talents.”
Since getting cancer she has taken up salsa dancing, painting and was voted a municipal councillor for Engomi in 2006. She also loves to read, swim and walks daily.
The only reason she agreed to this interview was so that other women could read it and learn to love themselves and that if they ever faced a similar health problem to remember to look for what was the best solution for them.
She said: “I learned that I must never give up or take anything for granted because there is always room for improvement. As long as I’m alive there will always be room to make my life better. I am very active and happy with my life. Before I neglected myself, now I make more time for myself and because I’m more relaxed I can also look after the people I love better, especially my four-old-granddaughter Malvina, who is simply adorable.”
The Requirements Of A Specialist Breast Unit
(Taken from a short guide to the European guidelines for quality assurance in breast cancer screening and diagnosis)
Women must be offered quality care for all stages of breast disease, from the earliest stages detected in screening to the most advanced cancer, within one specialist breast unit, where the care and follow-up are provided by the same core team of specialists.
Minimum quotas
There must be one specialist breast unit for every 250,000 to 300,000 population.
The unit must be large enough to have a minimum of 150 newly diagnosed cases of breast cancer per year.
Surgeons in the breast unit must perform surgery in a minimum of 50 new breast cancer cases per year and attend at least one diagnostic clinic per week.
Radiologists must read a minimum of 1,000 mammograms per year, or 5,000 for those working within screening programmes. There must be at least two qualified radiologists in each unit.
A multidisciplinary core team
The unit must have a clinical director of breast services.
All members of the multidisciplinary team – including surgeons, diagnostic radiographers, radiologists, pathologists, oncologists, data managers and patient support staff – must have special training in breast cancer obtained by spending one year in a unit recognised for training.
All members of the multidisciplinary team must attend a multidisciplinary meeting, held a minimum of once per week, to discuss diagnosis, pathological findings following surgery and to evaluate treatment options.
Facilities and services
The unit must have the imaging equipment necessary to ensure complete and adequate breast diagnosis.
Radiotherapy and cytotoxic chemotherapy may be given within the breast unit or in a separate clinic or hospital. However, the treatment a woman receives must be supervised by the breast unit and all treatment decisions made by its multidisciplinary team.
An Advanced Breast Cancer Clinic must be held once every two weeks at the breast unit, involving the clinical or medical oncologist, and the surgeon must be available for consultation.
A breast unit should hold outreach clinics in the smaller hospitals if these are at a distance from the breast unit. Outreach programmes are preferable to small breast units in low population areas as they ensure that women receive expert breast care. Outreach clinics should be held at least once a month.
Special services
Women should receive practical advice, support and counselling from specialist breast care nurses or a core team member with professional psychological training. All units should have at least two staff members serving this function.
Other professionals who are not mandatory core personnel should offer services associated with the unit: psychiatrists for extra psychological support, plastic surgeons for breast reconstruction, physiotherapists to treat lymphoedema, clinical geneticists to assess risk, a palliative care service, and there should be prosthesis fitting service within the unit.
Quality assurance
Units must record data on diagnosis, pathology, primary treatment and clinical outcomes, and these data must be available for audit.
Performance and audit figures must be produced yearly and they must be compared to defined quality objectives and outcome measures.
