And now comes the next generation of women in the family.

The five Foo sisters were well aware of their family's medical history and it seemed cancer was about to strike them too when eldest sister Lin, now 42, found a lump in her left breast in 2000. It showed she had breast cancer.

Lin had the lump removed and, five years later, had a DNA test done to see if she had a defective copy of a gene, known as BRCA2.

She did. The frightening news prompted the mum of three to have her ovaries and womb removed in March to reduce her chances of getting cancer again.

Her sister, Ching, 41, who is married with two sons, had the same test - with the same result. She also had her ovaries and womb removed, even though they had yet to be afflicted by cancerous cells.

The BRCA2 mutation is like a ticking time bomb, raising a woman's risk of developing breast cancer at some point to between 40 and 80 per cent. There is also a risk of up to 20 per cent of her contracting ovarian cancer.

The average woman's risk of developing breast cancer in Singapore is 5 to 6 per cent.

Currently, 121 women here have had the BRCA gene test at the National Cancer Centre, and a further 50 have done the test at the National University Hospital (NUH). Forty-four of these 171 women had the defective gene and about 10 have since undergone preventive surgery.

A mastectomy, or the removal of one or both breasts, reduces the risk of getting breast cancer by 90 per cent, while an oophorectomy, or the removal of one or both ovaries, halves it. An oophorectomy also lowers the risk of getting ovarian cancer by 90 per cent.

Doctors say at least one woman had both her breasts and ovaries removed to forestall cancers.

Ching and Lin baulked at the idea of removing their breasts, opting instead to remove their ovaries and womb.

'It's a huge thing for a woman to remove her breasts and I didn't even want to think about that,' said Ching, a quality surveyor. 'Removing my ovaries is a big enough step as it is.'

It means hot flushes and a decreased libido but, for women, this price is a small one compared to a mastectomy.

Dr Ho Gay Hui, a senior consultant of surgical oncology at the National Cancer Centre, empathises with women faced with the dilemma. 'It's a feminine thing that makes mastectomy so hard to go through. These women may be young, not even married and you're getting them to remove their breasts,' she said.

Breast cancer is the most common cancer among Singaporean women, with about 1,100 new cases diagnosed annually. Ovarian cancer is not linked to breast cancer, unless a woman has a mutation of the BRCA genes.

Fortunately, the genes are rare. Dr Lee Soo Chin, a consultant with The Cancer Institute @ NUH, said only one in 3,000 to 5,000 people carries the abnormal BRCA1 or BRCA2 gene.

Only women below 40 diagnosed with breast or ovarian cancer, or those with a strong family history of the two cancers, are advised to take the DNA test.

Although a mastectomy is the most efficient way to reduce the risk of cancer, doctors say most women choose to take the surveillance path. With surveillance, the patient undergoes frequent checks in the hope of detecting the cancer early.

Others take drugs to stop or slow the growth of breast cancer cells.

Besides Lin and Ching, the other three Foo sisters have yet to test for the BRCA gene. Health reports for the third and fourth sisters have been clear but the youngest, Wen, 35, was not so lucky.

Last December, doctors found a lump in her right breast during a routine annual health check. A fine needle test showed the tissue was cancerous.

Wen, a human resource executive, recalled breaking down in the doctor's office, shocked that cancer could hit her at such a young age.

She removed the lump in January and then had chemotherapy and radiation therapy. The chemotherapy left Wen bald and vomiting up to nine times a day.

'In a weird way, I was thankful that my family also had breast cancer because they understood what I was going through,' said Wen. 'I wasn't alone.'

Though the 5cm scar and her bald scalp are the only reminders of her cancer battle, Wen intends to take the DNA test soon to confirm if she has the BRCA2 gene like her two sisters.

'Most likely I will remove my ovaries if it turns out positive,' she said.

It will be the most difficult call of her life.

She is single.

mavistoh.sph.com.sg

Painful decision to remove breasts

'It's a feminine thing that makes mastectomy so hard to go through. These women may be young, not even married and you're getting them to remove their breasts.'
DR HO GAY HUI, senior consultant of surgical oncology at the National Cancer Centre

Family support

'In a weird way, I was thankful that my family also had breast cancer because they understood what I was going through. I wasn't alone.'
WEN, a human resource executive, after doctors found a cancerous lump in her right breast during an annual health check