Breast cancer is the most common cancer among women in Singapore, with more than 2,000 diagnosed each year, and about 400 die from the disease.
One in 13 women will get breast cancer in their lifetime and as of 2020, there were 2.26 million global cases of breast cancer, making it the most commonly diagnosed cancer in the world. Over 685,000 of those diagnosed have died.
Breast cancer incidence in Singapore has increased three times in the past 40 years, creating a huge socioeconomic impact when it affects women in their economically productive years, disrupting childcare and daily function as a family unit.
Yet the misconception that breast cancer only occurs in older women continues, and because of this fallacy, many young women do not go for mammograms or for regular breast cancer assessments.
Breast cancer no longer a death sentence
Being diagnosed with breast cancer today may not be a death sentence. Despite an increasing number of diagnosed cases, advances in diagnostic techniques and effective treatment options have significantly improved its survival rates.
One of these improved diagnostic tools is Mastocheck, a blood-based test that can be used to supplement the routine mammogram to improve chances of detecting signs of breast cancer early.
According to the 2019 Singapore Cancer Registry report released in 2020, the five-year age-standardised relative survival rate for breast cancer between 2015 and 2019 was 82.1 per cent.
Health Minister Ong Ye Kung said preventive care for breast cancer is a top agenda of his ministry and “if we can just be more aware of the threats and risks of various diseases around us (and) take early action… you can avert so much pain and suffering.”
Not a matter of making mountains out of molehills when it comes to breast cancer
The theme of this year’s Breast Cancer Awareness Month is Living Beyond Breast Cancer, highlighting the different collaborations that continue to move survivors forward as the society works every moment of every day to support people impacted by breast cancer.
For both Madam Jayanthi Kanagaratnam, 64, and Ms Nurhana Abdul Ghani, 38, breast cancer started out as insignificant lumps that the two women did not give it any serious thought.
Former teacher and mother of two, Madam Jayanthi’s cancer first appeared as a small lump on the right breast in early 2014. Thinking it was a pimple, she ignored it. The bump grew bigger four months later. Still, Madam Jayanthi continued to ignore it “as I was really busy”.
That year, she was tutoring her “O” level students in English, and her daughter was enrolling into a university in Australia. She was also readying herself for her nieces’ wedding in Singapore and Delhi, India.
“I continued to wonder what the little growing lump was but did not really pay attention while it continued to grow within me. I was well aware of breast cancer but because there was no history of it in my family, I felt there was no need to check it. I even convinced myself it could just be a cyst,” she says.
It was when Madam Jayanthi told her cardiologist about the growing lump, “he was shocked I had not done anything and immediately referred me to the Breast Care Clinic at NUH (National University Hospital). I was still reluctant and ‘disobediently’ delayed the visit until my family insisted. It was just before my daughter flew off to Australia that I had a biopsy done and was diagnosed with Ductal Carcinoma, Stage 2A Breast Cancer,” she says.
Ductal carcinoma in situ (DCIS) is when there are abnormal cells inside a milk duct in the breast. Considered the earliest form of breast cancer, DCIS is noninvasive or has a low risk of becoming invasive. DCIS is usually found during a mammogram done as part of breast cancer screening or to investigate a breast lump.
A highly strong and independent woman, she was dumbstruck by the news.
“I felt I was going to lose my freedom. I would now have to rely on people. First thing first, I could not go to settle my daughter in Australia for her studies,” she recalls, adding that she could not even cry.
Like Madam Jayanthi, Ms Nurhana did not worry too much when she first noticed a tiny bump on her breast. After all, she had a benign lump in her left breast removed when she was 16 and had it promptly removed. This time around It was not the same story. The lump grew bigger over three months.
“I was slightly complacent and thought that I’ve got this. It was just a lump and what are the odds of it being malignant since I was at my fittest then and I’ve been very cautious with my diet,” Ms Nurhana says.
But when the lump in her right breast grew bigger over the next three months, she “sensed it might be serious”. A biopsy, ultrasound and mammogram confirmed her worst fear – she had breast cancer. Ms Nurhana says she tried keeping calm, assuring herself that she had been through this before, “but sadly the calm was short-lived” because both her children were aged nine and two then.
Turning to pastor for guidance
A month after customer service specialist Venetia Ang was promoted, she was diagnosed with stage 2 breast cancer in October 2019. The cancer had invaded her lymph nodes and the diagnosis was clear: locally advanced breast cancer.
Ms Ang was stunned because, other than a tiny lump on her right upper chest, she felt “perfectly well”. “It was in April that I felt a tiny lump on my right upper chest when I did my routine breast check in the shower. I understood from friends that breast lumps are commonly found in the breast and are mostly non-invasive. My lump was located in my upper chest. I even had an x-ray done at a polyclinic and was told the result was ok,” she says.
But when the lump grew, she was referred by the GP to a breast specialist. “During the early diagnosis, I was told my right lymph nodes were affected. But the surgeon had to remove about 19 lymph nodes during the mastectomy and my cancer was reclassified from Stage 2 to Stage 3,” Ms Ang says.
Ms Ang says her husband David Cham was with her at the clinic when the news broke. “When we broke the news to the children, it was my son who broke down.
Knowing that Pastor Cecilia Lia from her church had been through the same diagnosis in 2007 since she shared her plight during sermons, Ms Ang decided to turn to her for help and solace.
“Pastor Cecilia was diagnosed with Stage 3 breast cancer and had been fighting the cancer from the beginning. She even told the congregation that she received an email from an overseas pastor, encouraging her by saying ‘your condition is not your conclusion’. I believe that because of this conviction, she’s in remission till now. When I was diagnosed, I went to thank her for her cancer testimony,” she says.
Treatment for cancer: A beautiful pain
Despite going under to remove their breasts and going through chemotherapy that is full of suffering, with side effects like headaches, nausea, inability to keep food down, the three survivors emerged beautifully from the pain.
Madam Jayanthi says she had been through accidents where she suffered injuries and “certain operations too”, but her mastectomy and the whole year of chemotherapy was “icing on the cake”.
“It was the darkest period of my life. I had to be brave, positive and try to smile despite the pain. It was for my two daughters. My eldest daughter was planning her wedding then and my second daughter was away studying,” she says.
But her family and friends rallied around her, not allowing her to be alone at any one point.
“My husband, my mother, my sisters and their spouses, my nieces and nephews, and my wonderful friends were my daily doses of inspiration. … Not a day went by without seeing a member of my family or a friend. They sat with me, held my hands and let me vent and cry. They brought gifts and food to keep me going,” she says.
Like Madam Jayanthi’s, Ms Nurhana’s journey is equally challenging. She calls it “the hardest battle, even harder than being diagnosed with the cancer itself”.
“Each time I was scheduled to do my chemo, it was always a battle. There are times when I dread going for my chemotherapy, stemming from thoughts that I walk into the centre healthy and come out weaker. I hated that feeling and I could still vividly remember the smell of the chemo drugs,” she says.
“The side effects that came with each chemotherapy was terrible. I experienced hair loss, my toenails detached from the nail beds, I suffered discolouration of the nails, pink-eye, nausea, fatigue and I also had hot flashes because my body went into pre-menopause,” she adds.
Ms Nurhana told Her World magazine last year that she even had the difficult conversation with her elder daughter Aleesya Adriana, who wanted to know what would happen to the children should she die and whether the girl herself will get breast cancer.
Ms Ang went through six months of chemotherapy and a month of radiation in 2020 and while she is grateful her bosses and colleagues held the fort at work during her nine-month absence from work and her family for taking care of her, she says her introduction to the team at Breast Cancer Foundation (BCF) taught her to survive.
Outwit, outplay, outlast breast cancer
Today, all three survivors can finally “ring the bell”, something that cancer patients all over the world do to celebrate the end of their radiation treatment or chemotherapy, and look to the future to help them survive the cancer.
They were even part of a June photography exhibition called Ahead of Time, featuring 25 breast cancer survivors and their children to mark the 25th anniversary of the Breast Cancer Foundation (BCF). Nine notable Singaporean photographers, including Mr Russell Wong and Mr Mark Law, were involved in the project.
After seven years since ending her treatment, Madam Jayanthi says she has learned “to be grateful and happy for all I have”.
“Both my daughters are now married and I have a lovely grandson. Since retiring from teaching, I’ve picked up many hobbies at the BCF. I now spend my time doing crochet, painting, and taking care of my grandson. I am living my life to the fullest. Cancer was really only a chapter in my life and I’ve still many more to add to my book of life,” she says.
Ms Ang is now a befriender to three friends who were diagnosed with breast cancer earlier this year, “and just as how the BCF mentors had walked with me through this journey, I’ll be walking with them too. I’m also helping about 50 women inflicted with breast cancer in a bible study class … to help them live a victory after cancer life”.
As for Ms Nurhana, about a year after her final chemotherapy session she gave birth to her third child, a son.
“He’s my miracle baby. As I was in pre-menopause during my chemo treatment, I never expected I could conceive again. Apart from being happy, having him right after my chemo came with other worries like whether the chemo drugs would affect my baby. I was assured by my oncologist that it was safe and nine months later, I delivered a healthy baby boy,” she says.
“If there are any other hardships that I face in life, at work or relationships, I always remind myself that if I have fought the battle to take back my health and life, nothing else is ever that difficult or impossible to conquer,” she adds.
The Ahead of Time photo exhibition to commemorate the 25th anniversary of BCF is ongoing. Please click here for the different locations.