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Tara Loader Wilkinson

Ahead of her 50th birthday, American internist Dr Lisa Larkin, an expert in menopause management, had been doing all the right things to live a long and healthy life, including having regular mammograms.
Her most recent routine scan had turned up nothing untoward. Given the all-clear, she went off on a camping trip with her children to climb Mount Kilimanjaro in Tanzania, Africa’s highest peak.
It was on this trip in late 2013 that she felt a large mass in her breast.
The routine mammogram had not picked up the cancer because Larkin had very dense breasts; as many as 40 to 50 per cent of women have them.

Breasts are made up of two types of tissue: glandular tissue and fatty tissue. If your tissue is more glandular than fatty, you have dense breasts.
On a mammogram, dense tissue appears white when compared to fatty tissue. Abnormal growths also tend to be dense and white, so imaging of dense tissue does not always show a potentially cancerous lump.
Larkin knew she had very dense breasts. But at the time, enhanced imaging for increased breast density on mammograms was not something that was done, even though it was recognised that dense breasts made it harder to screen for cancer.
She returned to her home in Cincinnati, in the US state of Ohio, but did not get the lump checked for another six weeks; her work schedule was busy with travel and speaking engagements. She recently took part in a women’s health conference in Hong Kong, Women’s Health in Focus: A Global Summit, for example.
She was also shouldering the stress of going through a divorce.
“I knew what it was when I felt it, and as a clinician, I knew what I was about to go through, and I delayed it. Yes, there was also an element of denial there.”

When she started getting back pain, she knew she could not put off the inevitable any longer. When she finally went in for a breast evaluation, it turned up a tumour that was 2.9 centimetres (1.14 inches) in diameter sitting on her chest wall.
There were five other primary tumours in the same breast, and the cancer had spread to her lymph nodes.
She flew to New York for aggressive treatment, including a double mastectomy, six months of chemotherapy and radiation over her chest. Her treatment took about a year in all.
This was 11 years ago. “It was a low point,” she recalls. “I remember driving to the airport for my flight and thinking, ‘This is great, I’m turning 50, I’m getting divorced, and I’m going to have no hair and a bilateral mastectomy.’”
Larkin experienced many unwanted side effects from her breast cancer treatment, such as hair loss, heavy scarring from the radiation on her shoulder and chest, and sexual dysfunction.

The treatment also put her into menopause, something that commonly happens with chemotherapy drugs. This led to cognitive issues and fatigue, and terrible hot flashes.
“The symptoms of menopause are just miserable,” says Larkin. “I’ve been on absolutely every kind of non-hormonal option and not much has worked well.”
In women who are breast cancer survivors, hormone therapy is not normally considered for menopausal treatment due to the potential risk of cancer recurrence or the development of a new hormone-sensitive cancer.
However, Larkin believes that for most women who are not breast cancer survivors, the benefits of hormone therapy outweigh the risks.
The one non-hormonal drug she tried, which helped, was oxybutynin, a medication typically used for an overactive bladder that can be used to help reduce hot flashes and night sweats.
It is a good option for those who do not want to use hormone replacement therapy, although it did cause her unwelcome side effects, like dry mouth and constipation.

She is looking forward to the time when another drug, elinzanetant, will become available in the United States. It is a non-hormonal medication being developed to treat symptoms like hot flashes and night sweats, which is said to have promising results without side effects.
Larkin is a big believer in changing your lifestyle to help with menopausal symptoms and advises her patients to get good regular sleep, to cut out alcohol – which is what she says has had the biggest effect – and improve their diet with micronutrients.
She also recommends acupuncture, breathwork and meditation.
“I tell my patients all the time I’m not the perfect poster child for doing everything right. I do a lot, but I take an 80/20 approach because we’re busy and life gets in the way. Between my husband and me, we have six children, and we want to enjoy our time with them. Breast cancer survivorship is a lifetime journey.”
There is also in the back of her mind an awareness that the future is not guaranteed, although the chance of recurrence decreases with the years since diagnosis.
“Life for a survivor always feels more fragile,” she says.

She is keen to send the message of the importance of regular testing for everyone and is an early adopter of the multi-cancer early detection test (MCED), which analyses blood samples to detect multiple cancer types, potentially enabling earlier diagnosis.
Although she warns that it does not replace mammograms, colonoscopies and Pap smears – which are established screenings for slow-growing cancers such as breast cancer – it can be useful to screen for aggressive cancers such as pancreatic and ovarian.
Larkin also emphasises the importance of carrying on with life and work while being treated. This kept her going and gave her a sense of normality and routine.
She has a positive message, which is that good things can happen even in the bleakest of moments.
When she was in hospital in New York, waiting for her first round of chemotherapy, she had a coffee with Dr Arthur Pancioli – the man who would become her current husband.
“He was one of my unexpected gifts from having chemotherapy. He has been a rock star throughout.”

The other gift was the kindness and love from friends, family and patients.
“I’ve never felt so much support in my life. It was really, really amazing, actually.”
In a post on Facebook, Larkin says, “Like climbing the mountain, battling breast cancer is a slow and long trek to the top. It pushes us beyond what we thought were our limits.
“Both journeys have been life-changing. I believe that dreams, whether climbing a mountain or conquering cancer, can be achieved at any age with a plan of action and the strength to take the first step forward.”
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Lifestyle

Health & Wellness

Health

Menopause expert Lisa Larkin talks about lifestyle changes and drugs to help with menopausal symptoms, and how good things can always happen


Menopause expert Lisa Larkin talks about lifestyle changes and drugs to help with menopausal symptoms, and how good things can always happen.


How doctor battled breast cancer then menopause, and found love along the way

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Menopause expert Lisa Larkin talks about lifestyle changes and drugs to help with menopausal symptoms, and how good things can always happen

Menopause expert Lisa Larkin talks about lifestyle changes and drugs to help with menopausal symptoms, and how good things can always happen