Doc Talk

Tackle breast cancer early

Don't put off treatment - be bold and find the strength to seek help

A perfume of cloying sweetness wafted into my consultation room as she entered.

Not wanting to appear impolite, I discreetly nudged open my window to let in some fresh air.

The 61-year-old patient settled languidly on a bench against the far wall. She was alone.

I smiled and invited her to sit across from me at my desk. She politely declined, but stretched forward to pass me a thick file that contained her medical results for the past two years.

"I think I need help with the dressings. I take two hours each time and I need to change them three to four times a day now, because they soak through rather quickly," Shirley said in a quivering voice.

She removed her batik blouse ever so gingerly, making sure not to disturb the carefully layered gauze dressings. I couldn't help but notice the serosanguinous stains cleverly camouflaged against the batik prints.

As she undressed, the sweet perfume in the air was quickly overtaken by the rankness of her malodorous discharge.

A tumour had grown like a fungus across her right breast, causing parts of the skin to split and form bleeding ulcers.

Shirley's daily two-hour routine involved acidic pH 2.6 baths to disinfect the tumour; meticulous manual exfoliation of the layer of bacteria build-up that often resulted in bleeding; essential oil soaks to soothe the ensuing bleeding; and gauze dressings to soak up the discharge.

She drank alkaline ionised water religiously and adhered to an austere diet free of sugar and carbohydrates to "starve" the cancer cells. While it seemed effective at first, the exhausting routine was taking its toll on her.

A retired educator, Shirley first noticed her breast lump two years ago.

However, being the only one who is single in the family, she assumed the primary responsibility of caring for her elderly mother who had suffered a stroke in the wake of her father's death. The series of family tragedies deprived her of the much-needed care for herself.

LEAVING IT LATE

Nevertheless, putting off cancer treatment is not ideal, because your quality of life suffers.

Also, not many patients can live long after a late diagnosis.

Only 20 per cent to 30 per cent of patients who were diagnosed with breast cancer late live for 10 years or more. In contrast, more than 85 per cent of women whose disease was discovered early were still alive after 10 years.

Shirley had already consulted two other doctors, both of whom had recommended chemotherapy. But convenience rather than cure was what she was really after.

She did not care if her cancer had spread; she had no desire to know where it had spread to.

"I do not intend to undergo chemotherapy or take any medications," she declared. "I suppose I will die, but till then, I'm just tired of the dressings and I want some help to fix it."

I advised her to do a radical mastectomy of the right breast to get rid of the foul-smelling mass of cancerous tissues. That involved removing the entire breast, surrounding chest muscles and lymph nodes.

Having taken that first step, Shirley found enough confidence in conventional treatment to consent to a computerised tomography (CT) scan to determine the stage of her disease.

She was pleasantly surprised to learn that her cancer had not spread.

With gentle assurance and encouragement that her quality of life would not be unduly affected, Shirley finally agreed to take an anti-hormone tablet for five years to keep the disease under control.

Arguably, a cure may still be possible, albeit less certain and requiring more complicated treatment options.

But in Shirley's case, had I doggedly insisted on chemotherapy or treatments which she was mentally unprepared for, she might well have rejected any form of treatment altogether.

WRONG IDEAS ABOUT THE DISEASE

Of the 9,634 new cases of breast cancer in Singapore from 2011 to 2015, about a third were diagnosed at the advanced stage.

Like Shirley, a subset of women with advanced breast cancer have to grapple with a tumour mass eroding through the breast skin, with not many other symptoms.

It is not immediately life-threatening but these women suffer from large, open wounds, recurrent infections, malodorous discharge, as well as chronic pain, social isolation and general weakness.

It is thus important to focus on relieving their symptoms while maximising their quality of life.

Still, there are also women who do not seek help early because, despite nationwide efforts to raise awareness, many still harbour erroneous views of the disease.

Some women think they are immune to it as they do not have a family history of cancer or any symptoms, apart from a painless, growing breast lump.

Yet others prefer to "let sleeping tumours lie" for fear of a biopsy or surgery upsetting the micro-environment of the tumour and causing it to spread with a vengeance.

Breast cancer, like any cancer, begins as a local disease, but progression and invasion is an eventual outcome if left untreated.

The progression time may vary but what is certain is that the unseen invasion of internal organs may become extensive, before the accompanying symptoms are noticed.

By then, treatment will become more complicated and costly; and a cure more elusive.

Technological advances beyond traditional film mammography have made it easier to detect smaller breast cancers earlier. The tools are now ready to bring us closer to curing breast cancer.

But women must first clothe themselves with the boldness and the strength to step forward.

•Dr Esther Chuwa is a consultant breast surgeon at Gleneagles Hospital. She sub-specialises in oncoplastic breast surgery.

A version of this article appeared in the print edition of The Straits Times on October 24, 2017, with the headline 'Tackle breast cancer early'. Print Edition | Subscribe