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lifewise | sep - oct 2011

k e e p i n g f a i t h

in the

pi n k of health Breast cancer may be a physically and psychologically devastating disease, but thanks to medical advances and strong support from their loved ones, sufferers can continue to enjoy a good quality of life.

S

inger Kylie Minogue was at the height of her popularity in 2005 when she was diagnosed with breast cancer. She underwent a partial mastectomy, chemotherapy and radiation therapy. She has been cancer-free for the last five years and is back on track with her career. While her story has been inspirational, to find that lump in one’s breast still strikes fear in the hearts of women all over the world. In Singapore, one in 17 women is diagnosed with breast cancer each year. Worldwide, nearly 1.5 million people were diagnosed with breast cancer in 2010. Breast cancer is an abnormal growth of malignant cells within the breast. It generally starts from either the milk ducts in the breast or from the milk glands or lobules. Dr Tan Ern Yu, a Consultant at the Breast Service, Department of General Surgery at Tan Tock Seng Hospital explains: “Genetic mutations cause cells to grow in an uncontrolled fashion that eventually overtakes and starves off the normal cells. Such mutations often occur as a result of uncorrected mistakes that arise during cell growth and renewal that naturally take

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by theresa tan in consultation with dr tan ern yu, consultant, breast service, department of general surgery, tan tock seng hospital

place during a person’s lifetime. To date, the exact cause that triggers these mutations remains unclear.” And what many people don’t realise is that it can occur in men too. All humans, men and women, have breast tissue, but this tissue is not developed at puberty in men, unlike in women. “Breast cancer is far more common in women because a woman’s breast tissues constantly change and grow under the influence of cyclical changes in oestrogen and progesterone hormones occurring every month throughout a woman’s reproductive life,” explains Dr Tan. Women most commonly discover breast cancer when they feel an unusual thickening or a lump under the skin while showering. Other signs and symptoms of breast cancer include puckering of the breast skin, redness, discharge from the nipple (not breast milk), change in the size or shape of the breast, peeling or flaking of breast skin and inverting of the nipple.

i have a lump… now what?

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PHOTOS: CORBIS

When a woman first sees a doctor after discovering a lump, the doctor usually conducts a clinical breast examination. The doctor may palpate the area, and ask her a series of questions which would include her symptoms and family history. Did her sister or mother have breast cancer? Did anyone in the family pass away from cancer? The doctor would also look for other signs, like the change in the size of the breast or skin, discharge from the nipple or inversion of the nipple. If there appears to be a cause of concern, the doctor will recommend further tests such as a mammography, breast ultrasound or core needle biopsy. Depending on the stage of the cancer, its size and location, one’s breast surgeon may suggest a lumpectomy (a wide excision to remove the cancerous mass together with a rim of normal breast tissue or mastectomy (removal of the whole breast). This may be followed by chemotherapy, radiotherapy, hormonal treatment or target therapy, depending on the character of the tumour. Preserving the body image after surgery is an issue to consider when deciding on treatment, but survival should be the utmost concern of every patient. “There are four stages of breast cancer, and also a pre-invasive stage known as ductal carcinoma-in-situ,” explains Dr Tan. The stage is usually determined based on:  the size of the tumour  the extent to which the axillary lymph nodes are affected  whether the cancer has spread to other organs like the liver, lungs and bones.


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lifewise | sep - oct 2011

k e e p i n g f a i t h Paddlers in the Pink is a dragon boat team made up of breast cancer survivors

what causes breast cancer The main risk factors for breast cancer include age, a family or personal history of breast cancer, certain breast conditions — like lobular carcinoma-in-situ, atypical ductal hyperplasia — and the extent of oestrogen exposure during a woman’s lifetime, says Dr Tan. “The extent of oestrogen exposure is influenced by the age of menstruation and menopause, pregnancy and breastfeeding, and also by oral contraceptive use, obesity, and alcohol intake.” Some risk factors that women have no control over include their gender, age, family history, the onset of menstruation and menopause. But there are lifestyle choices that may increase a woman’s risk of developing breast cancer, such as having a child at a later age, using contraceptives or hormone replacement therapy, being overweight, or having a sedentary lifestyle.

early detection saves lives With growing awareness of breast cancer, more women are going for mammograms. “Currently, the most reliable way to detect pre-cancer stages of breast cancer is through a screening mammography,” says Dr Tan. “This applies to all women above 40 with no known risk factors, and who have no symptoms of breast cancer.”

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New therapies have surfaced in the last few years to treat breast cancer, and to help reduce risk of recurrence. One of the latest is the development of targeted therapies. Herceptin is now routinely used for selected women with breast cancer. “Herceptin is an antibody that specifically targets breast cancers with certain characteristics and has been shown to reduce the risk of relapse by 50 per cent,” explains Dr Tan. American actress Christina Applegate made news in 2008 when she opted to have a double mastectomy upon discovering that she had the BRCA1 gene mutation. Her controversial decision raised the implications of the double-edge sword of genetic testing. Dr Tan says that the risk of getting breast cancer in women with a BRCA1 or BRCA2 mutation is so high that the option of removing the normal breast is often discussed. But BRCA1 or BRCA2 mutations are rare. For most women who have breast cancer, though their risk of developing breast cancer in the other normal breast is somewhat higher than average, it is not high enough to warrant the removal of a normal breast. Genetic testing for breast cancer is currently focused on detecting BRCA1 and BRCA2 mutations. Because these mutations are very rare, only selected women are offered these tests. These include women who develop breast cancer


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in the pink of health

early (below age 40), with two or more first-degree relatives who also developed breast cancer at a young age, says Dr Tan.

not just a physical disease The after-effects of breast cancer are wide-ranging, from the physical to the psychological and emotional. “Mastectomy is associated with relatively few after-effects,” says Dr Tan. “Most patients will find that the scar becomes somewhat more sensitive and report periodic ‘pins-and-needles’ sensations around it. Those who have to undergo surgery to remove the nodes under the armpit may find that the shoulder is more stiff and that the skin on the inner side of the arm feels more numb. The use of the arm and arm strength is not usually affected. Up to 15 per cent of these women who had axillary surgery may develop swelling of the arm, known as lymphedema.” The breasts — being possibly the most overt signal that one is a woman — are special to every woman too, not least because they are also used for the life-sustaining act of breastfeeding. The loss of a breast is often followed by negative effects on the patient’s self-confidence and self-esteem. “A significant amount of emotional and spiritual adjustment is often needed following such a life-changing illness,” adds Dr Tan. Breast cancer patients are also recommended to join support groups where they can get to know other survivors. One big plus in breast cancer treatment today is the option of breast reconstruction carried out at the same time of the breast cancer surgery. “In our institute, tissue is often taken from the lower tummy to create a new breast. Depending on the size and location of the cancer, the nipple may need to be removed, or it may be left behind in a nipple-sparing surgery. If the nipple is removed, a new nipple can be created at a later stage.” The spouses of patients are affected too. “Most male partners of these women are affected by the disease psychologically as well as financially. Often, they are a woman’s main source of support and encouragement during this difficult period, and they have to take up the role as the family’s sole breadwinner while the woman is on active treatment.”

the road to recovery

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diagnosing breast cancer M A MMO GR A M A mammogram is a breast X-ray. It can show early signs of breast cancer such as abnormal microcalcifiations (white spots).

U LTR ASOU N D An ultrasound uses sound waves to create images of the breast. It can reveal if that the lump is a fluid-filled cyst, or if it is solid. The features of the lump on ultrasound can also help the radiologist to determine the likelihood of it being a cancer.

B I O PSY A biopsy is often needed when doctors suspect a lump to be a cancer or when they cannot be certain of the nature of a lump. A biopsy can determine whether the lump is benign (non-cancerous) or malignant (cancerous). It may need to be guided by ultrasound or mammogram if the lump is too small to be felt. Biopsies can be done through fine needle aspiration or more commonly, through a core needle biopsy. A core needle biopsy utilises a needle loaded onto a ‘gun’. It extracts solid pieces of tissue from the breast that are sent for testing. The biopsy results usually return within a week. If the results come back positive for cancer, discussions about treatment are initiated.

PHOTO: MATTHEW LEE

The biggest concern of patients is a relapse. According to Dr Tan, those with BRCA mutations are at an increased risk of other cancers, and those who are on the drug tamoxifen (taken to reduce relapse) are at an increased risk of developing uterine cancer. “Because most breast cancer patients have a similar risk of developing other cancers as the general population, they are advised to undergo other screening tests, such as a PAP smear for cervical cancer and stool occult blood testing or colonoscopy for colorectal cancer,” says Dr Tan. The higher the stage of the breast cancer at the point of treatment, the higher the risk of relapse. “Relapse can either be considered locoregional, where it involves the chest wall or the axilla, or it can be disseminated, where it involves other organs of the body. Disseminated recurrence often has a

direct impact on survival and is the primary cause of death,” Dr Tan explains. The chances of a full remission are highly dependent on the disease stage and the treatments received. “For instance, if a woman had Stage I breast cancer and received all the recommended treatments, the chances of her surviving five years is 90 per cent. In contrast, a woman with Stage III disease has a 45 per cent chance of being alive at the end of five years.” Patients are encouraged to be vigilant with their breast checks and yearly mammograms. And we can help ourselves by staying as healthy as possible. Dr Tan shares her advice. “Although hard concrete scientific evidence is lacking, a diet high in red meats and animal fats has been linked to an increased risk of developing breast cancer. This is possibly because of the high content of cholesterol, hormones and other growth factors present in the foods. Other foods like green tea and soy have also been reported to prevent breast cancer, although the studies are not consistent. Having a healthy balanced diet is important, not only for cancer patients or those at risk, but for everyone.” Also, it is important for patients to keep a positive attitude, says Dr Tan. “Current treatments ensure that women continue to enjoy a good quality of life even while on treatment. A positive attitude will mean that a woman is more likely to complete her treatments, and be more actively involved in post-operative recovery.”


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lifewise | sep - oct 2011

k e e p i n g f a i t h

a n e w le ase of

life

Breast cancer survivors Agnes Aik and Irene Chui share how they overcame the disease with the support of their loved ones. by sherene kang and nellie tay

IRENE CHUI, 45, SENIOR HUMAN RESOURCES EXECUTIVE had stage 2 b breast cancer mother of a daughter aged 21 and a son aged 19

an I live without my second breast?’ That was the question I faced when I went for a prophylactic mastectomy on my right breast in August this year. By then, I had already lost my left breast to cancer. I have lost three of my family members to cancer. My cousin had breast cancer in 2002 and two of my uncles had stomach and lung cancer. Due to my family history and the positive results from a genetic test I took in 2007, the doctor warned me that the recurrence of breast cancer could be as high as 50 to 85 per cent. To me, the decision to remove my remaining breast meant stripping me of my femininity and sexual identity. But the thought of not being around to raise my children and living in fear of not knowing when the disease might strike again made it clear to me that I had to go for the surgery. I was first diagnosed with breast cancer in August 2001 by an oncologist at Tan Tock Seng Hospital. My general practitioner had recommended a scan when I told her about the lump on my left breast. By then, the tumour had already spread to my lymph nodes. The ultrasound showed that it was three centimetres in diameter and situated near my milk duct. My instinct was to question if death had come knocking on my door. I was fearful of losing everything in life — my job, my children and my husband. That day, I went home and looked at myself in the mirror. I broke down in tears, knowing that my body would never look the same again. I went for my mastectomy and breast reconstruction at Tan Tock Seng Hospital that same month. Two weeks later, I started on my treatment. This consisted of 12 shots of chemotherapy that lasted for six months. After which, I had six weeks of radiation treatment. My body did not react well to the treatment. I lost my appetite, had nauseous spells and had very severe ulcers around my mouth and gullet. At the end of the arduous nine months of treatment, I had lost 14kg. My family has been a great pillar of strength. When I was undergoing chemotherapy, my husband would ferry me to and from the sessions, feed me and change my bandages. I also received a call from my daughter’s teacher one day,

“ ‘C

asking me if I was all right. My daughter had expressed her grief about my battle with cancer in an essay assignment. This touched me deeply. My husband was also there with me every step of the way during my recent surgery, and his presence gave me the determination to fight on. While recovering, I also sought comfort from Paddlers in the Pink, a support group for breast cancer survivors. I have since been with them for six years. I am currently the captain of their dragon boating team and find motivation from counselling newer members, giving back the support that I have received. The members of Paddlers in the Pink have become a second family to me. My husband jokes that I spend more time with them than with him. We have dragon boat training every Thursday and Saturday. We’ve also taken part in several competitions such as the Gallop of the Dragons in May 2010, the One Malaysia International Dragon Boat Festival in June 2010 and the Singapore Dragon Boat Festival in July 2010. Dragon boating has helped to rebuild my confidence and physical strength after the ordeal of recovering from breast cancer. It has honed my determination and endurance, enabling me to physically overcome the emotional trauma from the crisis stroke by stroke. After my brush with breast cancer, I’ve also began to pursue my dream of climbing Mt Everest. I’ve come to realise how short life is and that I need to take control of it. My first trip was in 2003, 10 months after my last chemotherapy session, when I climbed to the Mt Everest Base Camp. I made a second trip in 2009 to Island Peak, another mountain in the Himalayas, this time together with my family. I wanted to show them that nothing is impossible.

glossary mastectomy This medical term refers to the surgical removal of one or both breasts.

prophylactic mastectomy A preventive mastectomy to reduce the risks of developing breast cancer.

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a new lease of life

My crisis has become my strength. I probably would not have accomplished so many things in my life if I had not overcome breast cancer. Even so, the decision to remove my second breast was a very painful one, even though I had fought the disease before. Despite losing my female organs, my brush with cancer has taught me to love my body. I now live my life to the fullest, pursuing adventurous outdoor activities without fear of having a relapse from breast cancer. I realise that there is life after cancer — you just need to focus on the light at the end of the tunnel.”

SEETOH WENHAO, 19, POLYTECHNIC STUDENT irene’s son

“I

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PHOTOS: EALBERT HO. STYLIST: EVON CHNG. HAIR & MAKEUP BY MANISA TAN (9295-3027) CLOTHES: IRENE WEARS SWEATER FROM MARKS & SPENCER AND HER OWN PANTS. WENHAO WEARS SHIRT FROM MARKS & SPENCER AND HIS OWN JEANS.

was nine years old when my mom first fell ill and I didn’t understand what was happening to her. I only knew that she was very sick. I started crying y g every time I visited her at the hospital and saw w all a the tubes sticking out from her body. Feeling helpless, I wo would ould tell her ‘Mom I love you’. My mom, on the other hand, was very calm. m. She told us not to worry and assured us that we would get et through t this as a family — that made me feel that I had to stay o st tay strong for her too. As a family, we tried to make the most of the e situation. My dad would watch over us, take care of my mom mo om and juggle his work at the same time. Sometimes,, he e even gave my mom massages or would rub her feet to help p her relax. I had to manage my studies on my own and wou would uld seek help from my teachers whenever I had problems completing om mpleting my assignments. I knew I had to be a good kid so th that at my mom would not be burdened with more worries. My primary school friends would try to cheer hee er me up and be there for me. I am grateful thatt my my older sister helped me through this ordeal. Sometimes, mes, she would explain to me what was happening. g. Having someone to talk to about my mom was comforting. As I grew older, I began to realise how insidious cancer is. I was afraid that the disease would strike my mom again. Hence, we were all behind her when she went for herr recent prophylactic mastectomy. We want herr to o be happy and lead a healthy life. My mom’s determination to overcome breast easst cancer has truly inspired me in my day-to-dayy challenges. I remember an inter-school basketball tba all match that I played in. I was on the basketball team forr Hougang Secondary then and felt very exhausted during ng the t match. I was at the point of giving up when I thoughtt about about my mom and the crisis she had to endure. That gave ave e me the perseverance to press on and if not for her, we e would w not have come in champions that day. My mom is also my best friend. I can talk to her about anything. The feeling of having almost lost her er has h made me treasure her more and become more alert to herr needs. I try

to remind her not to overwork when she comes back home late from the office. I have also become more involved in the activities that she does. My sister and I recently took part in the Singapore Dragon Boat Race organised by the Singapore Dragon Boat Association. I realised how much fitter my mom was compared to me! My mom is also a triathlete and has taken part in the Osim Triathlon. She recently encouraged me to partner one of her friends, who is also a member of Paddlers in the Pink, and their dragon boating coach in the Mixed Relay segment at the recent Osim Triathlon this year in July. I cycled while my teammates completed the swimming and running elements. The experience has shown me how breast cancer survivors are no different from us. I have never completed a full triathlon before but some day, I aspire to walk in my mom’s shoes to be a triathlete.”


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lifewise | sep - oct 2011

k e e p i n g f a i t h

AGNES AIK, 53, PETROL KIOSK STORE SUPERVISOR mother of two daughters aged 30 and 13 , and a son aged 26 . discovered that I had a lump in my left breast in June 2009 during a self-examination. Initially, I ignored it, but it continued to grow bigger. Six months later, I decided to go for a check-up at Toa Payoh Polyclinic where I had a mammogram done. I was referred to Tan Tock Seng Hospital for further tests and I found out that I had stage 2 breast cancer. Upon hearing the news, my husband (who was with me) called my son immediately. I was taken aback by the news as no one in my family had ever suffered from breast cancer. Though I was initially depressed, I told myself that I had to face up to reality and prepare myself mentally for the surgery to remove my breast.

“I

The doctor presented me with three options: to go for a mastectomy without breast reconstruction surgery; to have a silicone implant as a replacement for my breast; or to use part of my stomach fat to reconstruct my breast. I opted for the last option as a silicone implant has to be replaced once every 10 years. I had the surgery done on 11 January 2010 and was in Tan Tock Seng Hospital for about six days — patients who undergo a mastectomy without breast reconstruction usually stay in the hospital for only two days on average. I then spent about 20 days recuperating at home before I went back to work. I took short walks around the void deck of my block to get back in shape. I felt I had to go back to

i visit tthe breast cancer foundation supp support group to attend talks about the disease, share views and give su support to other women who have th the disease. my advice to other breast ccancer patients is to persevere and be positive no matter how diff difficult the treatment may be work as soon as I could as it would help take my mind off things; I didn’t want to feel miserable and alone at home. From March to June last year, I began chemotherapy treatment to kill off any remaining cancer cells in my body. My husband and children took turns to accompany me to the hospital for chemotherapy treatment after the surgery. I had one session of chemotherapy every three weeks for the first three months of chemotherapy. After that, I had chemotherapy once a week, and this lasted for another 12 sessions. During the first two days of chemotherapy, I felt fine and experienced no side effects. However, on the third day of the treatment, my hand started to feel a little numb. I also experienced nausea. Within a month of chemotherapy, all my hair fell off. Despite this, I continued working. When I had to go out, I would wear a hat. Soon after, I got myself a wig. I completed my chemotherapy last year, but my hair hasn’t been able to grow out completely since then. Sometimes, I hate the way I look, but though I feel I’m not as pretty as before, I tell myself that I must try to be happier. In July this year, my doctor told me that I was in remission. I feel tired more easily now as compared to the days before I had breast cancer. I try to take one step at a

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a new lease of life

time and hope that I do not have a relapse. All breast cancer patients have to go for annual check-ups after surgery to assess if there has been any relapse in their condition. My family has helped to comfort and support me through this ordeal. My husband would prepare traditional Chinese medicine to boost my health. My son even borrowed a car from his friends so that he could drive me to the hospital for chemotherapy treatment. Family members would also help out with the housework. Once every month, I visit the Breast Cancer Foundation Support Group to attend talks about the disease, share views and give support to other women who have ave the disease. My advice to other breast cancer patients is to persevere and be positive no matter how difficult the treatment tment may be. I’m very happy that I managed to walk out off that dark period.”

Agnes and I got used to her ‘new’ body — she didn’t feel well most of the time during that period. However, our relationship has improved. We are more loving and caring towards each other. Our lifestyles have not changed much after my wife’s surgery — we still eat the same food and go about our usual work routines. My advice to those who have wives with breast cancer is that they should do their best to encourage the patient. Accompany your wife. Don’t let her feel lonely and try to keep her spirits up.”

KEN LAU, 43, MAINTENANCE SUPERVISOR OR agnes’ husband hen our family found out that my wife had breast cancer, we were e shocked. Initially, we felt sad and lost, but ut I told Agnes not to worry as the disease is curable. She would ould not be alone in this struggle. She had to stay strong and the whole family would be supporting her. My father had liver cancer about 12 years ears ago. He was 59 years-old when he was diagnosed d with end-stage liver cancer. He passed away about five months later. In comparison, Agnes’ prognosis was better. r. I told my children not to worry as this disease is quite common mon among women. I said to them: ‘Stay strong, don’tt let mummy know that you’re depressed and be more e obedient.’ Before the surgery, Agnes discussed her reconstructive breast surgery options with t me. I told th her that the decision was up to her. I didn’t n’t feel that n’ the surgery would affect our relationship p or or the level of intimacy between us. To me it didn’t matter if she lost a breast. What was more important was for her to get better. I accompanied my wife during the entire ntire duration of her hospital stay after she had d her surgery. After the surgery, everyone in the family took more time to accompany her, show her more concern and cheer her up. We did our best to accommodate her temper too as undergoing chemotherapy treatment proved quite a tedious experience for her. r. She felt unwell all the time and her spirits ts were low. We would also organise outings to cheer heer her up. Sometimes we would go to the park or spend pe time at pend MacRitchie Reservoir. After she completed d ch cchemotherapy emot otthe hera rapy py treatment, we also went on short vacations places ons to o pl lac aces es such as Hong Kong and Malaysia to lift her spirits. s. It took about eight months after her surgery before

“W

CLOTHES: AGNES WEARS BLOUSE FROM G2000 AND BRACELET FROM MARKS & SPENCER. KEN WEARS SHIRT AND PANTS FROM MARKS & SPENCER.

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Breast Cancer Awareness Month (Lifewise Sep - Oct 2011)  

Breast Cancer Awareness Month (Lifewise Sep - Oct 2011)

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