Q&A: Dr. Roger M.J. Roberge
AUTHOR OF Why Me? Surviving, Coping, Living with Breast Cancer
As published in the Times & Transcript on page G4 on October 14, 2006
Dr. Roger M.J. Roberge has dedicated most of his life to working with breast disease. A native of Grand Falls, Dr. Roberge is a general surgeon at The Moncton Hospital, and made the decision more than 20 years ago to focus almost entirely on this scourge of women - and men. He has to his credit several awards including the New Brunswick Breast Cancer Network Award for being "The Physician Who Has Done the Most for Breast Cancer in New Brunswick", and the "Mon Petit Ange" Award for his work in breast cancer from the Katherine Wright Family Wellness Centre. His latest effort is his self-published book: Why Me? Surviving, Coping, Living with Breast Cancer. We were pleased to sit down with Dr. Roberge.
Travel & Leisure: This is a very exciting time for you Dr. Roberge, your first book!
Dr. Roger Roberge: Well it's very exciting because the response has been so tremendous, almost overwhelming ... some people say 'where did you get that quote' and I've been sort of picking up quotes (for the book) for years.
TL: When did the book come out?
DRR: Sept. 28th. It's new.
TL: And you're very busy with book signings and the like.
DRR: Yes.
TL: The inspiration for this book was your patients?
DRR: Absolutely, there's no doubt. I think that I have learned so much from my patients over the years. It's an example of mostly courage. It's amazing how women - and their families, find the strength to go through these disastrous moments. I'm always so impressed, and what I've been trying to do, because this has been ... not necessarily my whole life's work, but the last 10 to 15 years I've been doing practically only this.
... I think the book reflects my conversations with patients more than anything else. It's not a scientific book, but a lady yesterday told me, she said 'oh it's just so wonderful! I just wish I would have had it last year.'
TL: Have you had a lot of feedback?
DRR: Yes, and right now it's only positive, it's just amazing. I had a call from Cancer Nova Scotia yesterday, they want the book down there.
They want me to go and give a little talk in Springhill. I'm going to Sackville in a couple of weeks.
TL: Isn't that great!
DRR: It's wonderful! It's fabulous. Obviously there was a need.
TL: Absolutely, and you filled it.
DRR: ... there are many many good books out there (on breast cancer), the Internet is so full of information that people sometimes suffer from information overload.
TL: But this book fills a particular niche.
DRR: I think it's a little niche, yes.
TL: There's a CD that goes with this book as well on breast self examination. Your book is available on your website, www.whyme.ca - where else is it available?
DRR: Right now the only other place is at The Bay, and the gift shop at The Moncton Hospital - and my office of course. We expect to meet with other book dealers and things like this, but The Bay is the place that called me because they do raise a lot of money (for breast cancer) with their cosmetics. They have a real big thing in October, and they have the Think Pink area in the store. So they heard about this and called me up and said would you like to come and we'll sell your book. I said fine!
(Smiling)
TL: (Smiling too) Isn't that wonderful. This was a five-year project basically wasn't it?
DRR: Just about, yes.
TL: What format is the book in?
DRR: It's basically helping ladies go through the journey. For example, from the moment the diagnosis is made, then on the second part we backtrack and say 'well how do we make the diagnosis' and go through the different tests that women will be subjected to, and the things that they can expect to meet along the way. The types of surgery that are available, the other types of treatment that could be involved. Life after breast cancer which is very important. The big thing, too, is the team approach to all of this.
That women shouldn't be treated as just somebody with a disease, they've got to be treated as a very warm caring human being. I think that having many people involved such as nurses, social workers - occasionally even psychologists ....
TL: And this book takes away a lot of those surprises.
DRR: I hope it does.
TL: The proceeds are being shared with the Canadian Breast Cancer Foundation, the Katherine Wright Family Wellness Centre and the Dr. Leon Richard Oncology Centre, is that correct?
DRR: Yes, that's correct. I've been very much involved with the Canadian Breast Cancer Foundation, actually since the Atlantic chapter was formed.
I was one of the initial founding members of that board when it started 10 years ago or so. So I've always maintained my contact with them. The Katherine Wright Family Wellness Centre is our screening place, and the (Dr.) Leon Richard Oncology Centre is just absolutely the cat's meow. It's just a wonderful place if you have to use their facilities, and the patients all find that they're well treated, well looked after, well cared for. So I said we might as well spread it out, I didn't really write this to make any money. Just to break even would be good. (Laughing)
TL: (Laughing too) That would be good - it's self-published. Absolutely, I understand. What does this book mean to you on a personal level Dr. Roberge?
DRR: It means that I've finally may have gotten just about to the end of my own journey to a degree ....
TL: Professional journey.
DRR: Professional journey, yes. I can't retire just yet because I still enjoy it, and people still want to come and see me. People ask: 'When are you going to retire,' and I say 'well when women don't want to come and see me anymore I'll stop,' but it's getting worse. (Laughing) And I don't think this (book) is going to help me retire.
TL: (Laughing too) You've re-energized your career.
DRR: I think I blew it! (Laughing heartily)
TL: Yes, but in a good way. You are a general surgeon, but you're no longer operating are you?
DRR: No, that's right.
TL: You're focusing now on medical consultations and follow-ups?
DRR: Yes, and establishing diagnosis. So the lady who is sent to me because she has found a lump in her breast, I will do all of the investigations - even needle biopsies and things like this, or arrange for them to be done by the radiologist with using ultrasound or things like this. When the diagnosis is established I tell her 'well OK, now we know exactly what's going on. You need to have an operation, and who would you like to see and where would you like to go?' Then I just put all the papers together and send her there so there's no waiting.
TL: ... well that's comforting.
DRR: I think it fills a need.
TL: ... and it's important not to wait ....
DRR: Oh, the waiting is what drives women crazy, like everybody.
TL: If you know what's ahead, you might as well get on with it.
DRR: Get on with it, yes. Usually when somebody finds something they want it done yesterday.
TL: Breast cancer has certainly gained great prominence these past few years. The number of cases are on the rise, and thankfully the death rate is declining. Can you pinpoint the cause of breast cancer? Is that possible?
DRR: Not right now, but there are a few theories. For example the obesity - the fact of having too much fat in our diets when we're young. Fat is a reserve spot for estrogen, so we think that estrogen exposure is one of the factors. We're seeing young girls now starting to have their periods at eight and nine years old, which is very young ... and women are going through menopause later so there's a longer exposure time. They're not having large families and a lot of them if they do have one or two children, they don't nurse them. So if you were to have your children young and nurse them for a longer period of time, your total exposure time to estrogen would be decreased. So how much of a factor (it is), we don't really know.
TL: So in terms of prevention, is staying fit ....
DRR: I don't think there's any real prevention.
TL: I guess if you don't know the cause, you don't know how to prevent it. What role does heredity play?
DRR: Heredity only accounts for less than 10 per cent of breast cancers right now. There are some genetic changes like BRCA-1, BRCA-2 which is called Breast Cancer 1, Breast Cancer 2 genetic changes, and if women have those changes in their genes, their risk of breast cancer is 85 per cent. So it's extremely high. But most of the women who develop breast cancer do not have the genetic change, the genetic mutation. So the genetic mutation as we know it today, we only know two you see, so maybe in a few years people will look back at us and say 'oh those dummies. There was five genes and they didn't know.' Right now in the present context there are two known genetic mutations that do cause breast cancer - and ovarian cancer actually. Same gene.
TL: Same gene. What about over-exposure to radiation because of too many mammograms. Is that a risk factor?
DRR: I don't believe that it is because basically the mammogram machine is probably one of the machines that is most frequently tested, monitored and everything. We have pregnant technicians that work around them, so there's no spill.
TL: Years ago they didn't have the technology to discover even the most minute tumours or whatever.
DRR: Right now depending of course on the texture of the breast tissue, we can get diagnosis of tumours that are under one centimetre. But if it's a younger woman with very dense breasts, then we don't see very well. That's why for example in younger women, and I stress this, that younger women with bad family histories, the number one test for these women is an MRI of the breast.
TL: And all of the little tumours or whatever that you find, are they all (potentially) problematic?
DRR: Oh absolutely not! ... we have at one end of the spectrum (those that are) obviously benign and then something that's obviously malignant, and then in between we've got the great big bunch that we call indeterminate. So those we don't know whether they're going this way or that way, and those are the ones that we're going to perhaps have to biopsy with needles.
TL: Breast cancer can also strike men.
DRR: Yes, but very rarely.
TL: What is the female to male ratio?
DRR: I would think probably 99 to one. It's very rare in men.
TL: So why more common in women, more tissue?
DRR: More tissue - and more estrogen.
TL: Yes, that's right. Now you have focused your professional attention almost exclusively on breast cancer since 1991. What influenced that decision?
DRR: Well it goes back many more years than that - about 15 years before that I was doing general surgery and I would see someone that had a hernia and somebody that had gallbladder disease and someone who had hemorrhoids and someone who had a lump in the breast. I just thought that we sort of weren't looking after this person (with the breast lump) more specifically, and I thought that we should. I was able to get film from a pharmaceutical company and we transposed it into a VHS cassette and I set it up in my office and we started showing the movie on how to do self-breast examination. It was somewhat dated, but what we did then was when my secretary booked my office she would book half a day where it was only women with breast lumps ...
... the Medical Society had asked me - I was sort of the breast expert in the province, if I would go around and give some lectures and I said 'no, that's crazy. Why don't we make a film,' so we made the film on breast self-examination .... Three years ago I decided it needed updating and we did it on digital.
TL: And a copy of that is included with your new book.
DRR:Yes. ... so it just evolved slowly (focusing only on breast cancer patients), and as I was getting more work in that department, I started doing less in other things. It just worked that way slowly.
TL: What's ahead for you in terms of your work with breast cancer? Another book perhaps?
DRR: I'm not sure about another book, but what I would really like is to see us have a specific clinic for high-risk women so that we would have a small office, an examining room with a good computer program so that these women would be called back on a regular basis, every six months. So that they don't fall in the cracks of the system ... hopefully within a year or two we will have something going.
TL: Do you think you'll see a cure for breast cancer in your lifetime?
DRR: Prevention is going to be the area, but I don't think we can prevent until we know the cause.