SUNDAY STAR, 1 OCTOBER 2017

BREAST CANCER AWARENESS

Encouraging
action
General understanding of breast
cancer may be increasing among
women, but not so for men.
Turn the page to learn how it
affects the population.
2 Breast Cancer Awareness
AS one of the main care providers
among cancer charities in
Malaysia, the National Cancer
Society Malaysia (NCSM) is
dedicated to providing the best
possible education about cancer,
cancer care and patient support.
NCSM has been offering
counselling services for cancer
patients since 1980. In 2003, it
launched the Resource and
Wellness Centre to support patients
and survivors. Its aim is to improve
societys understanding of cancer,
consequently diminishing fear
regarding cancer and encouraging
early detection.
Over the years, NCSM has
established a breast cancer support
group called Pink Unity that
promotes peer-to-peer support.
NCSM has also set up different
wellness classes or activities such
as laughter yoga and dance.
According to NCSMs senior
project manager Viji Nair, many
breast cancer awareness
programmes and campaigns have
focused on the early stages of the
disease.
The society felt an urgent need
to highlight advanced stages of
Viji
Nair.
It's time for men to
be in the know, too
By IAN JEROME LEONG
CALL it what you may, be it male
egotism, pride or ignorance, but
there is a high possibility that the
next male you meet is oblivious
to the fact that men too can
develop breast cancer.
Moreover, you may even hear
him say words such as, Men do
not have breasts. We cannot
possibly develop breast cancer,
so it is definitely a womans
disease.
Unfortunately, he cannot be
further from the truth. While
males may only account for less
than 1% of all breast cancer
diagnoses globally, the fact of the
matter remains breast cancer
also affects males and can rob
lives.
Factors that can increase a
mans risk of developing breast
cancer include age, high
oestrogen levels, Klinefelter
syndrome (where there would
be lower levels of androgens or
male hormones), radiation
exposure and having family
members who carry breast
cancer genes BRCA1 or BRCA2.
The signs for breast cancer in
men are very similar to
womens, including the
development of a lump,
thickening of breast tissue,
having a nipple that is turning
inward, or an inflamed nipple
that may be secreting a clear
or bloody discharge.
Men can develop breast
A shoulder to lean on
NCSM members and cancer survivors join forces at the society's annual bubur lambuk giveaway event.
breast cancer, thus spurring an
initiative to start the Advanced
Breast Cancer (ABC) programme in
2013 based on data from the
Malaysian National Cancer Registry
2007 - 2011 that states 43% of
breast cancer incidences are
already in Stages 3 and 4.
We worked closely with the
pharmaceutical industry to raise
awareness and support for the ABC
community. Our first programme
was the publication of an ABC
information and awareness
brochure, which was followed
by the publication of Advanced
Breast Cancer Guidebook:
A Guide to Living with Advanced
lumps and the cancer can spread
to the lymph nodes in the armpit.
In men, it would be easier to feel if
there is a lump as they have less
breast tissue, so they should be
aware of the lump and seek help,
says Dr Yap Beng Khiong,
consultant clinical oncologist at
Ramsay Sime Darby Health Care
Subang Jaya Medical Centre.
He adds that the treatment for
breast cancer in men is similar to
women, such as surgery,
chemotherapy, radiation and
hormonal therapy.
Since there is a large number
of males who disregard this fact,
those who do eventually seek
medical attention tend to be
already well into the advanced
stages of breast cancer,
decreasing their chances
for positive treatment of the
disease.
Dr Yap shares, There has been
much research in the past and
from different countries that
reveals the presentation of men
with breast cancer is late and far
more advanced than in women.
Certainly, the awareness among
men is low because cases are not
common.
The uncommon nature of
the disease in men has a ripple
effect in creating attitudes of
indifference as well as lack of
word-of-mouth exposure and
clinical study.
Men may have a variety of
reasons for not being medically
diagnosed earlier such as
Breast Cancer.
This year, we created an ABC
microsite within our Stronger
Than Cancer website, says Viji.
The microsite, which is hosted
on www.strongerthancancer.org.
my, is an informative platform for
advanced breast cancer patients
and survivors. Users have access to
discussion forums on which an
advanced breast cancer forum
targeting patients and caregivers
was organised last year.
For NCSM member and
advanced breast cancer survivor
Nur Akmar Shuib, 44, she was
frustrated that there were no
symptoms or signs to indicate
believing that they are immune
to the disease, feeling ashamed
to have a condition more
commonly associated with
women or simply assuming
that their breasts look and
feel different as a result of
exercise or a sport-related
injury.
According to an
article published by
Reuters in 2011 titled
Male Breast Cancer
Rare, But Can Be
Aggressive, even
healthcare
professionals are
less likely to think
of men having
breast
cancer.
Not only are
lumps to be
deemed benign at
first, many experts
that include
members of
international health
bodies such as the United States
Preventive Services Task Force
agree that men with no family
history of breast cancer need not
be screened for the disease.
Looking at breast cancer
awareness campaigns such as Pink
October, it is also more common to
see companies, societies or non-
profit organisations focusing on
women in their activities as these
are likely to have a wider reach
and thus generate better returns
on value.
initial stages of her breast cancer.
Her journey with breast cancer
started with a Stage 4 diagnosis.
I did not experience any pain
prior to my diagnosis. The first
thing I had to do was find the right
breast surgeon and oncologist for
myself and a trusted caregiver for
my younger daughter, says Nur
Akmar.
She recalls feeling healthy and
happy right up to one night when
she found lumps on her breast and
armpit. Despite that, she continued
to remain positive.
There is hope no matter how
dark the scenario is. I had to accept
the fact that for a Stage 4 patient,
Nonetheless, suitable
treatments and relevant
support are out there should
men discover that they have
developed breast cancer.
The onus is thus on them to
put their ego aside and actively
seek help and address the problem.
SUNDAY STAR, 1 OCTOBER 2017
hospitals and necessary medical
attention are never far from ones
life. It will be a lifelong
involvement. Hence, a positive
mindset is vital.
Join support groups. There are
many of them online and they
provide vital sources of
information regarding ABC. More
importantly, set a target. What do
you want to live for after being
diagnosed? Reach for it, adds Nur
Akmar.
NCSM holds on to the philosophy
that cancer, including advanced
breast cancer, is not a death
sentence. It can be controlled for
years with many treatment options
and many women with advanced
breast cancer go on to live full lives
with the disease under control.
It encourages women to take
advantage of available support and
to join or even lead its online
forum community.
General cancer-related support
for all Malaysians is also available.
NCSM has developed several
modes of contact for people
seeking help such as its toll-free
cancer helpline (1800 081 000),
e-mail (help@cancer.org.my), a
mobile app (Stronger than Cancer)
and a website for advanced breast
cancer patients (www.
advancedbreastcancer.org.my).
Together with Etiqa, NCSM is
also offering free mammograms
for the underprivileged across
peninsular Malaysia.
n For more information,
call 03-2698 7300 or e-mail
angela@cancer.org.my.
SUNDAY STAR, 1 OCTOBER 2017 3
4 Breast Cancer Awareness
Separating facts from assumptions
BREAST cancer continues to be the
most common form of cancer in
women worldwide. According to
the World Cancer Research Fund
International, it makes up 25% of
all cancer diagnoses in women
globally.
The local front mirrors global
patterns, with the Malaysian
National Cancer Registry Report
2007-2011 reporting that one out of
every 30 women is at risk of getting
breast cancer.
Though women above the age of
40 are generally deemed to be at
higher risk of developing breast
cancer, the disease has been
reported among younger women,
proving that breast cancer
transcends age.
It is with knowing such alarming
facts that all women should
conduct self-examinations
regularly or seek medical
confirmation on an annual basis to
be able to detect the disease early
and have better chances of positive
treatment results.
Rather surprisingly, there is still
a large number of women who are
being diagnosed with advanced
breast cancer despite the fact that
Malaysia is among the upper
middle-income nations.
Preconceived fears
Dr Yap Beng Khiong, consultant
clinical oncologist at Ramsay Sime
Darby Health Care (Subang Jaya
Medical Centre), agrees that
there is an increased level of breast
cancer awareness among
Malaysian women due to extensive
media coverage, access to the
Internet and social media, but he
acknowledges that not everyone
has access to top facilities that
can provide diagnostic tests and
specialist care.
He also believes there are
various factors that hamper
Malaysian womens desire to act
such as social and cultural beliefs.
Consequently, free mammography
screenings that are organised by
the Government or societies tend
to receive poor turnouts.
All for the patient
THE International Agency for
Research on Cancers estimation
of 1.67 million breast cancer cases
diagnosed in 2012 globally means
the disease should not be taken
lightly and all women need to at
least conduct self-examinations
for breast cancer on a regular
basis.
The most important thing,
however, is to take immediate
action to be medically diagnosed
and receive the necessary
treatment should they discover a
lump in their breasts or show
symptoms suggestive of breast
cancer.
Yes, the possibility of having
breast cancer is frightening but
due to the evolution of technology
as well as the medical skills
available in Malaysia, women
stand a good chance to overcome
the disease, especially if the
disease is treated from an early
stage.
A rising proficiency
Over the last five to 10 years,
There is a multitude of cancer treatment options available, yet a large number of woman still neglect to report their
breast cancer symptoms.
When talking about breast
cancer, there is a range of aspects
to consider such as body image
as well as the views of family
members and spouses. They may
also have fears of losing their
breasts and this fear factor is very
big.
Another issue is cultural belief
and the stigma associated with
breast cancer. Some women will
first try alternative medicine as
they fear the side effects of
conventional treatment such as
chemotherapy and radiation.
There are many factors
involved but these are the main
reasons for most patients who do
not seek early help, says Dr Yap.
Based on his experience, he also
warns women not to base their
understanding of breast cancer
there has definitely been
development in new surgical
techniques, says Subang Jaya
Medical Centres consultant
clinical oncologist Dr Yap Beng
Khiong.
For example, oncoplastic
surgeons combine the skills of
removing a cancer lump and
cosmetic surgery to ensure the
affected breast retains or is as
near as possible to its original
shape and size.
Another development is in
terms of the technology and
machines currently available such
as intraoperative radiation
therapy (IORT), which provides
radiation during the lump
removal surgery, adds Dr Yap.
Traditionally, if a patient only
has a lump removed, also known
as a lumpectomy, external
radiation is recommended to
reduce the risk of recurrence in
the breast.
Sessions start three to four
weeks after surgery once the
wound heals and usually require
the patient to come in every day
purely on what is available
online as one will experience an
information overload.
He stresses that there is nothing
better than having a trained
specialist for professional medical
guidance.
More to be done
The high number of advanced
breast cancer reports in Malaysia
sparks the need for even more
awareness campaigns, roadshows
and media involvement to urge
more women to be wary about
their breast health.
Dr Yap says, The only way
to address the issue is by
continuously disseminating this
information.
The media plays a big part in
for three to six weeks, depending
on the situation.
Now with IORT and careful
patient selection, the patient
can have radiation at the time
of operation while under
anaesthesia.
Radiation is given in the cavity
where the tumour has been
removed, so treatment is
delivered inside the breast. When
they wake up, all the radiation is
done so they do not necessarily
need to have radiotherapy
afterwards.
IORT does not apply to all
breast cancer cases and the end
results are equivalent to that of
separate lumpectomy and
radiotherapy sessions. However,
IORT is a big step forward in
decreasing recovery time and
travel.
Malaysian hospitals are
also improving in the range of
services they offer and housing
specialised centres that provide
comprehensive care in diseases
such as cancer, including the four
pillars of oncology surgical (to
promoting breast cancer
awareness, including activities
such as Pink October, and
encouraging women who have
any breast lumps or symptoms
that are suggestive of breast
cancer to seek help early and
this cannot be emphasised
enough.
Recognising that more
advanced cases of breast cancer
seem to be reported in public
hospitals compared to private
facilities, Dr Yap suggests for
more activities to be organised
by societies at the community
level as well as in schools or
shopping malls instead of being
concentrated in big cities such as
Kuala Lumpur.
Stressing that women should not
wait before being diagnosed, he
remove lumps or tumours),
medical (the delivery of drugs and
medicine), radiation (in treating
cancer with radiation) and
interventional (delivery of
medication or internal radiation
directly onto the tumour).
Some centres do not have such
comprehensive services and
patients may need to undergo
treatment or tests in different
hospitals. It is important to have
more or all services under one
roof to avoid delays in diagnosis
and treatments.
The advantage is to allow the
patient to contact and have
meetings with all the specialists in
a short space of time without
travelling from one centre to the
next and start treatment in a
timely manner, he shares.
A helping hand
Dr Yap adds that the entire
dynamics of healthcare has now
moved to a service that puts
patients views and feelings as the
utmost priority.
SUNDAY STAR, 1 OCTOBER 2017
Subang Jaya Medical Centre's clinical
oncologist Dr Yap.
Some women will
first try alternative
medicine as they
fear the side effects
of conventional
treatment such as
chemotherapy and
radiation. There
are many factors
involved but these
are the main reasons
for most patients
who do not seek
early help.
Dr Yap
says, Earlier diagnosis leads to
better outcomes and better
survival, there is no doubt about
that.
n For more information, call
03-5639 1212.
Nowadays, when we provide
healthcare, we need to provide
patient-centred care. It is to
promote the idea that patients are
individuals and concentrate on
their views as well as their
relatives in decision-making not
a paternalistic view of doctors, he
says.
Having support groups and
forums are also among the
initiatives in various hospitals,
becoming places for patients and
family members to voice their
fears, symptoms and coping
methods with other families who
share the same experiences.
At the end of the day, I can
provide patients with all the
information but some patients
may be reluctant to talk about
their problems or share their
experience.
However, support groups are
there for patients. Through
recommendations and word of
mouth, they will hopefully realise
there is useful information there
and see how such initiatives can
help them.