Christine Aziz discusses the treatment choices for breast cancer with sufferer Sarah Haynes and oncologist Dr Victor Barley

In the last decade, breast cancer treatment has improved - mastectomies are no longer routine, and women are surviving breast cancer for longer in increasing numbers. But how much of a choice do women really have in their treatment and in dealing with the side effects of orthodox treatment?

Sarah's story
In May last year, Sarah Haynes (41), a speech therapist and mother of nine-year-old Phoebe, discovered a lump in her left breast. It was malignant. Reeling from the shock of the diagnosis, Sarah, who lives in Kingston-upon-Thames, Surrey, was immediately hurled into a roller coaster ride of treatments. These included a lumpectomy, followed by radiotherapy and a distressing few weeks on hormone therapy. A year later she is back to normal, and has had time to reflect.

'After hearing that she has breast cancer, a woman has only two choices - either to take the orthodox route suggested by the consultant, or take the route of alternative therapies. For me that wasn't a choice. I just wanted to get the tumour out even if it meant losing a breast.

'I wanted every cell zapped'
'The surgeon said that as the lump had been found very early, I would not need a mastectomy. He said he would remove the lump and surrounding area of tissue and take the lymph glands from under the arm followed by a course of radiotherapy. He said I might need hormone therapy, depending on the type of tumour it was. Within a week I had had the lumpectomy.

My surgeon assumed this was what I would want and didn't present it as a choice. After the surgery I went to see the oncologist and he was fantastic. He explained everything to me. He said I wouldn't need chemo but I would need radiotherapy. Because I had an oestrogen receptive tumour he also recommended hormone treatment. I had a long discussion with him and he said some women refuse radiotherapy, but I wanted to give myself the best chance. I wanted to make sure that every cancer cell was zapped.

It's very hard to get to grips with what's going on as you are in shock for such a long time. It's important to feel you have some control over what is happening to you. In my case, the medical staff discussed everything with me.

Another way of feeling less powerless was to find ways to complement the orthodox treatments. I went to see a homeopath, who gave me several remedies which boosted my immune system and stopped me feeling so tired. Aloe vera gel significantly reduced the redness of the skin after radiotherapy and homeopathic remedies stopped my panic attacks.

'Not everyone is as lucky as me'
'The oncologist presented a choice of hormone treatments. I could take Tamoxifen orally for five years or have injections of Zoladex every three months for two years.

I really struggled with this. I was fed up and didn't want any more treatments. I was worried about the side effects. I said I needed time to think about it. I researched the treatment and talked to the breast care nurse and other patients. In December I decided to go ahead and opted for Zalodex because the treatment was shorter. I had dreadful side effects and felt really ill. I made a decision not to continue with it because I felt quality of life was much more important than having something I couldn't manage. I started a course of acupuncture and that was effective in getting the toxins out of my body. By May this year I was back to normal.

I wish in hindsight I had gone with my gut feeling and not had the hormone therapy. But I was really lucky with the consultant I had. Everything was explained to me and I wasn't pushed into anything. Not everyone is as lucky as me.'

Sarah's advice
Sarah says her treatment gave her several important pointers she'd like to pass on to other women on the verge of treatment for breast cancer:

• 'The most important thing is to get as much information as possible on the treatments that are being offered to you.'
  
• 'Don't be rushed into anything. A day or two is not going to make any difference.'
  
• 'Don't make a decision about everything at once.'
  
• 'Don't feel that what the doctors say is written in stone and can't be questioned.'
  
• 'Complementary medicine helps you feel more in control and can be very effective in dealing with the side effects of orthodox treatments.'
  
• 'Always have someone accompany you on your hospital visits. Prepare questions. One of you ask them, while the other writes down the answers, which can be discussed at home.'
  
• 'Researching on the Internet is fine, but you need people - nothing beats talking to patients and the breast cancer care nurse.'
  
• 'Go with your gut feelings at all times.'

Advice from the oncologist
Dr Victor Barley is a clinical oncologist at the Bristol Haemotology and Oncology Centre and is a trustee of the Bristol Cancer Help Centre. He advises:

'Treatment depends on the type of tumour a woman has and how long she has had it. There are choices between conventional treatments and I like my patients to be involved in which way they go. Treatment should be tailored to individual circumstances and needs. Some women are frightened of radiotherapy and feel more comfortable with breast removal, while others prefer a more totalised treatment with radiotherapy and local removal.

Some patients are not sure and I arrange to see them in two weeks' time to give them more time to think about it. The most frequently asked questions are about side effects, and if the disease is incurable - 'How long have I got?'

Breast cancer usually involves surgery of some kind. Radiotherapy can be given on its own but the cure rate is not so good. In any case you cannot make a diagnosis without removing the lump. A biopsy only gives a clue.

Respecting decisions
'Women do have choices in their treatment. For example, a woman who wants to have children and whose fertility may be affected by chemotherapy might choose to forgo that treatment. Some women prefer to have chemotherapy first to shrink the tumour before surgery, rather than afterwards. I would like to think that most doctors would respect a woman's decision.

I'm uncomfortable with patients being whisked away and not being given time to consider the treatments on offer. Treatments are determined by the type of tumour and where it's at. If it's a big tumour, then a mastectomy is most effective. There are lots of different scenarios and in general women like to know what the options are and like to talk about them for a week with friends, doctors and family. One woman was told by the surgeon to have a mastectomy, but after a week of mulling it over she told him she wanted a lumpectomy. He didn't agree with this, but respected her wishes. She had radiotherapy afterwards and is now leading a full and normal life. But there are women who say, 'Just do what you have to do.' And that's their choice, too.'

Resources
Breast Cancer Care
Breast Cancer Campaign