Imagine the shock of finding a lump in your breast at the very young age of 15 years old. Julia Shabalala’s world came crashing down. Was it cancer? Would she survive this? After much testing, she was delighted to find out that it was just a fibroadenoma, a mobile, benign breast lump. And for nine whole years, Julia believed she had dodged a bullet.
“In 2013, the whole situation came back to haunt me. I thought I was fine and that I would be okay. Instead, I was diagnosed with breast cancer. And not just any breast cancer – I was HER2-positive,” says Julia
“The only thing running through my mind was how I was too young to even be hearing all of this. However, it was too late; the results were in and I was about to walk into a whole new world – the oncology world,” she said.
Thankfully for Julia, breast cancer is one of the most well studied types of cancer and research has shown that if it is diagnosed early, there are more treatment options available and patients will experience a better chance of survival[i]. But this, of course, can only happen if you are equipped with the right knowledge.
What the general public might not know is that breast cancer is not just one disease, but many different diseases[ii] and knowing what type of breast cancer you have determines the most effective treatment approach[iii].
Your type of breast cancer is usually determined according to the status of three specific receptors (they are like the antennae) that sit on the surface of a cancer cell and receive signals that stimulate them to grow. These receptors are the oestrogen receptor (ER), progesterone receptor (PR) and the human epidermal growth factor receptor-2 (HER2)[iv].
Exploring HER2-positive breast cancer
In Julia’s case, she was diagnosed with HER2-positive breast cancer. With this form of the disease, the breast cancer cells in the body have a higher than normal level of this HER2 receptor, which causes the cells to divide, multiply and grow more rapidly than normal[v].
HER2-positive cancer is more likely to grow and spread faster, and is associated with a greater likelihood of recurrence, poorer prognosis and decreased survival when compared to women with HER2-negative breast cancer[vi]. Additionally, it is harder to treat and does not tend to respond very well to standard therapies[vii]. Knowing you have this type of cancer will significantly affect your approach to treatment.
Julia’s life was a whirlwind after receiving her HER2-positive breast cancer diagnosis. “You move from appointment to appointment, you feel guilty for missing work, you feel scared that you’re going to die and you feel the need to be brave for the sake of the people you love when all you want to do is take a moment to fall apart,” she remembers.
Julia underwent a mastectomy with immediate reconstruction, 16 rounds of chemotherapy over six months and radiation for six weeks every day. Additionally, she also had to undergo HER2-targeted therapy.
During her chemotherapy and radiation treatment, she experienced fatigue, nausea, her nails turned black and she experienced joint pain, water retention, insomnia and sensitivity to smell, among other things. However, HER2-targeted therapy was much easier. “It was draining for me mainly because it was an everyday activity, but otherwise, it was not painful,” she says.
To this day, Julia says she can’t quite remember what her life was like before her diagnosis. “My graduation, attending law school, the job I had found and had to let go of – all of it seems to have happened many years ago. No one can prepare you for the emotions that take over.”
As with most cancer patients, her support system was key. Friends and family helped her every step of the way, as did her faith and positive mind-set. Yet there is still one thing she wished she had in her life at the time – and that is more information.
“Looking back, I wish someone would have told me that it was possible for my fibroadenoma to develop into breast cancer at a later stage… and that even after chemotherapy, the journey would not be quite over,” says Julia.
Julia knew all she needed to know about breast cancer, but unfortunately, she knew nothing about what her HER2-positive diagnosis meant and how it would impact her treatment and outcome.
Think beyond pink – educate yourself and share it with others
This lack of information is precisely why Be Cancer Aware, Roche’s cancer information platform, is encouraging the public to think beyond the diagnosis (pink) and instead, ask the right questions and get the correct diagnosis, tests and treatment for their particular cancer. Make it a conversation point between friends and family – it may save a life.
As you may already know, breast cancer is the most common cancer among women, but about one in five of these women are diagnosed with HER2-positive breast cancer[viii]. Additionally, local statistics show that at least one in 33 South African women get breast cancer in their lifetime[ix].
With this in mind, Roche believes it’s important to get screened for HER2-positive breast cancer due to its aggressive nature. It is also harder to treat and requires more than just traditional therapy to treat it[x].
To successfully manage or treat HER2-positive breast cancer, patients will more than likely have to undergo HER2-targeted therapy (also known as biological therapy). This treatment works by attaching itself to the HER2 receptors so that the cells are no longer stimulated to grow. It also helps the body’s immune system, destroy the breast cancer cells.
Julia’s advice for other people in the same position? “Educate yourself about your breast cancer and insist on being tested for HER2. Know your treatment options and share this information with others – it can go a long way to creating awareness and spreading the word.”
Julia Shabalala is part of an initiative called Look Good…Feel Better. This programme assists women in managing the appearance-related side effects of chemotherapy and radiotherapy, thereby helping to restore their self-image and confidence.
Julia is an ambassador for Be Cancer Aware. For more information about HER2-positive breast cancer, the Think Beyond Pink campaign and Julia herself, visit www.becanceraware.co.za or join the Be Cancer Aware Facebook page.
[ii] Gene.com, (2014). Genentech: HER2 Disease in Breast Cancer. [online] Available at: http://www.gene.com/patients/disease-education/her2-disease-in-breast-cancer [Accessed 19 Sep. 2014].
[v] Gene.com, (2014). Genentech: HER2 Disease in Breast Cancer. [online] Available at: http://www.gene.com/patients/disease-education/her2-disease-in-breast-cancer [Accessed 19 Sep. 2014].
[viii] Background information: HER2-positive breast cancer. p. 1
[ix] Slideshow – Breast Cancer.
[x] Breast cancer: A guide for journalists on breast cancer and its treatment. p. 4