Episode 10 – Bonus Episode with Dr Nicole Yap and Wendy Squires

Wendy Squires (00:10):

Welcome. My name is Wendy Squires. I’ve been a journalist for more than 30 years specializing in women’s health issues, which is why I have the great honor of introducing highly respected breast doctor and surgeon, Dr. Nichole Yap. She’s an expert in oncoplasty, which involves removing cancers with pleasing aesthetic results for patients. Training in both plastic and general surgery, Dr. Yap’s breast techniques were refined whilst working at the European Institute of Oncology in Milan at the Royal College of Surgeons in London and working with world-renowned experts in Paris and Leon. Amongst her many accolades, Dr. Yap is the former deputy chair of the Royal Australasian College of Surgeons, and is representative on the Cancer Council, Victoria Medical and Scientific Committee. She’s also a Pink Hope expert advisor and Vice President of the Medico-Legal Society of Victoria.

Wendy Squires (01:04):

Dr. Yap, it’s been fascinating talking to you. It’s now Breast Awareness month, and I think it’s really important that we ram home the importance of checking your breasts. But first off, I just want to hear from you that breast cancer is no more the death sentence that we thought it was in the past.

Dr Nicole Yap (01:24):

Well, that’s so true, but we have to get our figures better than the 6% they are quoted in the Western world. I think that’s really important. The only way to do that is that we don’t know how to prevent it because we don’t know all the risk factors involved apart from family history, and it’s a bit hard to change your parents. At the end of the day, we’ll have to find other ways and the research will continue. In the meantime, what we can do is if you do get diagnosed with breast cancer and are unlucky enough in that situation, we need to see you very early in the pace, because we do have the ability now, both with surgery and other adjuvant treatments, such as chemotherapy, targeted treatments, we’ve got a lot more targeted treatments. The prime example is the Herceptin drug, but there are others out there. And also endocrine treatments such as antiestrogens and radiation treatment that will allow you to live a really good, healthy and fulfilling life. That’s relatively cancer-free, but you always have to be vigilant.

Wendy Squires (02:42):

I think another interesting factor having spoken to you extensively on this subject is the fact that women do not wind up mutilated, or they don’t necessarily have to lose their hair through chemo. That changes, like the oncoplasty that you use, are amazing in terms of restoring or even making the breast better than appearance by the end.

Dr Nicole Yap (03:07):

Yes. Well, I’m hoping that message will get across because if it does, then people will present early, that will make them present early. And also if they do want aesthetic surgery, be it a reduction, a breast lift, a breast augmentation, that as you can see from our series, there’s quite a few people that present to me for those reasons, and I just happened to incidentally find a breast cancer, which is early, early, early, and so there’ve been so fortunate in that respect. It’s almost good to come in. You’re not vain. You come in with anything you like as far as the aesthetic side of things is concerned and you never know, we might also find a cancer very early and you will get treated for both situations.

Wendy Squires (03:53):

Some of the people we’ve actually been speaking to throughout this series are actually happier with their breasts, even though they’re been through- they have suffered cancer.

Dr Nicole Yap (04:02):

Yes, and aren’t they the happiest breast cancer patients you’ve seen? It’s amazing that all of them are so happy, and they’re the ones that have been diagnosed with breast cancer. Where else are you going to see that? You look up all these forums and you can see, I look up the Instagram posts and all these people that are so upset about their situation and it affects their family, their friends, their children, their whole life. But if you can create a super happy person because you can make them look and feel better, as well as treat the oncological aspects. It’s a win-win.

Wendy Squires (04:41):

It’s paradoxical really, isn’t it? That a lot of women put off looking after their own health to look after said family, husband, business, but realistically, the sooner you get to it, the sooner you can get back to it and save everybody the grief in the meantime.

Dr Nicole Yap (04:57):

Yes and if you don’t, then you’re not going to be there to look after them in the future. And that’s what I have, that’s a take home message. If you don’t sort out your own health, you can’t look after everyone else because it will be too late.

Wendy Squires (05:11):

Yeah, it’s Like putting the oxygen on yourself first when the plane’s going down in a way. Really?

Dr Nicole Yap (05:15):

Yes.

Wendy Squires (05:16):

And what about women who are breastfeeding? I know that a lot of women feel the pressure to breastfeed their baby for a certain amount of time, but if they feel something in their breasts…

Dr Nicole Yap (05:27):

Well, it’s a good time to feel something because they’re more breast aware because they’re breastfeeding. So don’t ignore it. And most of the time, just for the records, most people with breast lumps in this situation, it’s benign. It’s probably a blocked milk duct, but get it checked to make sure that’s all it is.

Wendy Squires (05:49):

Yes, and get rid of that underlying stress.

Dr Nicole Yap (05:50):

Well, that’s a problem with my very good friend who succumbed at a very young age. She had breast cancer when she was pregnant, and of course at that stage, the breasts were changing because of the pregnancy so it was very difficult to ascertain. Is it just the change from the pregnancy and the hormones that are changing because of the pregnancy? Or is there something else? And so she fortunately lived at least 10 years following that diagnosis because she presented to a surgeon and was diagnosed and treated to some extent. I think it’s really important that you don’t think “Oh, it’s because I’m pregnant or I’m having hormone changes or I’m on IVF.”, for example. IVF patients have the same issues, their breasts change to these sorts of situations you can never know until you get it checked. If you need a biopsy and you always biopsy a new solid lump.

Wendy Squires (06:57):

We also always know that prevention is better than cure in so many ways. Can we just recap the great tools that are out there now to help assist in your prediction of contracting breast cancer?

Dr Nicole Yap (07:10):

Yes. First of all, as I said, any breast symptoms, so lump nipple discharge, nipple retraction, skin dimpling, [inaudible 00:07:19] changes, even breast pain, get your breasts checked. Secondly, if you have a strong family history of a breast cancer, speak to a professional and see whether it’s worthwhile getting genetic testing. In some instances, it may or may not be, but certainly if you have a strong family history, you need to be followed up more regionally than just every two years with a mammogram. And thirdly, if you just feel, you just want to be checked because your friend, someone in your family has had breast cancer, you might be younger like in your thirties, don’t take any health professional’s view that you’re too young. Don’t worry about it. Stand by your guns and just get everything done, which means clinical examination, mammography, looking for pre-cancer change and a bilateral breast ultrasound.

Wendy Squires (08:15):

I think some of your patients today have shown too that the importance of a second opinion and that if you are not happy and you sense that something’s wrong with your breasts and you’re not happy with the answers that have been received, what do you do? You get a second opinion.

Dr Nicole Yap (08:32):

That’s correct.

Wendy Squires (08:33):

And you know in summary, obviously you’re highly specialized in your field. I think it’s important for women to know that sometimes GPs aren’t as specialized in this field. What would you recommend for someone who’s been to a GP that said, “Don’t worry about it, it’ll go away”, and they go home that night and they still feel something’s incredibly wrong?

Dr Nicole Yap (08:53):

Well, a second opinion from a breast specialist won’t go to waste. It will definitely not go to waste. They may reiterate what the GP said, which is great, and that’s fine, so long as they follow through all the things I’ve suggested the proper examination and investigations. And then if you’re not even happy with that [inaudible 00:09:19] third opinion, you have to know that what you feel has been thoroughly investigated and you are not a hypochondriac.

Wendy Squires (09:29):

And you’re worth it. I think in this Breast Cancer month, we all need to remember that and that are breasts are areas of concern and can be, and they’ve really deserved vigilant looking after.

Dr Nicole Yap (09:40):

They definitely do, because breast cancer after skin cancers is the most common cause of cancer in females.

Wendy Squires (09:48):

Well, let’s get that right down, Dr. Yap. Thank you again for your time. It has been fascinating talking to you. I really enjoyed the experience and good luck with everything in the future.

Dr Nicole Yap (09:58):

Thank you, Wendy, and I much appreciate you coming onboard for raising awareness for breast cancer.