Nine good days followed by nine bad days. No eyelashes, no eyebrows and no hair. No eating. Just vomiting, and no visitors allowed. Day 10, a miracle: she found the strength to go out again.
That’s how Safiya Patel, a 46-year-old woman living in Qatar, described her ordeal with aggressive chemotherapy treatment for her Stage III breast cancer.
“I begged my oncologist to stop because at that time my body was in so much pain. My oncologist would tell me, ‘just one more round of chemo to go, and I promise to lower the dose of medication and your body will be fine,’” said Patel.
Patel’s battle with breast cancer started in July 2013, when she felt a painful and noticeable lump on her left breast. At first, she brushed it off as kickboxing soreness and some kind of inflammation, but she later decided to take the matter more seriously.
“I have bad news. You have cancer,” Patel recalled how her physician told her the news. Patel had gone through a battery of tests at Hamad Hospital, including magnetic resonance imaging (MRI), a mammogram, ultrasound, and body scans.
Overwhelmed with the diagnosis, Patel tried to call her husband, but he did not answer, and she was left alone at that moment to grasp the weight of what she had just been told.
Apart from the radiation and chemotherapy, Patel also underwent a bilateral mastectomy, a surgical removal of both breasts, in order to prevent the cancer from spreading. The day after surgery, Patel was hooked up with sensor cables, needles and IV fluids, with nurses regularly coming to check on her. The wound site was opened with two huge drainpipes and a drain pouch. By this time, Patel had come to terms with being “opened, closed, prodded” and connected to cables. She had decided to do all that was available to be well again.
Having Indian roots and living in Qatar, Patel, a mother of three, knows of families where having breast cancer is seen as bringing shame to the family. While this is the case for many families, but certainly not all, Patel still hopes that more, if not all women will hold their heads high and be assertive with their health concerns, no matter the sensitivities surrounding them.
The stigma attached with breast cancer and the removal of breasts is also perceived by women themselves not just their families. Research in The Journal of Breast Health found that women view their breasts as a source and symbol of femininity, beauty and motherhood. It’s understandable then how a mastectomy would affect a woman’s both her body and her self-image.
“Being of Indian heritage and born in Zimbabwe,” Patel said, “I can say yes, some families will think having breast cancer is bringing shame, […] sometimes it is also fear and the unknown that may prevent women from having checkups.”
Lack of breast cancer awareness and acceptance remains a problem for women in Qatar, as many still refuse to get screened, according to Nancy Alaéddin, director of marketing and communication at Screen for Life, Qatar’s National Breast and Bowel Screening Program. This hesitance stems from a lack of awareness regarding the importance of screening, the stubborn fear of the screening itself and the ushering in of bad news, as if not knowing is better than knowing.
The daunting prospects of chemotherapy treatment and surgery are seen by many women as a reshaping not only of their bodies, but their social roles and perception of motherhood as well. Women like Patel are seen as trailblazers and exemplars for other women to freely come to grips with women’s health needs and all of the available measures that address their health.
Patel recalled when she had just undergone a mastectomy and was on her way for a post-surgery pap smear check-up at a clinic, she noticed an attempt to white-out the word “breast” on a brochure. This not only upset Patel, but made her think about how immature it was. The goal of the brochure was to promote self-examination and mammogram screenings, but “Why were they trying to cover the word breast? Is part of my body shameful to you?”
That fact has not gone unnoticed. Since the launch of Screen for Life, greater awareness has been raised and more than 23,000 women have been screened. More has to be done, however, as many women are still reluctant to share their experience with cancer or cancer screening, said Alaéddin.
Loss of Fertility
The aftereffects of treatment, such as not being able to have children, have led patients to experience emotional trauma, as they are not only perceived as less feminine but suffer from the common belief that their life has come to an end once they are diagnosed. Despite the challenges and struggles that women have had to face, some have managed to refuse to fall into despondency trap and use their strength to create a breakthrough in a post-treatment life.
Both globally and in Qatar, breast cancer is the most common cancer in women of reproductive age, and it may occur in young women before the completion of their reproductive plans, according to Nasser. “Although half of young women with newly diagnosed breast cancer, report interest in having children, less than 10 percent become pregnant after treatment,” said Nasser.
While screening is harmless, chemotherapy is not. Depending on the type of chemotherapy used, the dose, the age of the patient and her fertility status at the time of diagnosis, chemotherapy may cause damage to the ovaries, thus reducing the number and/or quality of eggs, according to Nasser.
“Women diagnosed over the age of 35 and receiving chemotherapy are more likely to lose their fertility by having an early menopause,” said Nasser. “Even if they don’t go through menopause and their periods return after chemotherapy, the menopause is still likely to happen sooner [5–10 years earlier] than if they hadn’t had chemotherapy.”
Women who have breast cancer also have positive estrogen and progesterone hormonal receptors, which means that the cancer cells grow in response to the hormone estrogen or progesterone. In these cases, hormonal therapy can cause menstrual periods to become irregular or stop and cause the ovaries to stop producing eggs. However, this does not automatically mean that younger women under the age of 35 will lose their fertility.
“Most women do not know that early detection means higher rates of survival and recovery (up to 90%) and that the breasts do not need to be removed totally. Even if a younger lady is affected and has to undergo chemotherapy and radiation, she will be able to have children afterward,” said Anke Ertan, an obstetrics and gynecology physician consultant at Preventive Medicine at West Bay Medicare.
Despite having to undergo chemotherapy and radiation after being diagnosed with Stage II breast cancer at the age of 24, Sondra Hope was able to have children after her treatment. Within two weeks of diagnosis, her doctors recommended that she should remove both breasts as a preventative. Given that the tumor was on her left breast, this led to her having a double mastectomy. Despite her mastectomy, the cancer had become Stage III after a recurrence in her left chest wall, eventually leading to Stage IV, the most severe and aggressive form of cancer, where it spread to her lymph nodes and both hip bones. While it has been an extremely difficult journey for Hope, her 6-year-old daughter continues to be her motivation to get past the challenges she has to face on a daily basis.
When Hope had first moved to Doha from South Africa with her husband, some of the first questions people would ask as a conversation starter was: “Do you have any children?” or “When are you guys planning on starting a family?” While she was aware that some of these questions were innocent as they were unaware of her situation, she does feel that the personal value as a woman is pivots on children.
“It’s almost as frowned upon [to not have children], like oh well it’s your duty,” she said. Hope believes that breast cancer and loss of fertility are perceived as a loss of femininity mainly because society how emphasizes a woman with her fertility.
Hope’s personal experience led her to realize that a woman’s physicality is something that is assumed and, in some cases, what people’s perceptions are based on. This causes her to question what would happen if someone walks past a woman with no breasts as opposed to one with large breasts.
“It will immediately be seen by others as something out of the norm. The question then comes in, is it us as women who feel we lose our femininity because of our breasts, or is it just because we know that society will view us less feminine because we don’t have our breasts?” she said.
Having to go through treatment and a potential mastectomy, women fighting breast cancer seek ways to re-explore their roles in society given their new health situation. Their re-exploration gives them a post-treatment reality in which they are able to reassert their role in society. This helps them shift from shrinking away from society and family life, and instead challenge stereotypical norms and expectations. Should they just stay home, take care of their family and cook? Do they go out and continue their attempt to seek advancement in their jobs? Do they continue their education? Or do they seek to find a supportive community?
Many breast cancer survivors in Qatar do assertively pursue a post-treatment life. Safiya Patel is a mother and branch manager of Starfish Lane Kids Nursery in Doha. Sondra Hope is a mother, nutritionist, wellness coach and creator of Yala Healthy, and Sandee Thompson is a language teacher and creator of Doha Wireless Warriors. All of them have had to deal with these stigmas difficult treatments associated with breast cancer.
After two recurrences with cancer, Hope needed to do something in order to take jurisdiction over her health, body and mind, since she did not have control over the cancer. Her medical situation caused her to lose a sense of control within certain aspects of her life, especially with her responsibility as a mother.
“Motherhood on its own is also a very out of control situation. It has humbled me, yet it has stressed me and it has caused me to suffer from severe anxiety,” said Hope.
Hope’s fight with breast cancer and undergoing treatment on a daily basis, changed her perception of motherhood completely. Her fight in staying alive has helped her explore ways of leading her own and her family’s life by being an active and present agent. “I have to be the strong one. I always have to be ok for my family, even when I am not okay,” said Hope.
Hope started her company Yala Healthy. Her aim was to create a place that made it easier, affordable, but also fun for people to be healthy. Through cooking, she was able to use traditional cuisine recipes as a way to recreate these dishes to be more organic and healthier, removing processed toxins and ingredients, that are found in many foods today.
Breast cancer survivors have found ways to empower themselves by using their struggles to come together and support each other. Sandee Thompson, who was diagnosed with breast cancer eight years ago and has had a double mastectomy, is part of an online group called “flat and fabulous.” Currently a Language Teacher at the College of the North Atlantic-Qatar, Thompson stresses the importance of this online support group in spreading the idea that having a mastectomy does not mean that a woman’s femininity is diminished.
“You need the support of other survivors who ‘get it,’” she said.
The journeys of women who have fought or are currently fighting breast cancer have challenged the singular transcendence of the role of motherhood within the Qatar community.
As the creator of Doha Wireless Warriors, a dragon boat racing group, Thompson said that the annual event is a safe place for survivors of every kind of cancer and for supporters who have lost a family member or supported a family member or friend through their diagnosis.
“It is a community boat. My message is simple: you are alive, you are stronger than you thought or than you knew, get in the boat,” she said.
It can be seen that these women within affluent societies are getting involved and turning disadvantages into advantages by combating complacency that many young women in Qatar have. But greater awareness of a post-treatment life is still needed, as there is a general lack of awareness regarding what patients can do after their mammogram screenings and during treatment and post-treatment.
Women fighting breast cancer need to be connected and find inspiration and hope with survivors who can guide them through what can be a terrifying experience and let them know there’s a light at the end of the tunnel.
“You are afraid for your life,” Thomson said. “Cancer doesn’t stop in your head after your initial treatment. It is there every time you think about needing your annual mammogram, every time pink October comes around, every time you have an unknown ache or pain,” she said.
It is clear that a shift in mindset and outlook on life has fueled the exploration of women’s roles in this society, and has helped the breakdown of barriers and stubborn perceptions.
“Breasts give your tee shirts shape, as my mother used to say, but they do not define the woman. The woman defines the woman,” said Thompson.