DON'T TAKE BREAST CANCER LIGHTLY

By Melati Mohd Ariff

Breast cancer is considered the leading killer of women under 40 in
Malaysia. Many Malaysians have underwent the painful experience of seeing their
mother, sister, friends or neighbours slowly succumbing to the ravaging disease.

This two-part series looks into why early treatment is important and the
unfounded fears that women generally harbour on the disease. This is the first
of the two part series

KUALA LUMPUR, Nov 24 (Bernama) -- Despite being diagnosed with breast
cancer, many choose to ignore on what to do next either due to anguish or
unfounded fears.

Many fear the prospect of undergoing surgery to remove their breast or even
undergoing chemotherapy.

Some just suffer from anxiety, fearing they will be divorced or neglected
by their husband.

Despite the critical diagnosis there are some husbands who force their
wives to seek traditional treatment methods, notes Dr Norlia Abdullah, a breast
surgeon and associate professor (Clinical) with Universiti Kebangsaan Malaysia's
Medical Centre (PPUKM).

Dr Norlia said this during an interview with Bernama.

She notes that such desperation is clearly evident among those from
villages or rural areas where the education and socio-economic standards are
low.

TIME LOST, LIVE LOST

Dr Norlia relates on the indifference in many of her patients that delays
treatment can complicate matters.

"There were patients who went missing after I explained to them in detail on
the diagnosis. They leave the room and just vanish. Six months down the road or
a year later they will come back to see me.

"These patients have lost six months or a year of valuable time to stop the
spread of cancer cells.

"By the time they return the cancer may have reached a critical stage.
Some would have spread to the bones or lungs. There is no use of regretting now,
there is no way in regaining the time lost in seeking treatment," explained Dr
Norlia who received training in breast cancer surgery and management from the
Royal Marsden Hospital, in London, the world's oldest hospital for cancer
treatment.

In ensuring the patients don't get confused with multiple opinions or resort
to alternative treatment, she says the patients are advised to discuss on the
disease and the treatment options with close family members only.

"There are some, especially the Malays, who put their faith in alternative
treatment that does not involve surgery. When speaking of breast cancer, the
majority of those seeking treatment from the start are the Chinese.

"If the patient feels ambiguous, the best thing to do is see the doctor
again or a nurse," said Dr Norlia who has been with PPUKM since 1992.

It is very important to win the patient's trust right during the first
meeting to ensure the patient comes for follow-up treatment.

Patients diagnosed with Stage One cancer can expect good treatment outcomes
if they see the doctor early.

"In the event they come for conventional treatment when the cancer reaches
Stage Four, say after trying 10 traditional treatment methods, I will really be
disappointed because treatment at this stage is difficult.

"Under such circumstances the treatment options are limited and we probably
will only be giving them medication to relieve pain," explains Dr Norlia.

But can women be solely blamed for seeking alternative treatment or seeking
treatment late?

LACK OF SUPPORT

Based on her own observation, Dr Norlia highlighted a disappointing fact
that many of breast cancer patients don't even have the support of their
husbands.

She provided an example where a woman came to seek diagnosis for the tumor
on her breast.

"We just took a tissue sample and before we could determine whether it was
malignant the husband had already divorced her.

"Therefore in view of the vulnerabilities like this, say if the woman is a
housewife with children and is depending on her husband, definitely she will
have her own reservations.

"Often this prompts the wife to conceal or ignore the problem. There are
wives who come to the hospital without their husband's knowledge," explains Dr
Norlia.

"We see in the wards women taking care of their sick husbands, feeding them,
cleaning them. Rarely we see husbands taking care of their wives the same way,"
she says.

ABORTING FETUS

According to Dr Norlia, in the event a pregnant woman is afflicted with
breast cancer, doctors will advise the woman to abort her fetus.

But in most women, especially Muslims, they will be reluctant to do this.

"This is among the reasons why many go soul searching after diagnosis and
return a year or two later where by the time the cancer has spread," he said.

The doctor says there is also an option for pregnant woman to undergo breast
surgery without the need to abort the fetus. If necessary, chemotherapy can be
given during pregnancy.

However, Dr Norlia points out this is only possible when the fetus is not
less that 12 weeks old but the risks are still there.

"If the woman is 10-weeks pregnant we would differ the chemotherapy until
the fetus reaches 15 weeks.

"But the risk of the fetus development being affected and the baby being
born underweight (less than 2.5 kg) or even dying during the treatment cannot be
ruled out," she said.

BREAST CANCER PREVALENCE IN YOUNGER WOMEN

She says that breast cancer that afflicts younger women, those in their 20s
and 30s, seems to be more aggressive that the one afflicting those above 50.

"We don't know why but the cancer cells spread quickly in younger women.
Therefore say a women aged 31 is diagnosed with breast cancer and is 10 weeks
pregnant, we will plan early treatment. If we wait until she delivers to start
the treatment, it means she will be without treatment for eight months!

"That is why we start treatment when the fetus reaches between 15 and
18 weeks old. Normally we will start with surgery to remove the tumor.

"Normally we do surgery and start chemotherapy at the end of pregnancy.
After delivery we continue with radiotherapy or endocrine therapy if necessary,"
says Dr Norlia.

She explains that the cancer cells will not spread from mother to the baby.

"The placenta serves as a natural barrier for cancer cells but not for the
AIDS, Hepatitis B or Hepatitis C virus and chemotherapy residues.

ADVICE FOR WOMAN

According to Dr Norlia, now there are newer treatments but the outcome still
depends on the stage of the cancer when treatment was initiated.

"Those with cancer need not despair. What is more important is that early
intervention is necessary for good treatment outcomes.

"Some come to me and ask will I live to see my children graduating from
university and if there are small children will I live to see them going to
school.

"Obviously they are really concerned with their children and therefore it is
only wise that they seek treatment early and don't wait until the problem has
spread to other parts," she said.

WORRISOME TREND

Dr Norlia notes that breast cancer incidence in women below 50 in Malaysia
is higher than in the West where breast cancer is more prevalent among women in
the 60-70 years age group.

The breast cancer incidence in the country stands at 47.4 for every 100,000
women.

While no latest data is available on the breast cancer incidence among the
different races, the 2005 data reveals the breast cancer incidence among Chinese
women are the highest with 1 in 16 of them afflicted by the disease, 1 in 17
Indians while for the Malays 1 in 28.

"In the West, the disease is detected early so the treatment outcomes are
better compared with Malaysia.

"Those afflicted with cancer in this country are much younger and seek
treatment much later, thus the treatment outcome is definitely not
satisfactory," she explains.

Dr Norlia noted, since October 2010, PPUKM has been offering breast
screening services for senior citizens with the primary focus on women in the 50
to 65 age group.

"Women who have registered for this service will undergo health screening
annually and mammogram biennially," she adds.

Nevertheless, women over 20 are encouraged to check their own breast for
signs of tumor or other problems.

-- BERNAMA