“My body knows how to recover. That’s what competitive strength athletics taught me. I’ve realized competing was the practice. Recovering from breast cancer is the game.” 

Less than 4 months have passed since Jasmine Lake found a lump in her breast. While recovering from a recent double mastectomy, she spoke to WHO/Europe about her experience of being diagnosed and treated in England’s National Health Service (NHS).

A native of Singapore, Jasmine grew up in India and attended university in Canada before settling in London, United Kingdom, 11 years ago with her Canadian husband. She is a fitness coach and has competed at the world level in strength athletics.

“I check my breasts regularly, probably more than the average person.” She attributes her awareness of the importance of breast self-exams both to her physical fitness work and to social media, which she uses for work and where she encounters people who share their cancer stories.

“I was in the shower, and I felt a lump that wasn’t there before.” It was mid-June. She was not unduly worried. “I imagined it would be nothing. It felt like a bruise, a bit sore. Usually, breast cancer lumps don’t hurt, and they are hard, not moveable like mine.”

Route to diagnosis

Jasmine filled out an online general practitioner (GP) consultation form and was happy to receive a response call the following day inviting her for a face-to-face consultation. Her GP promptly referred her to the one-stop Breast Clinic in St Bartholomew’s Hospital, a centre of excellence for cancer care in the heart of London.

The Breast Clinic is a building dedicated solely to breast cancer, with all of the necessary services under one roof. There, her mammogram, ultrasound and biopsy were all carried out in under an hour. 

Two weeks later she was invited back to St Bartholomew’s to receive the results of her tests. On this occasion, she met her cancer nurse and surgeon, Sarah and Laura, for the first time. They would jointly attend all of her subsequent consultations.

After the initial shock of receiving a positive cancer diagnosis, Jasmine’s practical, steady nature quickly took hold. She was aware that if caught early, breast cancer is highly treatable and, for her, this made the diagnosis less scary. Jasmine informed her family in Singapore, explaining that cancer had been found while reassuring her mother that she felt fine. 

The next step was to have a magnetic resonance imaging (MRI) scan, which happened 10 days later (generally the expected wait time is 2 weeks). The results followed a week later. The MRI results revealed that in addition to a 1.8 cm lump, there was a 4 cm lesion that needed to be biopsied. 

Fortunately, Jasmine’s long-planned holiday to France in August went ahead, and the day after her return, she went for her biopsy.  

These results confirmed ductal carcinoma in situ (DCIS). This is the earliest form of breast cancer, and it means that the cancer cells are contained in the breast milk ducts and have not spread into surrounding breast tissue. While DCIS is not life-threatening, treatment is usually recommended. 

Exploring treatment options

Jasmine had started doing her own research. She already knew that in terms of treatment, this diagnosis meant a mastectomy was more likely than a less invasive lumpectomy. Once this was confirmed, the conversation progressed quickly to options for breast reconstruction. This was a major source of concern for Jasmine, given its potential impact both physically and in terms of her career in fitness.

Deep inferior epigastric perforator (DIEP) flap reconstruction is commonly prescribed for patients who undergo a mastectomy. This uses abdominal fat to create a breast mound. Instead, Jasmine opted for breast implants in order to “preserve her pecs”, the chest muscles integral to her fitness and training. 

The question of getting implants was not straightforward either. Jasmine put a call out on social media asking other women about the effect of breast implants in female strength athletes. She discussed various options with her surgeon and was reassured to be given the option of getting implants above rather than under her chest muscles, thereby minimizing any impact on her core strength. 

Joint decision-making

Jasmine confesses that her greatest fear while discussing treatment options was not being given what she wanted. She was enormously reassured by her surgeon, who took on board all of her needs and concerns and advocated on her behalf. 

Jasmine learned that decisions regarding the size of her implants and whether to have nipples or not could influence the complexity of the surgery and her recovery time. She chose smaller breasts with no nipples, but plans to get nipple tattoos, a service provided by the hospital. In spite of the difficulty of having these conversations and making tough choices, Jasmine believes she is lucky to live in a place that gives her all of these options. 

“Do you have a surgery date in mind?”

Jasmine was asked to indicate her preferred date for surgery, based on whether she felt sufficiently ready to proceed or not. The earliest available date was in September, 2 weeks after the consultation to agree her treatment path. Jasmine decided to take it. 

The surgery involved removing the breast cancer and lymph nodes and putting in the breast implants. The lymph nodes are currently being tested to determine if she will require chemotherapy.

It is now October. Jasmine’s recovery has been remarkably fast, aided by her high level of fitness at the time of her diagnosis. To her, June seems like a long time ago. 

Waiting for results is an ongoing feature of the care pathway. As she patiently awaits the results of the test on her lymph nodes, she feels hugely positive about the care she has received. In particular, she praises the continuous communication with her cancer nurse, who calls her regularly with news, as well as when there is no news. Apart from a few minor administrative errors that did not impact her care but caused a little confusion, she cannot fault the care she has received. 

The experience has not changed her as much as it has reinforced her existing belief: “Make the most of what you have.” 

Jasmine’s story is an example of the cancer treatment pathway at its best – from early detection to rapid diagnosis and accessible and affordable treatment.