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INTERVIEWS VIEWS
THE socio-pathology of any
disease presents an astonish-
ing kaleidoscope – sometimes
brazenly alarming, strangely
anecdotal or glaringly poignant.
And so it is, with breast cancer.
There seems to be an icy final-
ity about the disease – a rising
new fear factor – causing jitters
among women, each time they
sense a lump in their breast.
A benign breast lump may
be nothing more than a “little
ouch!” for some women – but
for the growing numbers, the
onset of a malignant tumour
means a nightmare of pain,
fear of disfigurement, financial
burdens and an uncertainty, too
terrifying to contemplate.
Modern medicine continues
to overwhelm breast cancer
cells with brute force, slicing it
out with surgery, zapping it with
radiation or poisoning it with
chemotherapy. But still, breast
cancer is the leading cause of
cancer deaths among women
globally – and the strong signal
doctors are issuing is not just
“early detection of the malady”
but “early treatment” as well.
Staggering numbers
In cold print, the scale of the
breast cancer epidemic world-
wide and the magnitude of the
desolation is a cruel game of
numbers.
Each year one million women
are diagnosed with the disease
and about 500,000 die from it
worldwide. One in eight women
in the United States are afflicted
yearly, but in China and other
emerging economies, caseloads
are spiking to a new high.
By 2020, 70% of all breast-
cancer cases will be in develop-
ing countries or as epidemiology
(population study) defines as
“low and middle income coun-
tries” (LMCs). Painfully, while
the statistics of the disease are
increasing, the means to detect
and treat it early in Asia is pa-
thetic.
In Malaysia, one in 20
women will develop the disease
in their life time. The rate differs
between the main ethnic groups
with one in 16 Chinese, one in
16 Indians and one in 28 Malays
afflicted, according to the Na-
tional Cancer Registry.
Women diagnosed with the
disease are largely between 40
and 49 with just 50% of the cases
under 50 years, 16.8% below 40
and 2% under 30 years.
According to a study, “Epi-
demiology of Breast Cancer in
Malaysia”, published in the Asia
Pacific Journal of Cancer Preven-
Breast cancer:
Rising fear factor
AFTER ATTENDING AN INTERNATIONAL BREAST
CANCER SYMPOSIUM IN SAN ANTONIO WHICH
BROUGHT TOGETHER 8,000 ONCOLOGISTS,
JOSEPH MASILAMANY FILED THIS REPORT
OF A DISEASE WOMEN FEAR MOST, DETAILING
MALAYSIA’S BATTLE AGAINST THE RISING TIDE
OF THE MALIGNANCY.
tion, 90% of the lumps were felt
by the women themselves with
the average size registered at
4.2cm.
The authors of the study
reported that the women had
sought treatment only after a
three-month duration. “Malay
women seek medical attention at
later stages (stages 3 and 4) and
naturally with larger tumours,
they register lower survival
rates,” the study concluded.
A particular “case study”
defying clinical logic
happened at University
Malaya Medical Centre
(UMMC) where a
kidney donor with
a largely palpable
breast tumour had
“concealed” her
condition, either out
of fear or ignorance.
All was set for the
transplant surgery
and the metastatic
mass which had
already distended
into her abdomen,
was detected
by the surgical
team only after
anaesthesia was
administered.
The surgery to
transplant one
of her kidneys to
her husband was
immediately aborted.
As to how the cancer-rid-
den patient evaded stringent
theSun
pre-transplant donor-appraisal
remains a medical mystery.
Stark disparity
For a woman afflicted by the dis-
ease in the affluent West – new
diagnosis and treatment modali-
ties are plentiful but not so, for
the woman in Asia. The United
States spends about US$8.1 bil-
lion (RM29.3 billion) to diagnose
and treat breast cancer, but in the
city of Poona, India, home to 3.5
million women, only one medical
facility provides comprehensive
breast-cancer diagnostic and
treatment services.
In Central Asian nations,
mammography machines are
available, but a shortage of film
requires that doctors choose be-
tween taking the recommended
two-view image of a patient’s
breasts and taking a single-
view image of twice as many
women.
In South Africa, only 5%
of breast cancers are seen in
the early phase of the disease,
whereas in the US, that figure is
50%. Late detection of the disease
is one of the major challenges
Yip with a breast faced by doctors worldwide.
prosthetic In Kenya, if you cannot afford
which the to seek treatment overseas, “you
Cancer Resource just sit and wait to die”. This
Centre offers has prompted Nancy Brinker,
to those who founder of the cancer advocacy,
have undergone Komen Group, to say: “Poverty
mastectomy. is itself a known carcinogen.”
Ignorance and taboos
Every three minutes an Egyp-
tian woman is diagnosed with
the disease and her immediate
major concern is not the morbid-
ity of the disease – but the fear
that her husband will leave her.
Such secrecy and silence leads
not only to unnecessary misery
and untimely death.
Indian women afflicted with
breast cancer in the sub-conti-
nent, are sometimes forced to
use separate plates and spoons
because of the widespread belief
that the disease is contagious.
In Brazil, nursing mothers ask
whether they could contract
breast cancer
if their babies
burped during
breast-feeding.
One Malaysian
breast
cancer
survivor
was di-
vorced
by her
hus-
| THURSDAY FEBRUARY 5 2009
Umi Kalthsum counsels breast
cancer patients.
band because she refused to
have sex – fearing that sperm
was toxic and could aggravate
her condition.
Resource centre
Prof Yip Cheng Har of UMMC,
who was a delegate at the San
Antonio symposium in Decem-
ber is one harried doctor – on
her toes, multi-tasking as breast
surgeon, lecturer, clinician,
counsellor and letter-writer.
When theSun stepped into her
Cancer Resource Centre, where
she holds court, Yip was busy
typing letters for her patients.
The letters were addressed to
the Social Security Organisation
and the Employees’ Provident
Fund to elicit funds for the treat-
ment of her patients. Seeing her
fingers flying over the keyboard,
may not portray Yip as the likely
breast surgeon, or lecturer, but
that is the lot she takes upon
herself as a crusading doctor.
Yip also keeps in touch with her
patients via text messages and
voice calls.
Yip makes it a point to see
more than just the pathology of
the disease. Unwittingly she ends
up, not just treating the disease
but importantly too, journeying
with the “person” behind the
“pathology”.
“Looking into every area of
the patient’s well-being, educat-
ing them, making sure they keep
up with appointments and attend
chemotherapy, radiation pro-
cedures and completing every
course of therapy is inevitable,”
says Yip, who is assisted by
specialist (surgical) nurse Umi
Kalthsum Zakaria.
As Brinker said that “poverty
is itself a known carcinogen”,
Yip echoes a similar hint: “Life
is not fair, cancer treatment is
expensive and those who can
afford it get it all, and the poor
… there are far too many who
are left to their own doom and