Early diagnosis and a new approach to treatment

AS a doctor herself, 44-year-old Agata Dworak Kula of Cookridge, Leeds, knew how important it was to visit her GP when she noticed changes in her right breast in January this year.

A patch of skin had become dimpled, and, when she examined the area, Agata discovered a lump about 2.5cm across. Agata's GP immediately referred her to Leeds General Infirmary where she underwent a mammogram, ultrasound and biopsy. Within two weeks, breast cancer had been diagnosed.

Facing a month's wait before treatment would begin, Agata decided to have her treatment privately at Spire Leeds Hospital. Two days later, she went to see consultant breast and reconstructive breast surgeon Philip Turton, who decided on an innovative course of treatment.

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Mr Turton advised Agata to undergo a six-month course of chemotherapy prior to surgery. Although not suitable for treating every case of breast cancer, Mr Turton felt that in Agata's case, the chemotherapy would reduce the size of her tumour enough to allow the mastectomy (breast removal) and breast reconstruction to be carried out during a single operation. The chemotherapy treatment was delivered by Dr Timothy Perren, consultant oncologist at Spire Leeds Hospital.

Regular MRI scans enabled Dr Perren to keep track of and modify the treatment.

By August, Agata was ready for her surgery, and Mr Turton carried out the mastectomy. As the chemotherapy had been so effective, he was able to keep all of her own breast skin to enhance the reconstruction. He also removed all of Agata's lymph nodes on the right side as a precaution, since the cancer was found to have spread to two of them.

During the same operation, Mr Turton reconstructed Agata's breast using muscle from her back (called a latissimus dorsi flap). He plans to reconstruct Agata's nipple at the end of this year, once the breast has had a chance to settle.

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Agata says: "The pain was managed very well, and the doctors and nurses were excellent – someone was always available straight away if I needed anything."

Helping Agata through the whole process was a specialist breast cancer nurse who explained the treatment and provided helpful information such as where to buy wigs or specialist bras.

"Having a nurse to support me was very reassuring. She telephoned me after each chemotherapy session to check how I was, and even arranged for me to meet a woman who had already had the same surgery so that I could ask questions and see the results."

Agata's school-age daughter has been staying with her grandmother in her native Poland, which she normally does every summer, and has taken the news about the cancer calmly.

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Follow-on treatment includes a three-week course of radiotherapy. She will also have clinical examinations of her breasts every three months and an annual mammogram of her left breast.

Mr Turton said: "Agata was relatively young to develop breast cancer, which is quite unusual. Thankfully, she spotted the lump in the early stages which always improves the chances of success in treating the cancer.

"It's really important for women to check their breasts regularly for any signs of change and to see their GP immediately if anything seems different."

Nearly 46,000 people in the UK are diagnosed with breast cancer each year – one person every 11 minutes.

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Spire Leeds Hospital has produced a free mini-guide on carrying out breast examinations. Email [email protected].

THE SYMPTOMS

Changes in breast size and shape

A new lump or thickening in one breast or armpit

Changes in skin texture such as puckering, redness/soreness or dimpling

Changes to the nipple such as becoming pulled in, changing shape, pointing differently or a rash appearing

Discharge from one or both nipples that is not milky

Constant pain in the breast or armpit

Swelling under the armpit or around the collarbone

Although survival rates for breast cancer are getting better, breast cancer itself is becoming more common. Women who are over 50 and have been through the menopause are at a higher risk as are those with close family members who have had breast cancer, especially at a young age.