Life after breast cancer

Over the years, breast cancer has become one of the most researched and understood cancers. According to the BMJ, the average risk of dying from breast cancer within five years after being diagnosed and treated has fallen from 14% to 5% since the 1990s. For those diagnosed during 2010-15, six out of 10 women who have been diagnosed had a five-year mortality risk of 3% or less[1]. This means that women with a diagnosis of breast cancer commonly live long, healthy lives, and the question that begs answering is… what is life after breast cancer like? What is the impact on the psychological health of patients, and what does their long-term physical reality look like?

As with other cancers, chemotherapy is still frequently used; however, there are other treatments such as endocrine (hormone blocking) therapy, radiation therapy and biological agents that can also be used in the treatment of breast cancers. In this article, we discuss important questions about the long-term impact of these treatments.

Fertility and pregnancy

All breast cancer treatments have the potential to lead to deformities in the child or miscarriage. Many of the treatments significantly reduce fertility or result in an early menopause. Discussions pre-treatments are vital and fertility management options such as egg or embryo preservation are often recommended for the younger women that still want the option to have a child when in remission.

Bone health

It’s important that a bone-loss risk assessment is undertaken by the medical team prior to women commencing or at least during the breast cancer treatment. Women who experience menopause early due to exposure to chemotherapy have a higher risk of the bone-thinning conditions such as osteopenia and osteoporosis, due to the treatment effect itself and due to the lack of oestrogen. Post-menopausal women are at a greater risk, particularly if they are already in an at-risk category prior to treatment. Regular bone density tests, counselling on lifestyle changes and regular monitoring of bone health, are an important part of the treatment plan. Furthermore, these lifestyle changes and bone density monitoring must be continued post treatment.

Heart health

Cardiotoxicity is a well-known side-effect of traditional and targeted cancer treatments. Due to the increasing number of long-term survivors, the treatment induced heart disease and early atherosclerosis are being noted more frequently as potentially serious side effects. There is now a rapidly evolving field of cardio-oncology and cardio-protective strategies are increasingly discussed prior to treatment to mitigate the possibility of cardiotoxicity. Much is still not understood but there is increasing research effort to assist the oncological team in proactively protecting the cardiovascular system during treatment.

Psychological dysfunction

Emotional distress, including sadness/depression, issues related to personal appearance and the stigma related to the disease and sometimes the genetic predisposition to other cancers, are all realities to prepare for. It is important that every breast cancer survivor has a support team around them to help them navigate the complicated emotions during and post treatment. There are multiple studies that suggest that women who belong to a support group do better in the long term. This is another topic that is often ignored or bypassed by both healthcare providers and patients. There are so many treatment options available depending on the symptoms of the patient. Women need to remember that admitting that you have a problem does not make one inadequate in anyway or form… it makes one BRAVE and opens the door for many other women with similar issues to do the same.

Sexual dysfunction

The maintenance of normal sexual relationships is an important aspect of a fulfilled life, also and particularly for the cancer patient. Dysfunction is an extremely difficult topic for many women to acknowledge let alone discuss. Chemotherapy, endocrine therapy, surgeries, radiation therapy and the diagnosis itself all have a major effect in altering a woman’s sexual health and function and leave their traces not only on the woman’s body and mind but also influence the partner in the relationship. This new dynamic will often necessitate discussions with the inclusion of the partner. Relationship counselling is part of the initial disclosure of the diagnosis and in all further follow-up consultations.

It is also important for women to know that it is a common challenge and to feel comfortable in discussing any concerns with their preferred healthcare provider. There are many treatment options available that can be tailored to address the specific issues that the patient or partner may have.  Many treatment options also include the partner because shared counselling and understanding is often valuable.

It is insufficient that with the excellent and constantly improving healthcare options that are available that we can now offer our patients an unprecedented quantity of life without the quality-of- life that they deserve…there must be LIFE after breast cancer.

In summary, it’s important for the medical team to ensure that all patients are given as much information as possible at the point of diagnosis. Sexual health, self-esteem, fertility issues, bone and cardiovascular health should all be incorporated into the treatment strategy and supported by the multi-disciplinary team, so that life after breast cancer is filled with both quality and quantity.

[1] https://www.bmj.com/company/newsroom/most-women-diagnosed-with-early-breast-cancer-can-expect-to-become-long-term-cancer-survivors-say-experts/