KUALA LUMPUR, Sept 28 – Three out of every four women over 40 in Malaysia have never had a mammogram done, while one in two women do not practise breast self-examination, said Dr Ng Char Hong, a consultant breast surgeon at Sunway Medical Centre.
There are a number of reasons for this, he added, and one of them is that women do not know how to examine their own breasts because they have never been taught how to, whether at home or in school.
“Whenever they feel something, the lump is already quite big. Most women will be able to feel a lump that is 1.5cm and above, but very few ladies will be able to feel anything smaller than that, purely because they are not familiar with their own breasts.”
Many women also do not go for mammograms because they fear it will be painful, Dr Ng said. “Yes, it is uncomfortable but the newer 3D tomo mammograms are less painful than the old ones,” he explained, referring to the digital tomosynthesis 3D mammograms, which use X-ray signals to compile images of the breast from all angles.
He said some women are averse to mammograms because they think they will get cancer if they undergo a mammogram screening. “Mammograms detect cancer earlier, it won’t cause cancer. But that’s what a lot of people still think.”
The High Price Of Fear and Complacency In Health Care
However, the worst case scenario is when patients fear results and avoid treatment, Dr Ng said. “I had a patient who came to see me to do a health screening, she did a mammogram and found a lesion there. We did a biopsy and it turned out to be stage zero cancer.
“Stage zero cancer is very early. Most of the time we remove the lump and there is no need to do anything else, occasionally patients need radiotherapy.
“But this lady didn’t want anything to be done. As I recall, she disappeared. She knew she had cancer and it was at a very early stage.”
When she came back to see him around four or five years later, the patient was at stage two or three of the cancer, Dr Ng recalled. “That is very sad because she went for the health screening but she didn’t do anything after it.”
Some patients fear losing their breast, he said, because they equate breast cancer with a mastectomy. “But to be honest, that’s not the case anymore. At the moment, with all the new kinds of chemotherapy available, with all the new techniques of reconstructive surgery — most ladies do not end up losing their breast.”
Dr Ng was speaking on an online panel for the launch of the HER Time Matters campaign by pharmaceutical company Roche Malaysia, on September 22. The campaign was launched in conjunction with Breast Cancer Awareness month, which falls in October.
On the panel with him were Deepti Saraf, general manager of Roche Malaysia, Polin Lim, founder of The Asian Women (TAW), and Jojo Struys, wellness personality and founder of OhanaJo.
Struys also had a story to share about the price of complacency when it comes to taking care of one’s health. “I had a friend with a life you would see on glossy magazine pages,” she said, adding that things are not always as they seem.
“When she got diagnosed with breast cancer, she completely didn’t expect it. She just had a meltdown and she goes, ‘Oh my God, nothing matters apart from being able to spend more time with my kids’.
“She started to reflect on how little she was showing up in her life, even as a wife because she was so married to her work. It (cancer) just starts to get you to really evaluate what’s important.”
However, Struys’s friend did her research and went for treatment. “She discovered it, I think, at between stage one and stage two, and she managed to come out of it.
“What was frightening was she came out of it so much that she went back to her life as it was. It was almost as if it had never happened.”
Once you’ve had cancer, you’re on schedule for follow-ups, said Struys, who added that her friend kept postponing the appointment for a follow-up, resulting in a rude shock.
When her friend found out the cancer had returned, it was at a more advanced stage than it would have been if she hadn’t missed her appointment with the doctor.
“So, she had two massive shocks and the biggest takeaway for me is, even when you have already detected something, you’ve had this huge wake-up call, don’t rest on your laurels,” Struys said.
“Don’t just go: Okay, I’m alright now. Maintain your health, maintain that feeling of what’s important to you.”
Prioritising Women’s Health
Polin Lim said TAW offers a platform for conversations and stories like the ones shared during the panel discussion. “What we really need in Malaysia is to have these conversations (about the breast) normalised. I think breasts as a body part are oversexualised by the media.”
In line with the campaign, TAW will roll out programmes that remind women about the importance of focusing on their own health care needs. “Typically, we’re putting everyone’s needs ahead of ours and we forget to prioritise. We forget that we too matter,” she said.
TAW will also launch a new platform next month at talkhealthasia.com, where a video on how to conduct a breast self-examination will be available. “We use a prosthetic breast to show you how to do this.
“In Malaysia, from what I understand 60 to 70 per cent of breast cancer cases are diagnosed in stage two and three. If we can have these conversations among women, we can detect cancer earlier.
“Even at the pre-cancer stage of DCIS, women have so many more options.The later you diagnose, the less options you have,” said Lim.
DCIS or ductal carcinoma in-situ is non-invasive or pre-invasive breast cancer, otherwise known as stage zero breast cancer. At this stage, the cells that line the milk ducts of the breast have become cancerous, but they have not spread into surrounding breast tissue.
If left untreated, the cancer can spread out of the duct into nearby tissue, and then metastasise to other parts of the body, becoming an invasive breast cancer.
“Women are generally known to be overly self-sacrificial and often place the importance of others above themselves, lacking the urgency, awareness and focus to invest in their own health needs,” said Deepti, explaining the need for the campaign, which champions health empowerment, engagement and personal decision making.
“Only 12 per cent of women around the world are screened for any form of cancer. I think that’s something that’s hitting us hard at Roche.”
She said breast cancer is the focus of the campaign because it is one of the most common cancers among women in Malaysia and one of the most curable. “It’s something that if women were diagnosed at the right stage, we can help you to live longer.”
Through the campaign, she said Roche hopes to initiate a momentum of change in how women reimagine their time and how they prioritise health care.
“With the flexibility of so many innovative options, and where and how they (women) can access care, we hope they realise that a lot can be done that adds time back to them. And they can have good health care at their fingertips, nearer to their homes. We want to make sure they are aware of it. ”