Thesun 2009-02-05 Page12 Breast Cancer Rising Fear Factor

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theSun

| THURSDAY FEBRUARY 5 2009

INTERVIEWS VIEWS

THE socio-pathology of any disease presents an astonishing kaleidoscope – sometimes brazenly alarming, strangely anecdotal or glaringly poignant. And so it is, with breast cancer. There seems to be an icy finality 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 worldwide 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 breastcancer cases will be in developing countries or as epidemiology (population study) defines as “low and middle income countries” (LMCs). Painfully, while the statistics of the disease are increasing, the means to detect and treat it early in Asia is pathetic. 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 National 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, “Epidemiology 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-ridden patient evaded stringent

Yip with a breast prosthetic which the Cancer Resource Centre offers to those who have undergone mastectomy.

pre-transplant donor-appraisal remains a medical mystery. Stark disparity For a woman afflicted by the disease in the affluent West – new diagnosis and treatment modalities are plentiful but not so, for the woman in Asia. The United States spends about US$8.1 billion (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 between taking the recommended two-view image of a patient’s breasts and taking a singleview 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 faced by doctors worldwide. In Kenya, if you cannot afford to seek treatment overseas, “you just sit and wait to die”. This has prompted Nancy Brinker, founder of the cancer advocacy, Komen Group, to say: “Poverty is itself a known carcinogen.” Ignorance and taboos Every three minutes an Egyptian woman is diagnosed with the disease and her immediate major concern is not the morbidity 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-continent, 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 divorced by her hus-

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 December 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 treatment 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, educating them, making sure they keep up with appointments and attend chemotherapy, radiation procedures 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