Dr. Sam Christian

Dr. Sam Christian

Her 3 year old son frolicked on her colleague’s lap. He was playing with Spanish teacher Alex Marquez’s phone. “I’m calling Mommy in heaven,” he kept giggling. In the pew ahead, his 8-month old sister was cooing, pulling at necklaces, hair, glasses or whatever was within range of those cute, baby fingers. A trail of teary-eyed teachers took turns trying to comfort the little innocents, who for now, needed no comforting.

Not being the treating physician, I am not privy to specifics of this case. So when Aisha’a father, Mr. Sylvester Mark came to my office simply to say thanks for sharing in their time of mourning, I had no choice but to respect his wishes. More than anything else, he wanted to do whatever he could to save any other parent the pain of having to say farewell to a child this way.

So fast

All the Dominica Grammar School staff and students knew was that the energetic Ms. Aisha Valentine Mark had a beautiful baby girl in May last year. She had plunged right back into teaching with the same gusto with which she competed as a carnival queen contestant. She was so much in the thick of things during Independence celebrations that they were not too perturbed when she complained of some shortness of breath in early December. Next thing they knew, Christmas met her bravely battling in the ICU. A chest mass was responsible for her symptoms, but from where? Did it happen overnight, or was it related to her recent pregnancy? Irrespective, by the time her mid-February namesake birthday approached, we were celebrating her life.

Kathleen Cornelius, business teacher and breast cancer survivor, took it really hard. As Dominica Cancer Society president, and like those near and dear to Aisha, her world was rocked by the dizzying speed with which all this transpired.

If you are like the rest of us, you must be asking yourself, “Is it just me, or is the cancer rate really increasing?” Well, it is. Data from Health Information at Princess Margaret Hospital clearly confirms that. Environment Health officials recently resolved the asbestos scare at schools in the Bath Estate area. It turned out to be mould which was appropriately sanitized. They have not formally investigated the Dominica Grammar School for cancer causing agents. However, the entire staff remains concerned especially as Ms. Mark was by no means not the first teacher thus affected.

 

Breast cancer in pregnancy

So while this is indeed a terrible time, it is a very teachable moment. Pregnancy breast cancer most commonly affects women in their mid 30’s. At age 33, Ms. Mark would not have even had that first mammogram traditionally recommended at age 35. (If normal, the following one is usually at age 40 and annually/biannual thereafter).

Let’s be realistic about it, women who are not as ‘bosom-blessed’ are often ecstatic at how great they look during pregnancy. While this is a fairly natural response, it is precisely these same breast changes that mask lumps, making them harder to detect.  As a result, these lumps get noticed later and at a more advanced stage.  Mammograms are not as helpful in this time frame either because of the increased tissue density. Instead, doctors more frequently utilize ultrasound in order to avoid harming the fetus with xrays. Breast cancer in general is devastating enough. Breast cancer in younger, pre-menopausal women tends to be more aggressive. When occuring in pregnancy, it cannot get any worse – it’s breast cancer on steroids.

Why so dangerous?

The motto of Fire Services personnel is  “A child with a match is a child to watch.” An arsonist though, goes beyond that to do his dirty deed. Experts can tell from certain patterns whether an arsonist used an accelerant: fuel. In much the same way, the hormonal surges of breast cancer serves as an accelerant for breast cancer. It feeds the flames of a raging fire. Does that make sense? In fact, one of the most potent breast cancer medicines is the anti-estrogen, Tamoxifen.

Thanks to our frontline medical experts: pre-natal and delivery nurses, many lives have been saved by picking up a suspicious breast lump before it can do its dirty deed. Stakeholders passionate about early detection ensure that the word goes out far and wide in Dominica. But like the parable of the sower, birds sometimes come and eat some seeds before they can take root. Tried and true follow-up protocols can end up being replaced by myths and old wives tales like taking sea baths and such.

Treatment options

Monthly prenatal visits often highlight weight, blood pressure, sugar and leg swelling. Breast check-ups are occasionally relegated to a lower priority when this is actually the perfect time to reinforce routine monthly self examination. Even after delivery, lumps may be confused with mastitis and treated with warm compresses. 

All suspicious lumps should be biopsied. A lump found to be cancerous during pregnacy poses a real dilemma. Some doctors recommend termination of the pregnancy in order to go full speed ahead with chemotherapy and radiation which could harm the fetus. This option, however, is not in the Rule-book of conscientious people. Some have chosen to carry the baby to term and deal with the consequences. Again I am speaking generally here.

The bottom line is that mastectomy remains the only viable option during pregnancy, especially during the first and second trimester when the baby is being formed in the inwards parts. After delivery, it is consoling to provide reassurance to mothers that breast feeding is not a danger to the baby.

Pregnancy can take a serious physiological toll on the expectant mother’s body. Furthermore, they are not only increasingly suseceptible to the risk of abuse and neglect, but also to breast cancer at its worst. At the end of the day, even the wealthiest, most faithful and most diligent of us may not be immune, despite the best efforts at screening. 

Along the way, Pastor Randy Rodney met with Grammar School staff for prayer and counseling. Fr. Branker John in his moving homily focused mourners on the God of all comfort, the “Resurrection and the Life.” In that way, family and friends were able to better work through their grief and meditate on the circle of life. Mr. Sylvester and other loved ones were thereby able to bring themselves to a position where they could give thanks and praise – gratitude for the awesome joy that Aisha brought into all our lives.

Dr. Sam Christian is surgeon and health activist. He runs the Urgent Care on 137 Bath Road, which offers prompt medical treatment, surgery and acupuncture. He is radio host of the Medical Minute, Medical Adviser to the Dominica Cancer Society and author of the faith and fitness nutrition book, ‘Mannafast Miracle.’ Dr. Christian can be reached at 440-9133 or by writing to urgentcare.da@gmail.com.