SUNDAY STAR, 13 OCTOBER 2019

BREAST CANCER AWARENESS

It’s never really over

By ROSEMARIE JEREMIAH

FOR those of us who haven’t had any direct

experience with cancer, it’s easy to think
that once treatment is over, the cancer is
cured and the patient can jump for joy.
But truth is, like the aftermath of a passing
hurricane, rebuilding one’s life and
getting back to a normal routine takes
time and is an experience that is one’s
own.
After her last chemotherapy session,
Josephine Niles was absolutely relieved
that the worst of her ordeal was over. “I
looked forward to getting my appetite
back. I especially looked forward to my
hair growing back,” she shares.
However, while the hard part of her
battle was over, she still had to undergo
more treatment. She wasn’t too worried
about it, though, as just like her doctor had
assured, it was a walk in the park
compared to chemo.

You’re not alone

“Nothing prepares you for something
like cancer,” shares Niles, who fought her
battle with breast cancer more than nine
years ago. She shares that it was a personal
journey that strengthened her faith as well
as her relationships with her family and
friends.
Everyone in a woman’s life plays an
important role when it comes to the battle
with breast cancer. Throughout the whole
process, Niles shares that aside from the
medical team looking after her, her Josephine Niles (centre) surrounded by her loving family. She says her support system was not just the medical team looking after her, but
support system was made up of her late also included her late husband, five children, maid and the prayers of many.
husband, five children, maid and the
prayers of many. introduced me to Facebook. My family and others in similar circumstances, says, “I Staying vigilant
Her children, who were already working friends, who were added to my friend list, treasure the friendships I struck with other
or in university at the time, made it easier were actually wondering if I was really cancer patients.” “Unfortunately, breast cancer can recur,”
for her by taking over many household undergoing cancer surgery,” shares Niles Support groups, whether in person, online says ParkCity Medical Centre consultant
responsibilities. They also kept her with a laugh. or through community programmes, bring breast surgeon Dr Azlina Firzah Abdul Aziz,
company whenever they could and helped She adds that having a support group of people together and provide a safe who adds that among the things to look out
make her comfortable. peers who are either going through or environment and forum for exchanging for are physical changes, sometimes at the
“I remember when one of my daughters have gone through a similar experience perspectives, sharing concerns and gaining
stayed in the hospital with me and also helps. Niles, who has also helped confidence to face the future. > TURN TO PAGE 2

For financial security in times of need

ANYONE recently diagnosed with cancer
faces a confusing time. Their initial thoughts
can include, “What do I do next? Can I
survive this? What are my chances of
leading a normal life? What are my best
treatment options?”
Cancer was responsible for an estimated
9.6 million deaths last year alone, according
to the World Health Organization (WHO).
The statistics are just as alarming in
Malaysia, with the Global Cancer
Observatory 2018 reporting 43,837 new
cancer cases in the country last year.
Speaking at an event in May, Women,
Family and Community Development Deputy
Minister Hannah Yeoh said Penang recorded
the highest number of breast cancer cases in
the country, at roughly 50 cases per 100,000
women. This was followed by the Federal
Territories (Kuala Lumpur and Putrajaya) at
42 cases per 100,000 women and Johor (39
cases per 100,000 women).
Improving cancer mortality hinges on
awareness, early diagnosis and access to
treatment, but it is disturbing when the
Health Ministry claims that up to 60% of
cancer cases reported in Malaysia are only
detected at stages three and four.
The Healthcare Performance
Measurement and Reporting System noted
that up to half of breast cancer patients in
Malaysia could have been saved if they had
access to the right treatment at the right
time. Such statistics, however, need not be a
lasting reality for Malaysia.
A cancer diagnosis is life-altering as it
forces patients and their families and carers
to reconsider their priorities and cope with
new challenges.
The biggest challenge, however, is
escalating medical costs. WHO reports that
70% of deaths related to cancer occur in low-
and middle-income countries, with
affordable treatment being among the key
factors affecting mortality rates in addition
to late-stage presentation, lack of accessible
diagnosis and late detection.
Be prepared financially
Allianz Malaysia Berhad’s latest offering,
Allianz Cancer Protect, is aimed at helping
Malaysians better manage the financial
burden of cancer treatment.
Understanding the needs of cancer
patients, Allianz Cancer Protect features four
tailored plans: Plan 125 (for an insured
amount of RM125,000), Plan 250
(RM250,000), Plan 375 (RM375,000) and Plan
500 (RM500,000). In each plan, policyholders
can choose between a Lump Sum Insured
Amount (Coverage A and Coverage B) and
Overseas Medical Treatment Benefit
(Coverage B only) upon diagnosis.
Additional benefits include:
l Flexible premium payment terms
l Up to 200% insured amount of
guaranteed payment
l Up to US$4mil (RM16.7mil) in overseas
medical treatment benefit
According to Allianz General Insurance
Company (Malaysia) Berhad sales
management head Linda Lor, Allianz Cancer
Protect is all about providing protection that
really matters when it is needed the most.
The prevalence of breast cancer is rising
With Allianz Cancer Protect,
policyholders may choose between the
following options.
l Lump Sum Insured (Coverage A)
– If diagnosed with cancer, the insured
receives 200% of the insured amount
upon approval of the claim.
l Overseas Medical Treatment
Benefit (Coverage B) – If diagnosed
with cancer, the insured receives 100%
of the insured amount. Coverage B
policyholders have an Overseas
Medical Treatment Benefit Annual
Limit of up to US$2mil (RM8.4mil) and
an Overseas Medical Treatment Benefit
Overall Limit of US$4mil (RM16.7mil).
During the 36-month indemnification
period, the insured is allowed to seek a
second opinion and choose to either:
§ Receive an additional 100% of the
insured amount, or;
§ Activate the Overseas Medical
Treatment Benefit
in Malaysia. Lor stresses how important it is
for Malaysian women to be insured in the
event of a cancer diagnosis, saying, “Ask
anyone if they have a female figure in their
life who is affected by cancer. It could be
family, a friend or co-worker. Most of them
would probably say yes. That is the harsh
reality we face today.”
n For more information on Allianz Cancer
Protect, visit allianz.com.my/allianz-cancer-
protect or allianz.com.my
2 Breast Cancer Awareness
Ladies, do not
skip your checkups
> FROM PAGE 1
surgical scar near the armpits or the side of
the lungs, lymph nodes in the neck, as well
as pain that can’t be explained.
“Another symptom is feeling unwell or
losing weight unexpectedly because
sometimes, cancer can recur in different
organs,” she says.
Dr Azlina advises breast cancer patients
to undergo checkups every three months
for the first two years and every six months
after that. “The first two years of checkups
can be quite intensive and is sometimes
divided between the oncologist and
surgeon, depending on how serious the
cancer is.”
While most books tend to say a patient
can come in for an annual checkup after
the fifth year, Dr Azlina advises patients
who suddenly start feeling unwell for any
reason to undergo a checkup and bring it to
the attention of the attending doctor.
Dr Azlina recalls an incident where she
was following up with a patient who had
undergone treatment for cancer some years
ago. Every time the patient came in, she
was all smiles. However, on this particular
day, she wasn’t smiling. After asking her
patient some questions and examining her,
the only symptom that the patient had was
a loss of appetite.
However, tests showed a different story –
her cancer had recurred. “You must always
be on the lookout for recurrences,”
emphasises Dr Azlina.
Right choices and a positive
mind
Part of the recovery process includes
SUNDAY STAR, 13 OCTOBER 2019
Support groups, whether in
person, online or through
community programmes,
bring people together and
provide a safe environment
and forum for exchanging
perspectives, sharing
concerns and gaining
confidence to face the
future.
making healthier lifestyle choices and having
a positive mindset.
“I choose to be positive. I did have bouts of
tiredness, but I just moved on. I chose not to
dwell on what I had gone through,” shares The key to managing your breast cancer risk is early detection, so learn to self-examine,
Niles, who retired shortly after her treatment attend regular checkups and schedule mammogram and ultrasound exams as advised by
was completed. your doctor.
We may not be able to avoid all the
negative feelings in life and it’s unrealistic to Niles, who struggled to get her appetite curable. However, the key to higher
think that we can. However, people who are back, was grateful for her dietitian friend, chances of survival is early detection.
positive know how to keep life’s tragedies who helped her with her diet. Niles’ doctor discovered a lump in her
from spoiling all the good things life has to breast during a routine gynaecology exam.
offer.
“You have to cut alcohol out of your life,”
“It won’t happen to me” It concerned him enough that he referred
her to the National Cancer Society Malaysia.
shares Dr Azlina, adding that if you’re obese, According to the Malaysia National “The early diagnosis made all the
especially if you’re in the menopausal age Cancer Registry Report 2007-2011, cancer is difference,” says Niles.
group, you need to reduce your weight, one of the leading causes of death in Her advice to other women is to learn to
because you are at high risk of breast cancer
and recurrences.
Malaysia, with breast cancer being the most
common cancer among women. The report
examine yourself and go for mammogram
or ultrasound checkups at least every
She also advocates healthy eating and stated that one woman out of 20 will get alternate year.
urges patients to consult a nutritionist as breast cancer. “Don’t ever think that this will only
they begin the long journey to recovery. The good news is that breast cancer is happen to someone else and not you.”
SUNDAY STAR, 13 OCTOBER 2019 3
4 Breast Cancer Awareness
Self-examination is self-care
BREAST cancer is so common that
one in 20 Malaysian women
develops breast cancer in her
lifetime. Dr Daphne Anthonysamy,
consultant breast and endocrine
surgeon at Subang Jaya Medical
Centre, says it is best if the cancer
can be detected early and treated
accordingly for a higher chance of
survival.
She advises women to examine
their breasts around 10 days after
their periods, as hormonal changes
during the menstrual cycle may
cause breasts to feel lumpy and
sore and potentially lead to a
misdiagnosis.
For a proper self-examination,
one should stand in front of a
mirror, use the flat of her palms
and massage her breasts and the
areas around them, including her
underarms, with circular motions
to feel for lumps and irregularities.
Dr Daphne lists several breast
cancer warning signs to watch out
for:
l Asymmetry – When the
breasts look very different from
each other
l Abnormalities on the nipple
– Peeling skin, cracks and sores
around the nipple
l Nipple discharge – Any nipple
discharge requires medical
attention, especially when the
discharge is coloured
l Puckering of the skin –
Dimple on the breast
l Lumps
If you notice any of these signs
when checking your breasts, Dr
Daphne urges you to consult a
doctor right away. Imaging of the
breasts can be done via
mammogram for older women
with ultrasound as adjunct
screening, ultrasound for younger
women and MRI for women with
Don’t let fear get in the way of treatment
“A LOT of women are afraid to
come to hospitals for breast
cancer treatment because they
are afraid that if they are
diagnosed with cancer, they are
going to lose their breast,” says Dr
Tan Gie Hooi, consultant breast
and oncoplastic surgeon at
ParkCity Medical Centre.
However, that is far from the
reality. With modern technology
and advancements in medicine,
there are many more treatment
options for women in their fight
against breast cancer, one of
which is reconstructive surgery.
“Doctors will always try and
save the existing breast with
breast conserving surgery
(lumpectomy),” says Dr Tan. Only
in instances when it is not
advisable to have a lumpectomy
is a mastectomy (removal of the
Types of breast reconstruction
It’s important to choose
breast reconstruction that is
suitable for your body type.
The two types of breast
reconstruction available are:
l Implants
Breast implants, usually
made of silicone, are surgically
placed to reconstruct the
breast. These implants are the
quickest and simplest form of
breast reconstruction.
However, an implant does not
last forever. There is a risk of
Dr Daphne Anthonysamy.
breast implants.
Reducing the chance of
occurrence
There are no confirmed
preventative steps for breast
cancer. However, Dr Daphne says
it can be helpful if we recognise
our risk factors and take steps to
minimise our risk of developing
breast cancer.
“The risk increases as we age
and is notably higher in women.
Besides that, a first-degree family
history of breast cancer, having the
breast cancer gene (BRCA gene)
and undergoing hormone
replacement therapy can increase
breast cancer risk.”
All in all, she wishes the public to
know that there is a higher chance
of survival for breast cancer as
long as there is early detection and
proper treatment. As her final
advice for women, she quips,
“Always be breast aware.”
n For more information, call
03-5639 1212.
Dr Tan Gie Hooi.
whole breast) conducted.
In this scenario, Dr Tan finds
that a lot of women are fearful
about going through with a
capsular contracture, which is a
response of the immune system to
foreign objects in the body, years
after getting the implant. This will
require changing the implants and
a capsulectomy.
l Tissue flap procedure
In this procedure, a woman’s
own tissue is taken from within
the tummy (TRAM flap) or back
muscle (latissimus dorsi flap) and
used to create a mound to
reconstruct the breast. Sometimes
the tissue being moved is kept
Do not be fooled by the myth and misconceptions of breast cancer. Should you notice any warning signs, get it
checked immediately.
Choosing what matters most
Despite heightened
awareness and technological
advances, Dr Daphne
Anthonysamy, consultant
breast and endocrine surgeon
at Subang Jaya Medical Centre,
says misconceptions about
breast cancer are still prevalent
in Malaysia. She clarifies a few,
as detailed below.
False: It isn’t breast cancer if
it isn’t painful
True: In most cases, breast
cancer is actually painless.
False: Breast cancer occurs
only in elder women
True: Younger women can be at
risk of developing breast
cancer, too.
mastectomy because of body image
issues, as they can’t imagine seeing
themselves with one breast. “This
is where breast reconstruction
comes in,” says Dr Tan.
Breast reconstruction surgery
can be done either immediately
during the mastectomy or at a later
date. Delayed breast reconstruction
usually is done about one or two
years after treatment is complete.
Talking to your doctor
There are two types of breast
reconstruction for patients to
choose from – the use of implants
or tissue flap procedures.
While breast reconstruction is
available for everyone, you and
your doctor will need to talk about
your wants, needs, medical
conditions and any previous
attached to its blood supply, in
what is called a pedicled flap.
Other times, where a free flap is
done, the blood vessels are
disconnected and then
reconnected to a blood supply
near the new location (breast).
In instances where a TRAM
flap is used, part of the core
muscle of a patient’s abdomen is
harvested. Hence, patients are
advised not to stress the
abdominal muscle too much
after the surgery.
False: Traditional medicine can
cure cancer just as well as
modern medicine
True: Some people buy into the
sweet talk of a painless and
easier way of treatment with
traditional medicine. However,
this may cause a patient’s
condition to worsen by delaying
treatment.
False: When you undergo
treatment for breast cancer,
you will lose your breast
True: If treatment is sought early,
you may not need to lose your
breast. Lumpectomy, which is a
type of breast-conserving
surgery, only removes the lump.
Even if you have to remove
your breast, surgeons can
surgery before you decide. If you
are someone who wants to have
children after reconstructive
surgery, you will also need to talk
to your doctor to find the right
procedure for you.
“Most of the time, ideal
candidates for breast
reconstruction surgery are patients
less than 55 years old, who don’t
have any pre-existing medical
problems, such as diabetes or
hypertension, and is a non-
smoker,” says Dr Tan. However, if
you do have any of these
conditions, more caution is taken
with reconstructive surgery.
Because every person’s body is
unique, a number of factors are
Women must remember there are medical treatment options for patients
with breast cancer, including reconstructive surgery.
SUNDAY STAR, 13 OCTOBER 2019
carry out immediate breast
reconstruction.
False: Being diagnosed with
breast cancer equals a death
sentence
True: Breast cancer is actually
curable when diagnosed early
and treated accordingly. The
five-year survival rate for breast
cancer is 92% to 98% for stages
1 and 2, 70% for stage 3 and
20% for stage 4.
False: Only women get breast
cancer
True: Men can also get breast
cancer. While it is rare, it is
more aggressive when it occurs
in men because men have less
breast tissue.
usually taken into consideration
before undergoing breast
reconstruction surgery. “When we
suggest the type of reconstruction,
we look at the patients’ breast as a
whole, taking into account the
breast size and shape to know
the volume required for
reconstruction,” she says, who adds
that you should not be afraid to ask
your doctor what your options are,
emphasising that every woman
deserves to be told about breast
reconstruction and it is up to them
to decide if they wish to undergo
the procedure.
n For more information, call
03-5639 1212.