SINGAPORE: An avid cyclist who also runs and does yoga regularly, one 34-year-old, who only wanted to be known as Su Lin, was the picture of health when she first discovered a lump in her left breast in May.
Young and healthy, cancer was the last thing on her mind.
“I didn't think it was serious, because I knew of many friends who had cysts removed and it wasn’t serious. So I held it off for a while, until I was free enough to go and see a doctor,” said the primary school teacher.
In late June, after numerous tests and scans, came a diagnosis she never expected to hear.
She had stage 1 breast cancer.
“I couldn't cry also because I was so shocked,” Su Lin said.
“I didn't think that it would happen to me because I always thought that cancer was something that would only happen at an older age,” she said, adding that she has no family history of cancer.
It took her nearly four days to fully process the news and tell her family, who are in Kuala Lumpur.
“They were shocked but they were also being really strong for me,” she said.
“Everything was done via phone or via video calls, and so there was no physical contact like hugs. But even though it was bad, I still felt strong support from them ... and so that’s when I felt like ‘I can do this’,” she said.
With a renewed spirit of hope, Su Lin focused on getting treatment and recovering quickly.
In July, she underwent lumpectomy surgery to remove the affected part of her breast and is currently going through chemotherapy.
In telling her story, Su Lin hopes to raise awareness about breast cancer, and the importance of regular health screenings.
“Regardless of age, never take things for granted. Even for myself, I didn’t do regular check-ups but it’s so important to pay attention to your body, because we only have one body and one life,” she said. “So we have to take care of it and be more mindful.”
WHEN THE YOUNG GET CANCER
Su Lin was one of the patients highlighted by the National Cancer Centre Singapore (NCCS) in conjunction with Breast Cancer Awareness Month, an annual campaign held in October to raise awareness about the impact of breast cancer.
According to the Singapore Cancer Registry, 2,000 women are diagnosed with breast cancer each year. Between 2013 and 2017, 16.3 per cent of female breast cancer patients were diagnosed below the age of 40.
Doctors CNA spoke to said incidences of breast cancer in young women also appear to be increasing, which could be due to rising affluence and increasing levels of stress.
Dr Radhika Lakshmanan, a consultant breast and general surgeon, said she has seen a larger percentage of young breast cancer patients over the last decade.
Her clinic, which sees about 50 new breast cancer patients each year, has also observed a disproportionately higher number of women below the age of 40, who make up about 30 per cent of the clinic’s new cases.
“One of the postulations is that women are having their firstborn at a later age,” she said.
Studies suggest that women who become pregnant and have children at an early age have a decreased risk of developing breast cancer in later life. However, any pregnancy after age 35 may increase the risk of breast cancer.
The treatment approach for young breast cancer patients may also be more complicated compared to older patients, said Dr Lakshmanan.
This is because factors such as family planning must be taken into consideration when discussing or initiating the treatment regime, she said.
“Chemotherapy affects fertility in a negative way so before commencing treatment, they will be advised to consult a gynaecologist to consider the options of cryopreservation or embryo preservation as their chance of conception may drop after the cancer treatment,” she said.
Family planning was an important consideration for Ms Cindy Neo, who was diagnosed with stage 1 breast cancer in 2017.
At the time, Ms Neo was only 30 years old and was a year into her relationship with her partner.
“It was at the back of my mind (at the time), a topic that I had been discussing with my partner but we hadn’t quite decided whether or not we wanted children,” she said.
“But we wanted it to be an option and so, protecting that option was important to us.”
Another worry she had initially was the cost of treatments and surgery.
Still early in her career, she was not financially stable and did not have a lot of savings, said Ms Neo.
“It was a big worry for me because I kept thinking where's all this money going to come from ... how much money do I have to pay upfront and what happens if I’m not working ... so all these added to the mental stress I was facing at the time,” she said.
Fortunately, her insurance covered most of her medical expenses, which came up to nearly S$50,000.
As for Su Lin, who works as a primary school teacher, finding the time to go through chemotherapy proved to be a challenge.
"Having a full-time job, it's very hard to take time off on a weekly basis and my chemotherapy sessions are scheduled weekly every Friday," she said.
"So I have to juggle work while juggling life at the same time."
DON'T RULE ANYTHING OUT
While efforts such as the national breast cancer screening programme have helped to increase awareness of breast cancer over the years, a significant gap between knowledge and action remains.
The national population health survey published last year found that between 85 and 99 per cent of women were aware of mammograms. Despite this, just 38.7 per cent of women in the 50 to 69 age group said they had gone for a mammogram within the last 2 years.
It means more cases are detected at a later stage, said Associate Professor Veronique Tan, head and senior consultant of NCCS' breast surgery department.
“If you look at the case spread in Singapore, what is really alarming is that 10 per cent of our breast cancers are diagnosed at stage four. And if you take stage three and four as advanced breast cancer, 25 per cent are diagnosed in that one stage, which is really very high,” she said.
NCCS sees about 1,200 new breast cancer cases each year, Assoc Prof Veronique Tan said.
In comparison, South Korea – which has a similar population proportion to Singapore – sees only 1 per cent of breast cancer diagnosed at stage four.
Among common misconceptions about breast cancer is that it usually happens to those with a family history of cancer, said Dr Tan.
“A lot of women think that they don’t need to go for scans because there’s no history of cancer in their family and they feel absolutely fine. But actually, 85 per cent of women who are newly diagnosed with breast cancer have no family history.
“So having no family history doesn't mean that we're protected and conversely, having a family history doesn't mean you have to get breast cancer. The message is that everybody is at risk.”
While cases of breast cancer in men are relatively rare, it is also important not to rule that out, said Dr Tan, adding that she sees one or two male patients a year.
“A lot of older and younger men out there never consider that they can get breast cancer too,” she said. “And so, in a lot of cases, we see a delayed diagnosis because they don't think to present to the doctor.”
Discussions are ongoing between NCCS, the Singapore Cancer Society and the Breast Cancer Foundation to form a support group for the male breast cancer patients here, Dr Tan said.