Episode 8 – Instincts and Action with patient Rebecca Walker

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. Nicole 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. Yaps 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 it’s 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. Today Dr. Yap and I are going to be talking to Rebecca Walker. Rebecca has undertook something that is regarded as one of the greatest tools in cancer these days, which is actually understanding and listening to your gut. Dr. Yap, you saw Rebecca after she had been to a GP in regards to breast detection. Can you both fill me in on what happened?

Dr Nicole Yap (01:31):

Well, actually you had a friend, didn’t you who was diagnosed with breast cancer at the age of what?

Rebecca Walker (01:37):

She was, early forties when she found out she had breast cancer.

Dr Nicole Yap (01:43):

And you’re…?

Rebecca Walker (01:44):

37 now, I was 36 when I was diagnosed. Yeah. So yeah I went and had an ultrasound done on a couple of lumps that I was worried about and I was told there was nothing to be concerned about, but it didn’t sit well with me at all. So I was still concerned, especially after my friend was diagnosed. So yeah, I went and saw Dr. Yap and she sent me off for some further testing and they did find a tumor in my right breast.

Wendy Squires (02:10):

Thank goodness she did that.

Rebecca Walker (02:12):

I was very lucky. So they found it quite early and I was able to yeah.

Wendy Squires (02:16):

So Dr. Yap what did you advise Rebecca?

Dr Nicole Yap (02:19):

Well, because this was an unusual situation. She had an ultrasound and I read ultrasounds as well. And we know that under the age of 50, ultrasound sometimes misses 10% of breast cancers. Not for any other reason, except their look. They have sonographically benign features. And this was the case with Rebecca, but it did correspond, these nodules that she could feel, corresponded to the ultrasound findings. So I thought, well, if you can palpate it and you can see it, better get it biopsied.

Wendy Squires (02:59):

Can I ask what palpated means?

Dr Nicole Yap (03:01):

To feel it. I can feel a lump. So if I palpate my breast, I can feel certain things, that means I can feel lumps.

Wendy Squires (03:09):

Yeah. So what was next?

Dr Nicole Yap (03:13):

Well, we had a diagnosis of multifocal, meaning a couple of cancers there. So that’s very concerning in someone who’s got no family history and no other risk factors.

Wendy Squires (03:25):

And so young.

Dr Nicole Yap (03:28):

That’s right. I mean, how many people in their thirties. It happens, but it’s rare. And the issue is that it’s very difficult to work out someone who’s very slim, like Rebecca tend to have very lumpy breasts because there’s no fat that covers that the normal feel of your breast tissue, which happens to be lumpy. So you can’t tell whether that lump is a cancer or your normal breast tissue. So we had a long chat about that. And I said, well, if it’s so difficult to find on this occasion, what about the next occasion? When you get another new one, because at some stage being so young in Rebecca’s life, she will probably develop a new breast cancer. And so we made that a concerted effort to decide, to do a skin-sparing, nipple-sparing mastectomy with immediate prosthetic based reconstruction.

Wendy Squires (04:24):

So that just on one breast?

Rebecca Walker (04:25):

I had both of them done at the same time.

Wendy Squires (04:28):

Which realistically is wise, isn’t it? When you are this young and you’ve already presented with breast cancer.

Dr Nicole Yap (04:35):

Well, because this was almost missed. We don’t want to go through that situation again where it will be missed probably the next time. So even though I do follow up everyone after they’ve had breast cancer forever, I think it’s really important that we don’t fall into that situation again, we don’t need another one. And also we can make them look symmetrical.

Wendy Squires (04:56):

Was it a big decision for you? Did you have to talk about it with your family?

Rebecca Walker (04:59):

I did, but it was pretty easy in the end. Yeah. We decided we didn’t want to have to go through that ever again. And hopefully that’ll, yeah. Now we never have to worry about it.

Wendy Squires (05:08):

Oh, isn’t that wonderful. And how do you feel about your breasts now? What did Dr. Yap weld her magic [crosstalk 00:05:15].

Rebecca Walker (05:15):

Yes. But they started, yeah. It was only six, seven months ago that I had them done. So yeah. They’re starting to feel more like mine now.

Wendy Squires (05:24):

And were you happy with their appearance before?

Rebecca Walker (05:27):

I didn’t really have much breast tissue at all. Did I? So yeah. Yeah. I’m happy with the way it’s all turned down.

Wendy Squires (05:35):

Yeah. And what did you actually do to Rebecca’s breasts?

Dr Nicole Yap (05:38):

Well, I removed the breast tissue by an incision that’s hidden that sits underneath the breast tissue and the actual breasts now, as it’s sits. And once that was removed, we also did a lymphnode biopsy, which fortunately was negative for any disease. And then inserted a new prosthesis into the area so that it covered the space left behind. And we kind of filled them out after the breastfeeding drip.

Wendy Squires (06:08):

The breastfeeding drip, you just had children did you?

Rebecca Walker (06:12):

Yeah, I’ve got three, but they’re not young anymore. They’re 9, 13 and 15.

Wendy Squires (06:16):

Yes, they do. It does take its toll on us doesn’t it. So I’m really interested to ask you Rebecca, like if you think about it, I mean, it must be terrifying to think about it, but if you hadn’t gone for that second opinion, if you hadn’t trusted your gut. If you hadn’t pushed, because sometimes you feel silly after you’ve been to a GP and a doctor, someone has told you something, where do you think you’d be now?

Rebecca Walker (06:38):

I have no idea. And that is terrifying.

Wendy Squires (06:40):

Absolutely terrifying. I know that you are a huge advocate for women to understand and respect their gut and what it tells them about their breast. Would you like to enforce that for anyone who’s watching now.

Dr Nicole Yap (06:54):

That? Oh, definitely. I think Rebecca’s not the first person that’s come like this. I had another lady who she had felt a thickening, not even a lump. And the GP did a mammogram, not an ultrasound, just the mammogram, which was reported as normal. And she thought, “oh, well, it’s my GP. I should just stand by it.” But was still not sure and felt that thickening was getting worse. So she represented to another GP and they did an ultrasound and the ultrasound came back as negative apparently. So she then wasn’t happy and went further afield and ended up with me. And we ended up with an ultrasound, performed at a more breast specialist, radiology place. We found something really tiny that looked abnormal. And then I proceeded to do an MRI. Now an MRI is highly sensitive for diagnosing breast cancers.

Dr Nicole Yap (07:55):

So we know that if it comes back and it lights up, that it’s either going to be a breast cancer. It does have a 12% false positive rate. So we need to biopsy things. But if it comes back totally negative, I can stay with grate surety, you haven’t got a breast cancer. So with her, unfortunately it came back as extensive. She had eight centimeter diameter by that stage, breast cancer and had gone to her lymphnodes. So that was a bit down the track, which was a real pity she hadn’t come a smidge earlier. We might’ve stopped that situation from happening, which of course then led to having to go through a regime of chemotherapy, which is not the nicest thing on earth. And maybe if we’d caught it a bit earlier, she may not have. So this is why it’s really important to, if you really don’t feel, and she didn’t, she said all along, I wasn’t really happy with things. And I said, “well, too late, now the horse has bought.” So I haven’t said too much, but she knows that if she’d come a bit earlier, then she might’ve been in a situation like you.

Wendy Squires (09:03):

I’m wishing you all the best at this. Must’ve been a very life-changing experience for you.

Rebecca Walker (09:08):

Yeah, definitely. It’s definitely, yeah made me grateful for my health and yeah.

Wendy Squires (09:13):

I don’t think you’ll ever take for granted any lumps or bumps or…

Rebecca Walker (09:16):

No, and I won’t have to worry about that again which is nice.

Wendy Squires (09:21):

She’ll be checking that I’m sure as you go into the future. So thank you very much. And Dr. Nicole, I’ll see you next time.

Dr Nicole Yap (09:29):

Absolutely.