Is Breast Cancer Surgery Being Suspended Nationwide?

Hello Dedalus

I'm sorry that this is happening to you and your wife.  It's terrible news to get at the best of times, let alone at this frightening time in the world.

I am guessing that everything is a wait and see with regards surgery when it comes to COVID-19 and how each hospital is coping with the virus, so I am sure it will be different all around the country.  London seems to be particularly badly affected at the moment whereas my partner's Aunty was going into hospital on Monday to have 2 bunions removed! (Somerset - we are in Dorset).  Not sure if they cancelled on her, but it was still going ahead on Sunday.

If it's any help with regards timescales.  I had my first mammogram on 2nd June (back in 2017) and I didn't have an operation until 26th July. I nearly put it back until mid August and was told that I could quite happily do that if I wanted - so they clearly didn't worry that it would spread very quickly. My cancer was 15mm and hadn't grown in that time.  It was grade 2.  They measure growth rates by grade 1 - slow growing, grade 2 - intermediate and grade 3 - fast growing.  Your team will be know the grade of her cancer and will be able to decide how safe it is to leave it for the time being.  Mine hadn't spread to my lymph nodes.  I also had grade 3 DCIS of 54mm. (DCIS is 'pre cancerous cells', for the best way of describing it.  My cancer was oestrogen positive.  I hadn't been on any patches. I was obviously just 'high in oestrogen' in my body naturally.

ER+ (oestrogen positive) is the most common form of breast cancer and the 'best' form of cancer to have.  If it hasn't spread to lymph nodes, then for most people, chemotherapy isn't even needed, just radiotherapy.  Radiotherapy and the tablets are usually the belt and braces of treatment.  But if she is a low grade, not spread and whilst they estimate it to be small, she will be classed as stage 1 - I was stage 1 with a 15mm cancer.

I can understand your worry that they might treat her with the oestrogen reducing tablets first, but this will reduce the chances of the cancer growing as it is 'fired' by oestrogen.  I have been on Anastrozole (similar to Letrozole) for coming up to 3 years and I haven't suffered any bad side effects from them.  Each individual is different with how they react to the tablets and I guess she just has to hope that she will be, like me, one of the lucky ones.  I take mine with plenty of fluids throughout the day and I exercise a fair bit - I have a rowing machine - lucky now as we can only go out once a day.  Exercise helps to improve the mood which reducing oestrogen will naturally affect.

I feel blessed that I had it so long ago but if I were diagnosed now (and I'm sure our annual mammograms won't be happening this year!) then in some respects, I would be grateful if they could keep me out of hospital and 'tied me over' with a treatment to prevent it growing until such times as the hospitals are free of COVID-19.  I personally would be very concerned about going into a hospital now if I could avoid it.

If your wife's team feel that she has to have an operation, then I am 100% sure they will do it. It sounds as if they don't think it has spread to her lymph nodes either by the way they are talking.  So if it can be delayed for her own protection / lack of ability for them to carry it out, then it makes sense for them to assess her risk of not having the operation for the time being.

This is the advice from Macmillan: "Your clinician may want to review your treatment plans, including whether the risks involved in any treatment have changed. In some cases, this may lead to a discussion about a revised or modified treatment plan. This is because the risks and benefits of certain treatments may be different in light of the coronavirus (COVID-19) risk.

Hi Lesley

Many thanks for replying so promptly and in some detail.  Your comments were useful and helped to settle us a bit.

Your profile was also of direct interest re the stages and time frame of your treatments.

There are questions I would like to ask you re your treatment and experiences with Anastrozole etc, but feel I should possibly wait until we get the biopsy results.  I hope you don't mind me asking more questions in due course.

Unfortunately the specialist breast cancer nurse was quite negative concerning the availability of surgery due to COVID-19.  The doctor said they were looking at the possibility of surgery away from the hospital, (which I presume was through the takeover of a private hospital) but there was nothing more said than that!

I have been through all the stages of cancer treatment myself, but I find it emotionally difficult to contemplate my wife having to contend with these uncertainties at this difficult time.  She has had to cope with my treatment and 6 monthly CT scans, as well as recent significant surgeries herself.

Thanks again, and best wishes.

D  x

Hi Dedalus

I'm glad I was of some help to you and no, of course I don't mind more questions in the future.  

The waiting on results (as I am sure you know from your experience) is the worst bit and when you know the treatment plan the worries ease a little.  Although, at this time you and your wife have the extra worry and I really do feel for everyone having to go through it at this particular time.  I am sure the doctors are as much up in the air as everyone else at the moment - it just seems all so unreal at the moment with this pandemic doesn't it?  Added on to that, being diagnosed with cancer is enough to make anyone think they are living in a huge nightmare!

One thing I do know is that with me being ER+ and no spread, I found the worry of the treatment far,far worse than the actual treatment itself.  'Just' having the lumpectomy (wide local excision) and the radiotherapy was a walk in the park compared to my friend who was diagnosed a month after me with HER2 type and needed chemotherapy. I was back at work 2 days after my operation, drove myself 60 miles to and from radio and felt perfectly fine throughout it all.  She, on the other hand was off work for a year. They were talking about ER+ cancer - lumpectomy, tablets and just radiotherapy with me right at the start and everything that came back didn't change this, so I do hope it's the same for your wife.

Kindest wishes,

Hi,

I can't say how effective Letrozole alone would be for your wife but I do remember when I questioned my Consultant about the effectiveness of Hormone Treatment as the beginning of my cancer journey, him telling me he has patients who for some reason or another are unable to have Surgery and they do well on Letrozole alone.  I am on Femara, I was previously on Letrozole the generic, I have Arthritis which has become worse on the hormone treatment, it also affects my mood, which for me is the biggest side effect.

We learnt today that my Husbands Bladder Cancer treatment can't go ahead because of Covid-19, and they will look at his treatment again once the Virus is under control, he had a Stage 3 large tumour. He has accepted the delay more easily than I have.

It is another blow when their is such a change of plan, and piles on more anxiety.

Please keep us updated.

Best Wishes to you both.

Hi Peterawake

Many thanks for your reply.

Firstly, I am sorry to hear of your husband's situation, particularly as he has Stage 3 cancer.  I can empathise because I have a rare kidney cancer.

This COVID situation adds to already existing anxiety.  I feel these problems are not given much media attention.   We have to cope on two fronts. The politicians make a TV statement saying that cancer treatment will continue.  However, they don't elaborate on how certain vital treatments are excluded.

Thanks for the reassurance about those solely on Letrozole doing well.  If we extrapolate from that then perhaps it would be a good holding position until surgery could become available.

Is there anything that helps with the effect on your mood?  

I note that Femara is the brand name of Letrozole.

Thanks again

D 

They will also be testing if it is HER2 Like mine in which case drugs are used first prior to surgery.They need all the results to do an action plan,I was booked for an op but the HER2 result changed all of that.I also had to wait about two weeks for the results.

They will also be testing if it is HER2 Like mine in which case drugs are used first prior to surgery.They need all the results to do an action plan,I was booked for an op but the HER2 result changed all of that.I also had to wait about two weeks for the results.

Thanks Oscar TC

I haven't looked into the different breast cancer types so I don't know about HER2 yet.  I intend to find out as much as I can in preparation for the results in 2 weeks.

I must admit I am really struggling at the moment.  It is such an emotional time for the both of us particularly because of the two cancers.  I know we are not unique and this is a well trodden path.

If there was a painless oblivion button to push, I think we would both hold hands and push it!

D

Hello again Lesley

My wife is really panicking at the moment.  She has always believed in the benefits of oestrogen therapy, and indeed has experienced the benefits over the years.  She is terrified at what the combination of withdrawal and oestrogen blockers will have on her body and feeling of wellbeing.

We were heartened to read that you had little side effects.  How do you account for this?  What about low mood and painful joints?  I noted that you mentioned exercise.  Victoria Derbyshire also advocated exercise for painful joints.  

How well do you feel, and do you have any other tips to mitigate the side effects?  Do you think it is also down to your choice of drug regime?

D

  The oestrogen may be feeding the cancer,mine is not only HER2 but very oestrogen positive,even though post menopausal one ovary was still active,now wiped out by chemo.

    HER2 was once a hard one to crack,because of this a lot of research has been done into it and there is more and more to throw at it.Every few weeks more treatments appear in my professional journals.

     Stay safe