Breast cancer sucks; but early detection makes a positive difference to outcomes. With regular screening and being aware of changes in our breasts we can increase the number of positive outcomes following a cancer diagnosis. Specialist oncologic breast and general surgeon Nicola Davis joined Tauranga’s breast cancer team 18 months ago. She urges women to be breast aware. focus talked to Nicola about why she’s optimistic about the future of medicine for women who receive a breast cancer diagnosis and what’s kept her fixed on her medical calling since age 14.
Words: Millie Freeman
Cover & main images: Vanessa Laval-Glad
Other images supplied
Makeup: Sita Engling
Nicola Davis is one of three consultant breast surgeons in Tauranga, as well as a general surgeon, and one of four women surgeons across the Bay of Plenty. She says in most breast cancer cases women are likely to do well if their cancer is found early.
“Screening via mammogram every two years between ages 45-69 is really important and tends to pick up very early, treatable breast cancers. Overwhelmingly, the women who come to screening do better.”
Nicola also recommends all women from about age 25 examine their breasts every month to notice any changes – in the shower is easiest when it’s soapy and slippery. “If you’re concerned, don’t wait for something to change. Go and get it checked out,” she says.
The range of treatment options now available is also helping to increase the number of positive outcomes,
and Nicola says the future is optimistic for the majority of women who get breast cancer. Surgery itself has improved as have other breast cancer treatments, such as neoadjuvant therapy (which aims to shrink a tumour prior to surgery) and radiotherapy.
While screening is key to early detection, Nicola knows there can be downsides of mammograms potentially picking up benign lumps, requiring women to go through an anxious few weeks while they await biopsies and results. Sometimes this happens when women go for their first mammogram as there is no baseline with which to compare.
“Some women end up falling out of the screening programme because of the anxiety they experienced the first time. I completely understand their apprehension, however it’s so important to continue with two-yearly screening because of the much higher likelihood of picking up early-stage cancer than if they didn’t have a mammogram. Sadly, this is a common disease – one in nine women will be diagnosed with breast cancer in their lives.”
It was during Nicola’s third and fourth year of surgical training that she chose to specialise in breast surgery, largely because of the excellent mentorship she had received from her colleagues, who “showed me what a privilege it is to be a breast surgeon”.
2mm – size of the smallest cancer found by a regular mammogram
14.5mm – average size of lump found during regular mammogram
22mm – average size of a lump found by self-examination
“I meet people going through this traumatic experience and am able to help them come to terms with what breast cancer means to them and support them as they start their journey,” she says. “I see it as an extraordinary privilege to be able to do this work.
“I also enjoy using a combination of skills in breast surgery – general surgical skills as well as plastic surgery skills. Removing cancer is the number one priority, but getting a good cosmetic outcome comes a very close second.”
COSMETIC ADVANCEMENTS
This emphasis on cosmetic results has been one of the major changes in breast surgery during the last 10-15 years and has made a huge emotional difference to the outcomes for patients undergoing surgery, she says.
Women used to endure disfiguring ‘radical mastectomies’ with significant removal of breast tissue and muscle, however modern-day breast-conserving techniques, such as lumpectomy with sentinel node biopsy, result in far more satisfactory cosmetic outcomes for the majority of patients. The culture change towards better patient-centred care, where patients are actively consulted in their treatment, has also transformed the daunting medical process for many people, she says. Now, women navigating breast cancer in New Zealand are supported by a wrap-around team of specialists, from the breast-care nurse, to medical oncologist, surgical team and radiation oncologist.
“Working with patients in distressing or bad news situations is the hardest part of our work but as doctors we are trained for that and it’s important we are resilient and strong for our patients,” says Nicola.
“At the same time we are respectful to what’s going on for them and give them time and space to ask questions. In my practice I make sure my patients have all the information they need to make a decision that’s right for them, and when I understand what’s important to them I can make recommendations for treatment based on their needs and wants.
“It’s important to me that when patients leave a consultation they feel fully informed and have had their questions answered. I want them to feel they can move forward on their journey knowing they’re having the right treatment for them.”
DESTINED FOR MEDICINE
Nicola was in the fourth form (Year 10) at Manurewa High School in Auckland when she decided she wanted to be a doctor. She’s now 40.
The life course she set for herself so early on is one random trait she shares with her favourite backyard pets – honey bees, which she’s kept since her early 30s. Much like the daily flight path they follow between flowers, Nicola has never questioned her decision to follow a medical career, let alone deviated from her own flight path. After six years of Med School in Auckland, she worked as a house officer for three years at Middlemore and Auckland
City hospitals before embarking on the next phase of her training – initially as a non-training registrar for four years and then five years training through the Royal Australasian College of Surgeons. Having decided during this time to specialise in breast surgery, she then spent another two years in Australia doing her fellowship, before being appointed to her Tauranga role last year.
Manurewa High School also happened to be the setting for another life-changing decision. She met a guy she quite liked in her sixth form (Year 12) Stats class and the two formed a relationship. Despite living apart for spells when she was training around the country, Aaron became her husband, and her greatest support, and they’ve been together for 22 years.
REFINING HER GOALS
Medicine was a good choice and natural fit for Nicola because it’s a profession requiring both science and social skills. She remembers as a young fourth-year med student assisting during a laparoscopic surgery and being allowed to remove a patient’s gall bladder through the belly button. “It was amazing!” she says, and helped her refine her goals towards a surgical specialisation. She was totally hooked!
“Seeing that patient the next day feeling well enough to go home made me realise how much of a positive difference I could make for someone. In the majority of work you do, people come in with a problem, you fix it and they’re better for it. That really appeals to me.”
On the ‘people skills’ side, Nicola has plenty of experience to draw on. Growing up in a big family in south Auckland with community- minded parents (her father ran a youth justice programme to rehabilitate young offenders and her mother was a GP practice manager), she was always involved in community events and fundraising for the likes of Women’s Refuge. Empathy for others was instilled at an early age, so when Samoa was devastated in the 2009 tsunami, Nicola didn’t hesitate to step up and offer her medical skills for three weeks in the island’s short-staffed smaller hospitals. Along with her parents, she arranged a “massive” container of household and medical supplies, including donations from GP clinics of medicines and sutures that were so desperately needed.
RAISING AWARENESS FOR WOMEN
By appealing to women to become more breast aware and maintain two-yearly mammograms, Nicola hopes to increase the number of positive outcomes for women who get breast cancer. At the same time, she wants to increase another concerning medical statistic – only four female surgeons practise in the entire Bay of Plenty. Historically surgery has been considered a male domain, and women have been discouraged from entering the specialty profession, lacking the mentors to aspire to.
“Women make up 60% of Med School graduates yet only 11% of the surgical workforce, which means we’re missing out on some of the brightest and best,” she says. “It’s up to us to encourage and mentor the junior female doctors and give them an opportunity to see the seniors out there doing it.”
In July Nicola and her registrar Dr Sharon Jay hosted an inaugural networking evening with female house officers and registrars, and Nicola plans to make it an annual event with other social get-togethers in between.
“It’s about changing perceptions. I want to normalise the fact that women can be surgeons. It’s such a great career and I want women to feel it is accessible to them. From a patient point of view, overwhelmingly people like to connect with someone like themselves, which is why diversity in medicine, especially breast surgery, is so important.”
Luckily for our region, and just like the bees in her backyard by the sea, Nicola’s future flight path remains rooted in the Bay. She has no plans to deviate to hospitals in other countries, saying her role here is “incredibly rewarding”, and why would she leave this little slice of paradise, especially when she and Aaron love hiking, kayaking and fishing in New Zealand’s great outdoors? We couldn’t agree more!
BE BREAST AWARE – EARLY DETECTION COUNTS
- Breast cancer is the most common cancer affecting New Zealand women with more than 3,300 cases diagnosed each year.
- Screening mammograms are important because early detection can result in more positive outcomes.
- Women aged between 45-69 are encouraged to get a mammogram every two years. Screening is free through BreastScreen Aotearoa.
- Self-awareness is also important. From age 25, all women are encouraged to examine their breasts to learn what is normal for them and recognise changes.
- If you notice any changes, such as a lump or thickened area, nipple inversion or discharge, persisting redness, unusual pain, breast distortion, or dimpling or puckering, see your GP for an assessment. While many breast changes are due to non-cancerous conditions, it is important to get it checked.