I was diagnosed with breast cancer when I was 40. I was working as a consultant breast surgeon and married to the man of my dreams. Life couldn’t have been better. I remember howling on the sofa, I thought it was the end of the world. When I got the results of my biopsy my consultant was crying, my husband was crying. But I felt like I was looking down on someone else. Like, it can’t be real.
I was only 40, so at that time I had chemotherapy, a mastectomy, radiotherapy and hormone therapy in the form of tamoxifen. As a surgeon, I was expecting the physical symptoms, but the instant menopause because of tamoxifen was the hardest thing. I had brain fog and headaches, insomnia and joint pain, and I knew nothing about the impact it would have on my relationship, my job and my entire life.
I think it’s fantastic that this new drug anastrozole is now licensed and available as a preventative treatment for women at high risk of breast cancer. Later on in my treatment, I was given this drug after a local recurrence because although it’s available now as a preventative drug, it’s been available as a treatment for several years. It makes sense for women like me with oestrogen-driven breast cancer to take it because it reduces the risk of our cancer coming back.
After cancer, the fear of it returning never completely goes away. I have just been treated for a second local recurrence, and have tried to reduce the risk of a third one by exercising, cutting down on alcohol and eating a healthy diet. To a certain extent, you have to accept that despite the drugs, another recurrence is out of your control.
Now post-menopausal women at high risk of developing breast cancer (which means having at least two relatives with breast cancer), have the option to reduce their risk by taking anastrozole. The drug has been shown in trials to reduce the risk of breast cancer by almost 50 per cent.
But I would urge women to consider their choice carefully. As a breast cancer surgeon, I’ve seen how hard the side effects of this drug can be for women and also suffered from them myself. Essentially, it takes away the last remaining bits of oestrogen that post-menopausal women have, and some of them go on to have extreme menopausal side effects as a result.
That means severe aches and pains in their joints and muscles because oestrogen is a natural lubricant. Without it you feel stiff, have a much higher risk of bone fractures, hot flushes and night sweats, no sex drive at all, a painful dry vagina and an increased risk of urinary infections.
So I think women with a strong family history need to weigh up the pros and cons of those side effects very carefully and how much this drug will reduce their risk. As you get older, your risk of getting breast cancer can go down to that of a woman without increased risk, and you should be getting additional mammograms to pick up breast cancer at an early stage. Of course, not everyone will get bad side effects from anastrozole. For most of the women in the study, these problems settled down after a year, and not everyone suffers from them in the first place.
After having breast cancer, my partner and I had to find new ways of being intimate and deal with the depression and anxiety. The stress that cancer puts on a relationship is so hard when you don’t feel sexy, you don’t like how you look and you don’t want anyone to touch you. It takes time to learn to like yourself again before you can let your partner like you. Dermot and I have always been open with each other. We talk about everything and he understands; he’s great at listening. I’m very lucky to have that because I know a lot of women get divorced when this hits them; it’s too much for their partner to cope with.
The surgery was also a shock even though I was a surgeon. I initially had a reconstruction with an implant, but radiotherapy caused it to go hard and tight like a tennis ball. I had it removed when I had my first local recurrence of breast cancer and am now flat on one side. It took a while to come to terms with my post-mastectomy body, and I’m lucky that I’m small-breasted, so it’s not that obvious. But I’m not ashamed anymore.
After treatment and recovery, I was forced to retire early at the age of 43. I still suffered from chronic pain, and I lacked the strength for surgery.
I missed helping people, but I now use social media to debunk claims about behaviours, food and supplements that some people claim can cause or prevent cancer. I also wrote a book [Under the Knife], because I wanted people to understand what life is like as a surgeon. Exercise got me through treatment and helped me cope with the mental and physical side effects of everything I’d been through.
In July 2023, six months after my mum died, my cancer came back with another nodule near my mastectomy scar. I had more surgery, and more radiotherapy and started targeted therapy to try to stop it from happening again.
I’m not going to lie. There were some dark days. The illness I’d devoted my life to treat had robbed me of my breast, my fertility, my libido and my job. By talking and writing about how I overcame the challenges of a cancer diagnosis I’ve gained a new purpose in life.
Exciting new treatments and discoveries for cancer are coming all the time. I wouldn’t have been offered anastrozole as a prevention treatment anyway as I had no family history of breast cancer. But if I had been high-risk and offered anastrozole as a prevention treatment, my personal feeling is that I wouldn’t have gone through with it. I would do everything I do now. I would examine my breasts regularly, go for mammograms, maintain a healthy weight, exercise and cut down on alcohol, as we now know that those things can also drastically cut your risk of getting cancer.
But life is unfair, you might do everything right and still get cancer. What I’ve learned, and it’s taken me five years to get to this place, is that I have to accept the risks, look for the fun and get on with my life.
As told to Laurel Ives
Under the Knife: Life Lessons from the Operating Theatre by Dr Liz O’Riordan is out now. For more information on breast cancer visit liz.oriordan.co.uk; breastcancernow.org.
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