Breast Cancer Awareness Month: Your guide to diagnosis, treatment and support in Malaysia
According to the Breast Cancer Welfare Association of Malaysia (BCWA), one in 20 Malaysian women are at risk of developing breast cancer. In any case, it’s important to get diagnosed as early as possible to optimise the positive outcomes of your diagnosis.
However, even if early detection was not possible for you, there are plenty of treatment avenues for you to explore. In light of this, we’ve consulted both the BCWA and a consultant oncologist to create this guide for Breast Cancer Awareness Month.
Find the answers to all the questions you could possibly have ahead.
How do I self-examine?
If you aren’t already, you should be conducting a self-check at least once a month. According to the National Breast Cancer Foundation of America, “forty per cent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important.”
How to do it? Ideally, you should be feeling your breasts in a multitude of different positions; click here to find the full scope of what the Breast Cancer Welfare Association of Malaysia (BCWA) recommends. In their article, they cover how to perform the self-exam, the different positions you should check your breasts in, and what to look out for.
As for all you lads out there—don’t think you’re exempt from this, either. You have mammary tissue too; although it’s uncommon, it’s definitely possible. In fact, Dr Malwinder Singh Sandhu, the consultant clinical (medical and radiation) oncologist at Sri Kota Specialist Medical Centre, says that around 1 percent of all breast cancer cases happen in men.
Should I get a mammogram?
In addition to your regular self-examinations, you should also be getting a mammogram annually after the age of forty years, or if you suspect you may be part of the high-risk population. Specifically, the ‘high-risk’ group includes women with a past history of breast or ovarian cancer, women with a family history of one or more first or second degree, relatives with breast cancer before the age of 50 years, women in the age group of highest incidence, above 40 years, and women that are on Hormone Replacement Therapy (HRT), as stated by the BCWA.
The key to a positive prognosis with breast cancer is early detection; essentially, you want to find the disease before it has a chance to spread. Mammograms are indispensable in the early detection of breast cancer, as they are able to detect lumps two to three years before they are palpable.
I have been diagnosed with breast cancer—what are my treatment options?
It depends on the type of breast cancer you have, but generally, your options include: Chemotherapy, radiation therapy, hormone therapy, immunotherapy, targeted therapy and breast cancer surgery.
Consult your doctor to assess your options—no one treatment is universal. Your treatment needs to be personalised to your needs.
What do I do if I cannot afford treatment?
Ms Ranjit Kaur, the President of the BCWA and a breast cancer survivor herself, took us through a few of the available options, stating: “If you have been working before, SOCSO can be one of the resources that you can go to to get financial aid. You could also withdraw money from your EPF. Further, organisations like Zakat and MAKNA provide support as well."
On the other hand, there are some pre-emptive options to look into such as a solid health insurance plan, or hospitals that are providing patient-assistant programmes that provide support.
“Ultimately, our mission is to improve the quality of life for breast cancer patients, and reduce the risk of premature mortality by driving awareness, early detection, medical treatment, and timely treatment.” — Ms Ranjit Kaur, president of the BCWA
What is the difference between breast cancer and metastatic breast cancer?
Metastatic breast cancer (mBC), also known as Stage IV breast cancer, describes when the cancer has spread from the breast to other organs in the body. The most common sites for the breast cancer to metastasise include the bones, the liver, the lungs and the brain. It can occur at diagnosis, or even months or years after the breast cancer has been treated.
What are the symptoms for MBC?
The symptoms depend on where your cancer has metastasised:
Brain: It depends on the area of the brain that is affected, but you may experience headache, nausea, fatigue, weakness, confusion, memory loss, speech problems and seizures.
Lungs: Sometimes, breast cancer cells spread to one or both lungs through the blood or lymph system—in this case, you may experience symptoms of breathlessness, coughing, pain and loss of appetite.
Liver: The symptoms include pain, nausea, loss of appetite, hiccups, jaundice, exhaustion and itchy skin.
Bone: This kind of metastases occurs in around two-thirds of women with mBC, and it is the most common site causing cancer-related pain. With this kind of metastases, you may experience pain, bone fractures from bone weakening, spinal cord progression, anaemia, and fatigue.
If you do not show symptoms, how do you diagnose breast cancer?
Typically, your healthcare provider would be conducting serial investigations such as chest X-rays, CT scans and PET/CT scans. Your best bet is to ensure you’re going for regular medical checkups.
Is mBC a death sentence?
Unfortunately, mBC is incurable, however the right treatments allow for long periods of remission. Dr Malwinder says “we can provide long-term duration of remission, which means that we are trying to make mBC as chronic as possible. We are trying to make it so you can live another 5 to 10 years. Take something like diabetes and hypertension, where you can live many, many years with it; we are trying to make mBC into the same position as that.”
With regards to your local mBC treatment options, you can either opt for surgery or radiotherapy, which won’t cure your cancer, but will palliate your symptoms.
Ms Ranjit Kaur also highlights that the Thrive website has funding resources that you can refer to, as well as information about mBC, treatment options, support groups, financial assistance, video stories of courageous mBC patients that would help those living with mBC feel less isolated, as well as the upcoming #UnPause patient handbook.
What puts me at a higher risk of developing metastatic breast cancer?
The development of breast cancer is strongly linked to the hormones in a woman’s body; specifically, this refers to increased oestrogen exposure. Early menarche (the first occurrence of menstruation) and late menopause will mean that your body is exposed to oestrogen production for longer.
Similarly, hormone therapy with oestrogen further perpetuates exposure and increases the risk of breast cancer. Finally, in obesity, adipose tissue is converted to oestrogen, which further increases your risk of breast cancer.
I have breast cancer. Does that put me at a higher risk of COVID-19 infection?
The short answer is yes. Dr Malwinder explains that: "Cancer patients are immunocompromised. means that your body immunity is low, so you are much more prone to having any infection."
Are there any diet restrictions once I start treatment?
Dr Malwinder suggests that instead of eating three meals a day, you eat smaller, more nutritious portions more frequently throughout the day.
Further, he advises that you try to avoid raw food, because raw food may have organisms inside that may pose a slight risk of infection for your newly immunocompromised body.
Mostly, however, he says you should “just eat whatever you want, but make sure you exercise to burn it off later.”
Is it safe to get treatment for my cancer in this pandemic?
In this pandemic, Dr Malwinder says that your individual case will be reviewed and categorised into three tiers in order to determine whether you need treatment immediately.
Tier 1: High priority
Patients whose condition is life-threatening or clinically unstable and/or where the planned treatment is likely to result in significant benefit.
Tier 2: Medium priority
Patients whose condition is serious, but not immediately life-threatening and where a short delay in treatment can be considered. However, a delay of longer than six to eight weeks could potentially impact on outcome and/or the amount of benefit.
Tier 3: Low priority
Patients whose condition is stable enough that any treatment can be safely delayed for the duration of the COVID-19 pandemic. This includes patients whose planned treatment is unlikely to provide a significant benefit.
There are a few ways your physician can adjust your treatment plan to accommodate the pandemic, such as:
- Delay any non-essential surgery and/or offer neoadjuvant therapy (treatment to buy time before surgery) to delay your surgery
- Recommend a chemotherapy ‘holiday’ (a break from chemotherapy) if you are on maintenance therapy and have established remission
- Switch to a chemotherapy regimen that requires less frequent infusions (there are multiple different programmes of chemotherapy from once weekly to once every three weeks)
- Switch from intravenous to oral chemotherapy so you can treat yourself at home
- Take prophylactic growth factors to help boost your immune system and antibiotics to wade off potential infections
- Consider accelerated or hypno-fractionated radiotherapy schedules
- Change your treatment schedule to reduce the frequency of hospital visits
- Communicating to your cancer care team virtually (online or via phone) to avoid or lessen the frequency for physical consultations.
In addition, Dr Malwinder has described a few adaptations that hospitals may adopt to accommodate the pandemic, such as:
- Screening for COVID-19 symptoms prior to patient visits
- Proper spacing in the waiting room
- Spacing out appointments to limit the number of patients in the waiting room at a given time
- Compulsory face masks
- Frequent sanitisation (wash your hands)
- Socially distance yourself
I feel isolated after my diagnosis—is there anyone I can reach out to?
“You need a strong social support network of care for all breast cancer patients, but especially for late-stage cancer patients. Those are the most vulnerable patients,” Dr Malwinder says.
This support community can be found through the BCWA—Ms Ranjit Kaur prides herself on her organisation’s well-established “signature peer support and community outreach programmes that work to provide psychosocial support, access to treatment and advocacy.”
She elaborates that “communities can relieve the fear and uncertainty through their experience, encouraging words and accurate information.” Find out more about the BCWA’s wonderful service here.
For more information about Breast Cancer Awareness Month, click here.