Breast cancer...

the other side of the story
The day a woman is diagnosed with breast cancer will be burnt into her memory for ever. How she deals with it can very much depend on the medical staff and their approach. Sarah Kilby asks four key female members of different cancer teams about their fight against the disease


Sue Jones is Associate Specialist Breast Surgeon at Maidstone Hospital in Kent. Aged 48, she is married to consultant breast cancer surgeon Peter Jones who is also part of the same breast cancer team based at Maidstone. Both also see patients privately at the nearby Somerfield Hospital. They have three children, Lottie 18, Sophie, 16, and Fred, 14.

The job
Sue is one of approximately 15 female breast surgeons working in the NHS. She sees patients two weeks after they have been referred by a GP (which is the recommended time specified by the Government). From the results of a mammogram, Sue has to explain what sort of cancer she suspects, and the type of surgery needed. At present, lack of operating space means that women in Sue's area have to wait up to six weeks for surgery. Maidstone Hospital has a strong policy of preserving the breast where at all possible, so most of Sue's operations are lumpectomies, plus removal of lymph glands, with immediate or delayed reconstruction.
How I unwind "At home, talking things through with my husband, Peter over a large glass of wine."
Most important lesson I've learnt "How to stress the positive."
Greatest reward of my job "Being able to reconstruct a breast during life-saving surgery, so that a woman never has to wake up without a breast."

"Most of the women I see have already found a lump themselves, or have been to see their GP with symptoms. So they already know that something is wrong, and their mammogram provides more proof. But the full picture doesn't emerge until after surgery, of course, so I have learnt to take my patients forward step by step.

"Even if I find unexpected complications when I first look at the mammogram, by the time I see the patient I am calm and confident. I say, 'As I thought,' and I explain what we can see on the X-ray, and what I suggest we do next.
"It's a huge amount for a woman to take in all at once: a) you have cancer; b) you will lose part, or all, of your breast and lymph nodes; c) you can have your breast reconstructed; and d) this is how I can do it. All this to someone who is still in a state of shock.
"Being treated by a multidisciplinary team provides a patient with a whole range of support. My colleagues, particularly the breast cancer nurses, can keep going over and over the information until it sinks in.
"The next appointment, which takes place about a week after surgery, can be the hardest of all if I've discovered something more serious during the surgery. Sometimes Peter and I do these meetings together, along with the oncologist. Time hasn't really made it any easier but experience has certainly taught me how to stress the positive. Its possible to give the whole truth: it's where you place the emphasis that counts. I can soften the worst news that it has spread by saying, 'I've taken out 15 lymph but it was only in one.
"It's hardest to deal with young women perhaps in their twenties, with young families. You know that any kind of cancer is so much more aggressive in the young. My heart sinks, even before I know the whole scenario. I see them sitting in front of me, and I think that may there's going to be a tragedy.
"It's really the breast cancer nurses and the oncologists, however who bear emotional brunt when there's a recurrence of the disease. But if I wasn't saving the lives of lots of women, I wouldn't do my job, it would just be too depressing.
"I do tend to take my work home - that's inevitable. What gets both Peter and I down the most is when an operation doesn't go entirely according to plan. We are both perfectionists and are very hard on ourselves. But at the end of a bad day we can talk it through, pour a large glass of wine and get on with the supper. We work very closely during my sessions, sometimes seeing patients together and unless the patient expresses a preference, we tend to share the list arbitrarily between us.

"My greatest reward is being able to reconstruct a breast and give a woman back her confidence. As a woman, I think I have a special understanding of body image; and during reconstruction of the diseased breast, I'm quiet happy to improve the patient's other breast at the same time, if she wants it. Our local newspaper recently featured an ex-patient of mine - a young police sergeant - who decided to have an implant in her other, healthy breast. She was courageous enough to go public with her splendid new bosom, which must have been an inspiration to other women.

"I'm really optimistic about the future of diagnosis - imaging gets more accurate every day, and using the most sophisticated ultrasound, a gifted radiologist can detect microscopic, pre-cancerous tissue. Sometimes I have to operate using a microscope to remove cells that are invisible to the naked eye. As techniques and early diagnosis improve it's becoming less necessary to remove a whole breast; a partial mastectomy or lumpectomy, plus radiotherapy achieves equally good results and is less traumatic".

Peter Jones, The Consultant Surgeon.(Sue's husband)

"Sue and I work in close proximity - we operate in adjoining theatres and often pause between operations to comment on each other's work. We've known each other a long time, and there isn't any competition between us. We often see patients together and pool our knowledge. "After we met, sue had to be more flexible with her career as I moved around hospitals, so that we could work in the same part of the country. She spent longer than average in surgical training and also worked in general practice, which added to her exceptional skills.

When I became a consultant at Maidstone Hospital, Sue joined me and helped me establish a specialist breast clinic. Sue, alone does all the reconstructive breast surgery here; I do fewer breast operations, because I'm also involved in general surgery, plus I'm on call for emergencies. With her seven, fixed sessions, Sue is better able to plan her time around the family. "However, I'm hoping to get the funding to bring Sue in as a full-time surgeon by the end of the year to deal with the increasing workload. "We each bring different strengths to the team, and we bounce ideas off each other. For example, Sue will ask if I think a particular breast is suitable for reconstruction, and I will ask her opinion on some of my cases. We rarely disagree - and then only mildly!"