Breast Cancer in New Zealand

Courtesy of My Generation.

More than 600 women die every year from breast cancer and New Zealand has one of the highest incidences and the third highest death rates from the disease in the western world. But, huge changes have been made in treatment and attitudes over the last three decades, as Robyn Yousef reports.

A diagnosis of breast cancer 30 years ago in New Zealand was more often than not seen as a death sentence. Now 80 per cent of women in this country who are treated for the disease are cured, and the experts predict a cure for breast cancer within the next decade.

“Yes, a cure for breast cancer within 10 years – all the international experts are working towards that and I believe it will happen,” says Auckland breast surgeon John Harman.

Harman has witnessed a raft of advances in breast cancer treatment, including the introduction of needle biopsies for diagnosis. “In the past a sample was taken during surgery to see if it was cancerous or not and so women in recovery were clutching at their breasts not knowing the outcome.”

The accuracy obtained with a needle biopsy means a diagnosis is confirmed before surgery, enabling women to discuss and review their treatment options.

Breast surgeons are now also training in reconstructive surgery with the introduction of oncoplastic surgery, which combines plastic surgery with surgery for breast cancer. This development has also had an unexpected outcome. “With women now knowing the result of a reconstruction is so much better than it was 20 years ago, many are now opting for a full mastectomy when they could settle for a partial mastectomy or lumpectomy,” Harman says.

Another monumental change has been the use of sentinel node biopsy  – an injection given before the operation which identifies the first lymph nodes the cancer could have spread to, which can then be removed during surgery for testing.

In the past, all women had an axillary (armpit) surgery taking more nodes than a sentinel node biopsy. The sentinel node procedure minimises the amount of surgery and lowers the risk of complications like lymphoedema, which causes swelling of the arm. Harman says the removal of these lymph node often cause real damage (women who have had breast surgery often say this incision creates the most pain) and while it’s not suitable for all patients the number of women needing lymph node removal is now down to about two or three out of 10.

The introduction about 10 years ago of breast MRI as a screening tool for women who are at high risk for breast cancer has also impacted on treatment. “This is  very accurate and should be used annually with a mammogram and ultrasound for high risk women.”   Harman believes this method will be used more extensively as equipment becomes more accessible.

Another major step in New Zealand’s offensive on breast cancer was the introduction of 12 months funding for the Chemotherapy drug, Herceptin, back in December 2008. But, of course the major coup has been the launching of the free national breast screening programme, BreastScreen Aotearoa with free mammograms for all women aged 45 to 69.

“This has been huge. The survival rate for breast cancer in this country 15 years ago was 75% and now with the screening programme it’s 80% and improving every year,” says Harman.

But, apart from all those medical matters, Harman has seen a massive change in the general attitude towards breast cancer since he was an inky-fingered med student in Dunedin.

Breast cancer is no longer a disease , which is discussed in muted tones or kept as a family secret. Most New Zealanders now appreciate that while it still kills more people in this country each year than road accidents and has a devastating effect on so many, breast cancer, if it is caught early enough, is largely curable.

Read three stories from New Zealand women who are all long time survivors of Breast Cancer.