I Practiced What I Preach

By Dr Georgina Magoma

“The gap that stands out is what happens when an abnormal result is picked up”

This story has a happy ending. I promise.

For the past few years, I had been experiencing breast pain, more on the right side than on the left. At around the same time, I had started exercising quite a bit, so I thought the pain was probably due to a sore chest muscle. And even if it was not, I reasoned that perhaps, as a woman of childbearing age, it could be hormonal. So I brushed it aside.

I joined my medical oncology training about a year into experiencing these symptoms. With clinical practice and participation in tumour boards, I finally decided to get to the bottom of the pain. But I pre-empt myself.

Several breast examinations had made me concerned. I had felt what seemed like a thickening just under my right nipple and, on expressing, had noticed a bloody discharge. I panicked. I was not quite ready to deal with what the outcome might be if there was cause for alarm. Part of this was tied to my desire to have another child and in true occupational-hazard fashion, the worst possible scenario lingered at the back of my mind.

One afternoon, after running the medical outpatient clinic, I finally decided to get the issue resolved. For me, proceeding with the check-up was really about confirming that nothing was wrong and that I could continue with my plans.

For the first time in a while, I went for a medical check-up. I received two concerning results: one from my blood work and another from my breast ultrasound. The sonographer had picked up something. A small mass, BI-RADS I, he called it. He assured me it looked like a fibroadenoma.

This did not fully reassure me. I interrogated the report. It looked wider than it was taller, I thought. Good. But that alone was never going to be enough.

Three weeks later, I finally got an appointment with a radiologist who had been highly recommended by a breast surgeon I had consulted. During those three weeks, I was caught in uncertainty and fear. I sought reassurance wherever I could find it. By the time I walked into the consultation, I was convinced that the first ultrasound findings would be disputed. I expected to be told that my breasts were normal and that I could proceed with routine screening.

Then I would laugh at all the times I had allowed my thoughts to run to the worst possible scenario.

I thought this consultation would be the end of the matter.

To be honest, everything before and after the consultation was a blur. The doctor examining my breasts found a few cysts on both sides, which were not concerning. However, on the right breast, there was a dilated duct with a mass in it. She explained that just by looking at it, it was difficult to tell whether the cells were normal or abnormal.

A vacuum-assisted biopsy was recommended as the next step, rather than complete surgical removal of the ducts, which could affect a future breastfeeding experience.

Being on the other side of the consultation, as a patient, gives one insight into what our patients experience. No sooner has a “diagnosis” been made than the next steps are proposed and appointments made. In that moment, I felt there was very little time to process what I had just heard.

But I survived the day and the week before the procedure. I told myself: it is a ductal papilloma. I am young. The biopsy result will be normal.

The biopsy process was smooth and minimally invasive. The results were expected in seven days. The wait ended up being ten days.

Ten days of playing every possible scenario in my head. Ten days of mourning dreams and aspirations that could potentially be affected by an abnormal result.

When I finally received the pathology report, I rushed to the conclusion: no features of malignancy or atypia noted.

The report was forwarded to the breast surgeon, who reassured me and recommended routine screening going forward.

I would rethink going through the screening process again, not because I do not believe in early diagnosis and treatment, but because of the psychological toll that comes with waiting amid so much uncertainty.

But I am also aware that I write from a place of privilege. I received a favourable result. I had colleagues who pointed me in the right direction, explained things to me and reassured me at every step. I had both the national health insurer and a private scheme that catered for every medical expense.

Today, I think of the patients before me, the patients to whom I recommend cancer screening.

The gap that stands out is what happens when an abnormal result is picked up.

What referral pathways are available to them? Are they seamless, affordable and accessible to everyone, regardless of socioeconomic status? Is psychosocial support available after an abnormal result is identified?

The reality for my patients may be very different from mine.

I hope to be part of a system that strives daily to make these pathways as seamless as they possibly can.