This month New Zealand's Breast Cancer Foundation celebrates 25 years of helping Kiwis fight the deadly disease. In light of the milestone, the Herald looks at how far we have come and how far we have to go.
Stories of hope: 25 years of fighting breast cancer
Diana was diagnosed with breast cancer just over 25 years ago, at age 36. Photo / Brett Phibbs
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"The way he said it was so cold, it was just like a matter of fact. I couldn't believe it. Not in a million years did I think it was cancer and suddenly I was preparing for my funeral," Mcilwrick told the Herald.
But she refused to accept that was her fate - for the sake of her kids.
"I couldn't bear the thought of them having a new mum and not being there for them," Mcilwrick said.
She had one option - urgent surgery to remove her breast and lymph nodes, then as much chemotherapy as she could handle before radiation covering her whole chest.
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There was no testing to see if the cancer had spread beyond her breast and lymph nodes - her doctor "assumed it had "but "hoped for the best".
Targeted treatment hadn't been available and wouldn't have been possible as doctors didn't know the type of cancer they were dealing with.
The risk of developing heart and lung disease later in life was also high as there was little that could be done to protect the organs during radiation treatment.
Funded breast reconstruction surgery wasn't available in the public hospital. Instead, she was offered "an uncomfortable sack" to put in her bra.
"I remember thinking 'how am I going to take my boys swimming at the beach? And thinking what if it falls out?' "
Looking back, Mcilwrick said she wished she had taken a photo of herself before the surgery.
"It all happened to quickly, I barely had time to process that after surgery I would have no breast."
She had chemotherapy every three weeks for six months after the surgery.
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"I'd be in hospital for four hours in the morning, then I'd come home and go to bed and virtually be vomiting for eight hours straight.
"I'd be really sick for about seven days and then just as I'd be coming right again it would start all over," Mcilwrick said.
Against the odds, the treatment worked and she has been cancer-free since.
"Getting cancer gave me a new perspective. No longer was I worried about what might happen. For the first time, I really started living.
"One day my husband came home from work and said he'd been offered a job in India and I immediately said 'let's go' so we did.
"I remember a friend saying my husband suggested we move to Auckland and freaked but after getting cancer I knew how short life was," Mcilwrick said.
Though she is grateful the treatment worked, Mcilwrick said she was one of the lucky ones.
These days, Mcilwrick's chance of survival would be a lot a greater, her doctor would have had a clearer idea of how much her cancer had spread and she would likely have targeted treatment options.
NOW: Carol's story - 'The big thing is getting rid of the fear'
For former nurse Carol Padgett, the thought of losing her breasts to cancer was terrifying. She opted for a different option - neoadjuvant therapy (NAT).
It's chemotherapy before - and hopefully without - invasive surgery to remove the breast. The treatment wasn't available 25 years ago.
"I decided if I was going to go for this option, then it was going to work," Padgett told the Herald.
Three months later Padgett is seeing encouraging signs.
"I saw my surgeon on Wednesday. He said the reduction in my tumour was amazing, it's working - I could feel that it was working after the first dose."
The 57-year-old found a lump "out of the blue" but, unlike 25 years ago, her diagnosis was a lot simpler. A mammogram and ultrasound located the tumour and a fine needle biopsy confirmed it was cancer.
She was then able to have an MRI and bone scan to see how aggressive the cancer was and if it had spread.
The tests showed it hadn't spread but the type of cancer was ER+/ HER+ which is high risk.
The positive side of confirming the type of cancer meant her doctors were able to treat her with specialised anti-HER2 medicine.
Surgery was the first option given but Padgett decided to do her own research and spoke to people who had been through breast cancer and come out the other side.
"The big thing is getting rid of the fear and getting your mind right to reduce the stress. Once you get a clear head about it and focus on the future it becomes a lot easier," Padgett said.
She found NAT was becoming a more common line of treatment in New Zealand and was showing promising results.
Traditionally, NAT has been reserved for those patients whose breast cancer is either an inflammatory subtype or inoperable.
But it's become increasingly common for patients with operable breast cancer to undergo chemotherapy first, particularly when it's likely the same chemotherapy would have been recommended for them after surgery anyway.
The approach can help shrink tumours to facilitate surgery and allows a real-time assessment of the sensitivity of the cancer to treatment.
After completing chemotherapy just last week, Padgett was now starting detox before doctors assess whether she will need surgery and radiation.
Padgett's hopeful that if it comes to that she will be able to get breast conserving surgery (lumpectomy) rather than a mastectomy.
However, if she does get a mastectomy she'll have a wide range of funded reconstruction options through a public hospital. The Breast Cancer Foundation is funding a pilot at Wellington Hospital testing the role of stem cells in fat grafting during breast reconstruction.
Though Padgett has been impressed by her treatment so far, she said there was still areas which needed improving.
"Being on the other side has been a real eye-opener. I think there is still a lot of groundwork to be done in terms of treating patients with respect and dignity.
"I still can't believe the lack of communication, for example different departments not talking to each other and I do think this is an area that could make a huge difference for patients."
THE FUTURE: 'We can advance targeted treatment even further'
In 25 years, a blood test taken at birth could indicate whether a baby will be at high risk of getting breast cancer later in life.
At the moment, New Zealand women discover breast cancer after feeling a lump or being picked up in the screening programme from the age of 45.
"We can identify to a degree women who are at higher risk due to family history but in the future we are hoping to refine that with genetic testing done at birth," Auckland breast cancer surgeon Eletha Taylor said.
This would mean people who are at high risk of getting breast cancer could get earlier and more frequent screening or could even be screened in a different way, such as a blood test, rather than through imaging, Taylor said.
"And some people may have a very low risk of getting breast cancer so may not need screening as frequently.
"At the moment we have a one-size-fits-all approach but in the future we hope it makes screening more personalised based on risk," Taylor said.
But this type of testing is still a long way off becoming a reality.
"Research is still very much at the early stages but some of the technology that could make it possible is there," Taylor said.
Collecting as much genetic data from as many New Zealand women diagnosed with breast cancer was the first step.
Already if a New Zealander has a family member with breast cancer, they can get a blood test to see if they have inherited the harmful mutation and have an increased risk of developing the deadly disease.
If the mutation is present, that indicates the person has inherited it from their parent and may pass it on to their own children - even if they don't develop cancer themselves. The result also means their full siblings have a 50 per cent chance of having the mutation.
Diagnosing cancer will become easier with the development of a liquid biopsy to give an exact profile of the tumour.
"This will mean we can advance targeted treatment even further."
Taylor said neoadjuvant therapy (NAT) - chemotherapy before surgery - will likely become more common after trials are conducted in Christchurch and Auckland.
The Breast Cancer Foundation last year funded the pilot of a neoadjuvant clinic at Auckland Hospital, which has led to a reduction in treatment time for patients and enabled new drug treatments to be introduced for patients with high-risk breast cancers.
"The next stage is looking at whether there is a group of people who won't need surgery at all," Taylor said.
"It used to be every woman diagnosed got a full mastectomy and all lymph nodes removed and that moved to a part mastectomy and some lymph nodes.
"Hopefully, we will see that trend continue so women can potentially avoid surgery all together and tailor treatments to each individual women.
"It's exciting."
