If it seems scary to find a hard lump in your breast, it’s even scarier when someone you love finds one. In March last year, while I was studying in the UK, my mother called to tell me that she had done a breast self-examination and found a tiny lump. She’d then gone for a biopsy after which her doctor confirmed it was malignant. The decision was made to remove it within a week.
I received this news 20 minutes before I had to go to a three-hour class. My mother’s cheery tone over the phone had done nothing to assuage my fear – not just of the idea of cancer, but the fact that she was to undergo an operation at the age of 92. Going under general anaesthesia at that age itself posed a risk. I also feared for my father who must have been badly affected by the news. My father had undergone two heart operations but always had my mother to care for him. Here, it would be her who needed caring, a reversal of positions that he’d never been prepared for. When I called him, however, he sounded calm and told me I needn’t return home to be by my mother’s side. My parents, being both doctors themselves, had complete faith in the medical profession and felt safe in their surgeons’ hands.
Mum went through the operation on a Saturday morning. As well as cutting out the lump, the doctors also administered some radiation to ensure that no other cancerous cells remained. She came out of the operating theatre after two hours and recovered so well that she could be discharged the next day. Having celebrated her 94th birthday this year, she’s doing well.
Cancer by numbers
Breast cancer is the most commonly-occurring cancer in women and the second most common cancer overall. In 2018, there were over two million new cases of breast cancer globally. According to the World Health Organization, it occurs in both high-income and low-income countries, with Africa recording the lowest number of cases. But even there, the numbers are increasing.
There’s a difference, however, in survival rates. In 2012, 58 per cent of deaths occurred in the developing world. In North America, Sweden, and Japan, over 80 per cent of women with breast cancer survive. But this reduces to around 60 per cent in middle-income countries and below 40 per cent in low-income countries. The reason for this is clear: in poorer countries, women tend to present late because of a lack of programmes promoting early detection. Furthermore, poorer countries have fewer facilities for adequate diagnosis and treatment.
In Malaysia, breast cancer cases have been rising significantly. The National Cancer Registry published by the National Cancer Institute reported 31 cases per 100,000 women between 2007 and 2011, to 34 cases per 100,000 women between 2012 and 2016. However, an earlier study on the epidemiology of breast cancer in Malaysia reported a higher rate from the NCR: 46.2 women per 100,000 in 2004. This, the authors of the study said, translated into approximately one in 20 women developing breast cancer in their lifetimes. If we don’t become struck by it ourselves, most of us know at least one woman with breast cancer, including some who have died from it.
Understanding the risks
The reasons for getting breast cancer are not easy to pinpoint. Genetics play an important part: if you have close female relatives who’ve had cancer, it’s wise to go for regular breast examinations and mammograms. Her mother’s death from breast cancer prompted Angelina Jolie to make the drastic decision to remove both of her own breasts as a preventive measure. Most of us will likely not have to do that, but it helps to be aware of our genetic risks.
Hormones too play a part. Some women have shied away from hormone replacement therapy (HRT) when they’re menopausal because the risk of developing cancer can be high. It’s possible, however, to opt for a more natural – not chemically-based HRT – which may be safer.
Death rates are linked to some lifestyle and dietary factors. Studies have shown that 21 per cent of all breast cancer deaths worldwide are attributable to alcohol use, being overweight or obese, and physical inactivity. This proportion was higher in high-income countries (27 per cent), where the most important contributor was being overweight and obesity. In low- and middle-income countries, the proportion of breast cancers attributable to these risk factors was 18 per cent, with physical inactivity the most important determinant (10 per cent).
If you have babies later in life, or not at all, you do increase your risk. And if you don’t breastfeed for long when you have babies, your risk of getting breast cancer is also higher. This explains the difference in the incidence between developed and developing countries. In advanced countries, where women have careers outside the home and marry and have children later, there’s unfortunately a link with an increased risk of cancer. In less-developed countries, poorer women marry earlier and breastfeed longer, and therefore protect their health in this way. But changes in lifestyles in many developing countries like ours have also led to an increase in incidences of breast cancer.
Putting yourself first
This is not to say that we should all marry early, stay home, and have babies. Those add to stress as well, another possible factor in making us vulnerable to cancer. To prevent breast cancer, regardless of whether we are careerwomen or homemakers, it’s important that we look at our lifestyles and make the decision to do better, to eat better, and exercise more. Early detection is everything.
Learning how to examine our own breasts is crucial and can make the difference between survival and death. In Malaysia, 90 per cent of breast cancer cases were presented through women who detected a lump in their breasts themselves, usually between the ages of 40 and 49. However, between 1993 and 2004, some 30 to 40 per cent of those women were already at Stage 3 or 4, making it much more difficult to treat and consequently to survive.
Since my mum discovered her lump and needed her lumpectomy, she’s been open about her experience and is very encouraging of other women who may be going through the same thing. After all, if she could go through it at age 92, facing the ordeal with confidence, so can other women. Fear of cancer can be deadly. The authors of the study on the epidemiology of breast cancer found that, on average, most women who found a lump in their breasts took three months to see a doctor. Treatment within those three months could have saved their lives in some cases.
The only way to decrease fear is through knowledge. This site, by the US Centers for Disease Control and Prevention, has lots of basic information about breast cancer. Other useful sites include this one by Cancer Center. For local information and support, do look up the National Cancer Society of Malaysia that can also provide counselling and refer you to peer support groups.