sunday star, 4 october 2015

specialbreast cancer

awareness

Overcome it together

2 breast cancer awarenessSUNDAY STAR, 4 OCTOBER 2015

Second chance for survivorsBREAST cancer is a disease that can be detected and treated early despite this, it is the most prevalent cancer among Malaysians. The Health Ministry projects that one in 19 Malaysian women have a lifetime risk of developing breast cancer.

Patients can go on to outlive the cancer, especially those whose cancers are detected in the first stage. According to Dr Chong Kwang Jeat, resident radiotherapy and oncology consultant at Mahkota Medical Centre Malacca, survival rates are improving thanks to increased awareness, early detection and better access to treatments.

He emphasises the importance of reaching out to educate women, especially in rural areas, since quality healthcare is still largely an urban fixture.

Besides doctors and professionals, the media plays a large part in spreading awareness to rural communities, says Dr Chong.

A clear example of this is the case of Angelina Jolies preventive double mastectomy. In the months after the New York Times published her piece explaining this choice back in 2013, doctors in Austria, Australia and Britain reported a spike in risk-reducing mastectomies and gene testing enquiries following extensive media coverage on the topic.

The influence of her celebrity on the public health issue was undeniable. British health services wrote in the journal Breast Cancer Research that hearing about the first-hand experience of someone so glamorous and famous may have lessened patients fears about a loss of sexual identity post preventive surgery and encouraged those not previously engaged with health services to consider genetic testing.

Invisible scarsFor women around the world,

the idea of losing any body part to a disease can be an upsetting one.

Besides the physical side effects, undergoing a mastectomy can put women through emotional and mental strains. It is not uncommon for women to feel a loss of self-esteem and sense of worth as a result of a distorted self-image.

It impacts a womans femininity and sexuality not just the physical aspect but the psychological confidence of a woman, which is derived from her self-perceived attractiveness and confidence in intimacy, says Dr Saunthari Somasundaram, president and medical director of National Cancer Society Malaysia (NCSM).

For many, the support of family and friends, especially a partner, is crucial in surviving this period. Many women feel personally responsible for their condition, and begin to entertain thoughts that they are less worthy of being loved.

Partners need to be supportive both physically and emotionally.

Women need to know that their spouses love for them transcends their physicality, says Dr Saunthari.

As a breast cancer survivor, 43-year-old Lizz Khalid can relate to this situation. Initially, I did worry that my husband would leave me but he ended up playing a huge part in helping me regain my confidence after the mastectomy with his continuous affection, care and love, she shares.

Lizz underwent a mastectomy after finding a lump in her breast in 2008. She admits initially going through a denial stage, but wasted no time in seeking the best surgeon, oncologist and treatments. It was two months before I finally decided to go on with the mastectomy, following the advice of three different doctors, she says.

Lizz opted to wear a prosthesis after her surgery, a decision that her husband also supported. She says her journey with breast cancer has made her stronger, and taught her to stay positive with the mindset that life will be better post-mastectomy.

Seven years on, I can gladly say I still feel confident. With the help of the prosthetic breast, I look and feel the same and can still enjoy life to the fullest, she says.

A personal choiceReconstructive surgery and

prostheses are modern-day developments of medical technology that improve the quality of life for breast cancer patients after mastectomy. According to Dr Saunthari,

Malaysian women who undergo mastectomy are now more likely to receive prosthetic aid from the Government and non-government organisations (NGOs).

Lower costs, greater awareness and accessibility as well as the use of less invasive techniques have helped women get over the fear of surgery and the after effects of reconstruction, she says.

The main drawback for many women is the cost of reconstruction. However, it is reassuring to have the National Population and Family Development Board (commonly known as its Bahasa Malaysia acronym, LPPKN) offer a free set of prosthesis and two bras for breast cancer patients under certain terms.

It is interesting to note that some women do not find reconstructive surgery an important part of breast cancer treatment. For 67-year-old Vivien Boey, for example, all that mattered was the restoration of her health and well-being.

I did not find reconstruction surgery or prosthesis necessary as long as I was able to live on. I just wanted to have my operation done as fast as possible knowing that both breasts had cancerous lumps, she says.

Boey underwent a double mastectomy with follow-up treatments involving chemotherapy and radiotherapy, which took a toll on her mental and physical well-being.

With support from her doctor and family, she is now able to live healthy and happy while watching her grandchildren grow up.

Women going through and recovering from breast cancer need the support of family and friends to survive the journey.

By THERESA BELLE

Attention and awarenessMEDICAL experts weigh in on certain aspects of breast cancer that women should be more aware about:l On research and medical opinion

There is an abundance of information and choices but it is difficult to find clarity and confidence in what is the right treatment or plan for an individual, especially with so much conflicting information on conventional, complementary or alternative therapies. Dr Saunthari Somasundaram, president and medical director of National Cancer Society Malaysia (NCSM)

Go to doctors and specialists for the facts since no two bodies or conditions are the same. What works for you may not work for the next person.

l On effective support systemsWhile you are in the hospital,

get your friends to help out with tasks instead of visiting or sending flowers. Compile a list of people whose favours you can call in when you are busy or sick they can help with everyday tasks such as driving you to treatment sessions, picking children up, buying groceries or cleaning, Dr Patricia Gomez, consultant breast surgeon at Pantai Hospital Kuala Lumpur.

There are also support groups such as NCSMs Pink Unity (pinkunity@cancer.org.my) where breast cancer survivors provide assistance to other women going through their journey with the disease. Dr Saunthari

l On complementary and alternative treatment

Chemotherapy drugs are widely studied before being released into the market, so we are well aware of their pros and cons and can therefore provide appropriate consultation.

Complementary treatments are not written off completely, but we advise against solely pursuing alternative treatment while ignoring the tried and tested methods prescribed by medical health professionals. Dr Gomez

l On attitude towards cancerThe most important factor in

surviving cancer is adopting the right attitude. Research shows those who do things to help themselves and others, even when battling cancer, survive and do better. Dr Gomez

Cancer survivors themselves speak of the importance of a positive and hopeful mindset after all, what affects you mentally can also affect you physically.> SEE ALSO PAGE 4

tumours are sent to the laboratory so that pathologists can examine and provide a detailed report. It is only after the doctors have looked at all the information will they decide on the required treatment, he says.

Signifying a current trend of treatment in oncology, all treatment programmes are individualised and tailor-made for each patient.

Surviving the experienceThe most important factor for

breast cancer survival is to receive

SUNDAY STAR, 4 OCTOBER 2015

breast cancer awareness 3

Take the right precautionsTHE threat of breast cancer must not be taken lightly as the disease afflicts a global estimated figure of more than one million women every year. It is also the second leading cause of cancer deaths among women, after lung cancer.

Due to the severity of the disease, women need to learn the importance of recognising the early signs of breast cancer and to seek medical attention before the cancer cells spread to other parts of the body.

According to Dr Chong Kwang Jeat, resident radiotherapy and oncology consultant at Mahkota Medical Centre (MMC) in Malacca, the level of awareness among Malaysians must be improved.

The level of awareness is higher in urban areas such as Kuala Lumpur and Malacca, as people generally have a higher socio-economic status and are better educated in matters related to the disease.

But there are still a number of patients, especially those from rural areas, who come into our hospital when they are already in the advanced stages of breast cancer, says Dr Chong.

Dr Chong believes that although the general awareness levels are increasing, there is a lot more that has to be done so that women in rural areas consult medical specialists as soon as they find something amiss and while they are still in the early stages of the disease.

Necessary treatmentsBreast cancer is a

heterogeneous disease, meaning its a bag of various diseases. This, along with the different types and stages of the cancer, are important elements that determine what sort of treatments the patients

undergo, says Dr Chong.After a lumpectomy or

conservation surgery, patients may require chemotherapy, radiotherapy, hormonal therapy and/or targeted therapy.

To determine the most suitable treatment option for each patient,

The most important factor in surviving breast cancer is to get the necessary treatments at the early stages of the disease.

the necessary treatments while the disease is still in its early stages.

In general, at stage four, even the best treatment in the world cannot save and cure you. Early detection and receiving immediate appropriate treatments save lives, says Dr Chong.

There are women who only come to the hospital after they realise that their alternative treatments did not work and they then learn that the cancer has progressed to the advanced stages. People must come in for appropriate treatments as soon as they get confirmation of the disease, he stresses.

The journey does not end after surgery. Rehabilitation programmes are also important for their physical, mental and emotional well-being.

Dr Chong advises breast cancer survivors to try as much as possible to lead a normal life and believes that survivors can lead equally good lives as anyone else, if not better.

This is because they can and do become stronger after the experience and begin to appreciate loved ones and life more.

n For more information, call 06-285 2999.

Dr Chong Kwang Jeat.

4 breast cancer awarenessSUNDAY STAR, 4 OCTOBER 2015

MUTATIONS in the BRCA1 and BRCA2 genes are able to indicate risk of female breast and ovarian cancers. These genes produce tumour suppressor proteins, and mutation affects the ability of the proteins to repair damaged DNA. Thus, cells are more likely to develop additional genetic alterations that can lead to cancer.

These genetic mutations can be identified through a screening test together, BRCA1 and BRCA2 account for about 20% to 25% of hereditary breast cancers and 5% to 10% of all breast cancers.

Stories such as Angelina Jolies play a great role in informing women not only to care for themselves, but to do so in the best possible way. In her New York Times article My Medical Choice, she made it clear that the double mastectomy she underwent was the best choice for her due to individual circumstances: mutation of the BRCA1 gene (which put her at an 87% risk for developing breast cancer) and considerable family history of the disease.

Surprising liabilityDr Patricia Gomez, consultant

breast surgeon at Pantai Hospital Kuala Lumpur, says preventive double mastectomies such as the one Jolie opted for are win-win for insurance providers and gene carriers.

Jolie had a high chance of getting breast cancer by the time she turned 80 if she had gotten cancer in her 50s or 60s, she would have spent much more on treatment than the cost of her preventive procedure, Dr Gomez explains.

However, she reveals that this is far from the current understanding and practice of insurance providers. In fact, breast reconstruction post-mastectomy is considered cosmetic surgery and is therefore not covered by most insurance plans.

Though insurance companies in Malaysia have a long list of diseases they cover, this list is about 30 years behind the rest of the industry and does not reflect

the exponential advancement of medical technology, says Dr Gomez.

This is why although there are facilities for genetic screening in Malaysia, we dont tell our patients to do it once you have done the test, you must disclose this information to insurance companies and they can blacklist you and your family members as there is no legislation to stop them from refusing coverage.

Exercising freedomThe old adage prevention is

better than cure rings true in cases such as these but if you

were to opt for a preventive mastectomy like Jolie, the money would have to come out of your own pocket. The cost can be anything from RM50,000 to RM100,000 which is still less

Choice and opportunity

than what one would spend on years of cancer treatment.

Although Malaysian women in the low- and middle-income bracket are not privy to the same opportunities as wealthy celebrities such as Jolie, the actress sends important messages of early detection, prevention and specific treatment in her article.

Explaining that her decision was one made with advice of medical experts, including doctors, surgeons and naturopaths, Jolie wrote, There is more than one way to deal with any health issue. The most important thing is to learn about the options and choose what is right for you personally.

Talk to your doctor about the best treatment options for you, whether they be preventive or otherwise.

These are some local organisations that make breast cancer awareness and support their main cause. They provide information, counselling and support services for women and their families and friends.

National Cancer Society Malaysia (NCSM)

Making cancer literacy, prevention and early detection its primary goals, NCSM works to improve the lives of Malaysians through screenings and educational programmes in various locations around the country.

As a non-govermental organisation, it is also constantly on the lookout for volunteers to help in community outreach programmes.

Phone: 03-2698 7300Website: www.cancer.org.myE-mail: contact@cancer.org.my

Breast Cancer Welfare Association Malaysia (BCWA)

BCWA focuses more on the well-being of women with breast cancer by providing emotional, social and material peer support.

Patients are taught ways to care for themselves during and after treatment to ease their burden and ensure they do not have to fight the disease alone.

Phone: 03-7954 0133Website: www.breastcancer.org.myE-mail: info@breastcancer.org.my

PRIDE Foundation MalaysiaAlso known as Pink Ribbon

Deeds, this charitable body focuses on awareness efforts as well as improving accessibility to treatment and care of breast cancer at all levels of society.

PRIDE has organised educational, empowerment and sponsorship programmes to reach out to and engage women going through and living beyond breast cancer.

Phone: 03-7960 0366Website: www.pride.org.myE-mail: info@pride.org.my

Seek assistance here

Reconstruction of the breast post-mastectomy is considered cosmetic surgery and is not covered by most insurance plans.

Boost in energyARE you feeling constantly run down and fatigued most of the time? This may be your body alerting you that something has gone amiss.

Most of the time, fatigue is connected to emotional and physical stress. The worries and strains of lifes demands stemming from work, family and relationships can be exhausting, leaving you restless and worn out.

Tiredness is also attributed to one or more lifestyle factors, such as inconsistent sleep, lack of exercise, poor nutrition, irregular mealtimes and overconsumption of alcohol.

Fatigue can be a symptom of a weak immune system or underlying medical conditions. Needless to say, constant exhaustion can take a toll on you if left untreated.

It can pose profound consequences on your health, job performance and overall quality of life.

Combating fatigueIt is time to adopt a healthy

lifestyle and fuel your body with the essential nutrients it needs to keep your immune system working up to par.

Get enough sleep and rest, manage stress, have a regular exercise regime, consume a nutritionally balanced diet, stay hydrated and stay away from known stress factors.

You can also increase your nutritional intake by taking herbal supplements.

Enhance your energy and vitality

Ganoderma lucidum, also known as lingzhi or reishi, has a long tradition of use in Asian countries, particularly China and Japan.

It is a medicinal fungus with a variety of bioactivities that has long been praised for being one of the best folk remedies for its capability to promote health and longevity.

The major health benefit of lingzhi is its ability to help moderate the immune system.

It acts bi-directionally to normalise the immune systems by bringing it down when it is overstimulated and ramping it

up when it is weakened. A strong body with a robust

immune system is vital for optimal health maintenance, not only to prevent weariness, but also to fend off serious illnesses such as cancer.

Besides its immune-enhancing benefits, lingzhi may also help to boost energy, improve the bodys recovery and healing ability, reduce fatigue as well as nourish the heart, liver, lungs and kidney.

Recent studies discovered that

lingzhi spores are more potent than the fruiting bodies. The spores are cracked using advanced technology to facilitate the release of the active ingredients.

The essence of lingzhi obtained from cracked spores is more readily absorbed by the body and hence offers greater curative efficacy.

Besides lingzhi, other medicinal mushrooms such as shiitake, cordyceps and yunzhi have gained much attention due to their various therapeutic properties.

A proprietary blend of medicinal mushrooms can be an excellent adjunct to boost your immune health and overall quality of life.

This article is brought to you by VitaHealth.

n For more information, call 03-7729 3873.

Lingzhi mushrooms provide immune-

enhancing benefits.

5SUNDAY STAR, 4 OCTOBER 2015

6 breast cancer awarenessSUNDAY STAR, 4 OCTOBER 2015

The third annual Wear It Pink Womens Health Summit seeks to initiate discourse about womens health issues and policy change in Malaysia through roundtable discussions with stakeholders. Its patron Tan Sri Rafidah Aziz is seen here participating in a discussion at last years summit.

Dr Patricia Gomez

Summit to address health concerns

THIS year, Pantai Hospital Kuala Lumpur is organising the third annual Wear It Pink Womens Health Summit on Nov 5.

The summit, which will feature workshops for women with breast cancer and survivors, a fashion show and a roundtable discussion with policymakers and associations, among other events, has two aims.

The first is to spread awareness and education about breast cancer; the second is to be a platform for advocacy for survivors in terms of engaging with stakeholders and government agencies as a means to bring about changes to healthcare policy and regulation.

According to Dr Patricia Gomez, consultant breast surgeon at Pantai Hospital Kuala Lumpur and organising co-chairperson of the summit, the reason such engagement and discussion is needed is that women are not being provided the measure of access to healthcare or insurance that they require.

We want to get everyone to look at the things that are still not right in the system, so we are slowly trying to change the way that policymakers and insurance companies look at diseases, especially breast cancer. Malaysia is lagging far behind other countries when it comes to insurance coverage for a range of diseases, she says.

Bridging gapsFull and comprehensive

insurance coverage for breast cancer is almost non-existent in Malaysia, mainly because insurance companies are reluctant to take the risk of covering a person with breast cancer or even a survivor.

The Womens Health Summits work to prompt discussion and discourse about this subject and initiate change goes a long way to making the playing field level when it comes to insurance coverage and access to healthcare not just for women with breast cancer, but for any Malaysian living with any disease.

The way things currently work is that a person who has or has had breast cancer, or who has a genetic predisposition to cancer which can be confirmed by genetic screening or inferred by family history is either denied medical insurance coverage or has to pay higher premiums for coverage.

This acts as a barrier to obtaining healthcare, which in turn means that many are unable to afford treatment for breast cancer, which is an eminently treatable and survivable cancer.

The only way to prevent genetic discrimination when it comes to being eligible for insurance is to have proper legislation put in place, says Dr Gomez.

She also points out that as breast cancer survivors can go on to live full and long lives after surviving the disease, there is a large untapped market that insurance companies should take advantage of.

Further, in Malaysia, reconstructive surgery for the breast is considered a form of cosmetic surgery and thus sometimes not eligible to be covered under medical insurance,

another prohibitive regulation that denies many women much-needed healthcare.

People buy insurance because they want protection. They would not buy insurance policies that do not offer the protection they need.

It boils down to insurance companies keeping up with the advances in technology and medicine.

Dr Gomez explains that medical technology and knowledge has advanced so far that reconstructive surgery can be offered at the same time a lumpectomy or a mastectomy is performed it is bundled into one procedure so that the patient goes into the operating theatre with a diseased breast and comes out with a new one.

If insurance companies do not change their policies to be in line with the kind of disease management that we are doing now, they will have no takers for their policies, she says.

Reconstruction is important

Asian women generally tend to develop breast cancer at a younger age than their counterparts in the West.

The major incidences of breast cancer in Malaysia occur between the ages of 45 and 55, and doctors are seeing a trend towards younger women being diagnosed.

In most Western countries, almost 70% of breast cancer

patients are more than 55 years old.

This means that Asian women tend to be diagnosed with breast cancer at the time when they are at the height of their careers, have small children and are at the prime of their lives.

Therefore, it is incredibly important that women do self-examinations, come forward for screenings and obtain proper treatment in the early stages.

Dr Gomez points out that education goes a long way to ensuring that women are aware of breast cancer and understand what the proper treatments are, including the different options for surgery.

At the end of the day, the breast is a very important organ, not least because it forms part of a womans sense of self and sexuality.

Having a whole breast where there was once a diseased one is an important part of psychological recovery. This is why reconstructive surgery is such an important part of treatment and should not be considered merely a cosmetic procedure, she says.

She adds that through the past two summits and various efforts of advocacy, insurance companies in Malaysia are getting on board this idea there are new policies available that cover reconstructive surgery.

However, women who are at the age when cancer is a real possibility already have policies that do not cover such procedures.

Success on the horizonIn this years summit,

representatives from the Life

Insurance Association of Malaysia, Health Ministry, Women, Family and Community Development Ministry, National Cancer Society Malaysia, and various insurance companies and non-governmental organisations, among others, will be present at the roundtable discussion to talk about these issues and more.

This being the third Womens Health Summit, Dr Gomez says that progress is definitely being made to solve all these healthcare issues, not least because the summit engages directly with the insurance companies and the Government.

The Health Ministry in particular has been very positive about moving healthcare access forward and has put in place initiatives such as providing access to free or subsidised mammograms for women aged 40 and above at all LPPKN clinics.

The summit also benefits from a very committed and vocal patron in Tan Sri Rafidah Aziz.

We would consider this summit a success if the result of the summit is legislation that governs how insurance policies are sold and does not allow genetic discrimination in insurance policies, says Dr Gomez.

n For more information, call 03-2296 0773 or 03-2296 0837 (Breast Care Centre).

The Womens Health Summits work to prompt discussion and discourse about medical coverage and initiate change goes a long way to making the playing field level when it comes to insurance coverage and access to healthcare.

Last years Wear It Pink Womens Health Summit saw a good turnout to participate in workshops and discussions designed to bring better awareness and understanding about breast cancer.

Malaysia has healthcare facilities to screen, diagnose and treat breast cancer, such as those available at Pantai Hospitals Breast Care Centre, but not enough women are coming forward to take advantage of them.

Awareness, accessibilityTHE level of awareness among urban Malaysians of breast cancer and the need to go for regular screenings has been getting better over the last few years.

In rural areas, however, the level of awareness is still below standard. Coupled with the fact that accessibility to proper screening and treatment facilities is poor, this means that a large number of women only go for treatment at the later stages of their cancer or, even worse, do not seek treatment at all.

Awareness and accessibility in the east coast of the peninsula and in Sabah and Sarawak is sorely lacking. Though the big government hospitals all over Malaysia generally have good facilities, the smaller rural government hospitals and clinics lack the facilities and specialists required to provide much needed breast cancer screening and consultation, says Dr Patricia Gomez, consultant breast surgeon at Pantai Hospital Kuala Lumpur.

In Malaysia, healthcare for breast cancer is mostly urban, she continues. It is widely available in urban areas, but it is opportunistic, meaning the women have to come forward themselves to seek it.

In countries such as the United States and United Kingdom, national screening programmes are available where the government invites women to get regular screenings; the programmes are essential as the incidences of breast cancer are high in these countries about one in nine women present with breast cancer.

In Malaysia, though the numbers are not as high, they are increasing. A few years ago, every one woman in 30 was diagnosed with breast cancer. Now, the average is one in 19, though certain Malaysian races have higher incidences for example, one in 14 Chinese women is diagnosed with breast cancer.

But these are hospital-based figures, so there may be a large number of women with breast cancer who never come forward. The incidences of breast cancer in Malaysian women may be much higher than we think, says Dr Gomez.

Workshops such as this one at last years Wear It Pink Womens Health Summit help educate both men and women about breast cancer.

BraVida, part of Pantai Hospital Kuala Lumpurs Breast Care Centre, stocks prostheses and special bras for breast cancer patients and survivors.

Dr Rema Kunjappan.

SUNDAY STAR, 4 OCTOBER 2015

breast cancer awareness 7

Besides accessibility, there are several reasons for women not seeking treatment, including social stigma or even plain denial.

Because knowledge about breast cancer is poor, families and communities may not give a woman with breast cancer the support she needs or may ostracise her for having a disease.

The woman herself may go into denial because of the belief that having a cancer means there is no

PANTAI Hospital Kuala Lumpurs Breast Care Centre is a one-stop breast disease centre that does not just deal with breast cancer but all diseases to do with the breasts.

The team of specialists at the centre is able to refer to oncologists, radiologists, pathologists, plastic surgeons and many more in the same hospital, all of whom contribute to the centres multi-disciplinary approach to diagnosing and treating breast disease.

The centre benefits from Pantais tumour board, which meets once a week to discuss ongoing cancer cases at the hospital.

Specialists are able to discuss treatment options and get a consensus of the best treatments for patients in keeping with internationally recognised standards of practice.

In addition, the centre has a dedicated trained breast care nurse who supplements the specialists consultation with other kinds of support.

Once the patient has seen specialists, the nurse will discuss treatment timelines, cost and funding options, and even things such as where to get wigs and prostheses.

The Breast Cancer Welfare

Association (BCWA) also provides voluntary peer group support by visiting the patients during therapy.

The hospital has a cancer support website where anybody can pose questions to doctors.

The Breast Cancer Centre has its

hope for survival. We need to remove the barriers

that prevent women from seeking treatment. The best way to get

around these barriers is education, says Dr Gomez.

Women in Malaysia should be educated not only about breast

Providing breast care

cancer, but also that they should be making decisions about their own bodies and health, she continues.

It is unfortunate that in many families, such decisions are still made by the males, who may also not fully understand what needs to be done.

Both men and women should be educated about breast cancer, the need for proper treatment, and the need for early treatment, she says.

Dr Gomez reveals that in this years Wear It Pink Womens Health Summit, which is organised by Pantai Hospital Kuala Lumpur, besides discussions and workshops about breast cancer and womens health, there will be a programme for men.

This programme will teach men why it is important to bring their women forward for screenings and treatments and also how they can be a pillar of support for the women in their family who are diagnosed with breast cancer as they go through their treatments and beyond.

own specialist bra and prosthetics shop called BraVida, which stocks several bra and prosthetic options.

Our main objective is to support the doctors in their treatment and the patients in their recovery process, says Dr Rema Kunjappan of the Breast Cancer Prosthesis & Chemotherapy Support Centre.

BraVida stocks specially made bras for post-surgical breast cancer patients, breast prostheses and other items that a breast cancer survivor may require such as special swimwear or compression sleeves (tight sleeves that help drain lymph from the arms for those who have had their lymph nodes removed).

The BraVida team also provides advice on exercising and the best options for prosthesis. Dr Rema explains that every woman has different requirements, not least in the shape of her body, and so each person has to be fitted with the right prosthesis.

These are not just items of clothing or silicone lumps. The right bra and prosthesis not only

helps with how the person looks, it also helps them build confidence. It can make the difference of whether or not the woman feels she is able to go out in public, return to work and return to her social life, says Dr Rema.

n For more information, visit www.pantaicancersupport.com

Dr Patricia Gomez

Both men and women should be educated about breast cancer, the need for proper treatment, and the need for early treatment

8 breast cancer awarenessSUNDAY STAR, 4 OCTOBER 2015

Treating the silent killer

THE most common form of cancer affecting Malaysian women is breast cancer where the cells in the milk producing glands (lobules) or the ducts become abnormal or divide uncontrollably.

In most cases, these abnormal cells result in the growth of a painless lump that could possibly alter the contour and size of the breast.

While medical experts have not determined the exact cause of breast cancer, women must be aware of the risk factors that are associated with the disease

These include a family history with the disease, carrying the BRCA I and BRCA II genes, exposure to radiation, history of benign breast lumps, obesity, late menopause and unhealthy diets.

Women who have concerns regarding their breast health due to family history, experience palpable abnormality or abnormal discharge from the breast must instantly seek professional help.

If the disease is not detected in the early stages or if the patient does not receive appropriate treatment, the abnormal cells can spread to other parts of the body such as the lymph nodes, lungs, bones, brain and liver.

This will create even greater health complications and every woman must take the necessary precautions as breast cancer can lead to fatality.

Specialised healthcareFortunately, this life-threatening

disease and its related medical conditions can be treated if individuals are diagnosed in the early stages and receive the proper care and therapy.

There are many hospitals and healthcare facilities within Malaysia that specialise in the various aspects of breast health and breast care.

Designed and developed over a few years, the Cancer and Radiosurgery Centre in Subang Jaya Medical Centre (SJMC) is one such facility that offers a one-stop solution for cancer patients from assurances and guidance on the most suitable treatment options, to surgery and therapy.

Patients who visit the Cancer and Radiosurgery Centre are assured that all their health needs are fully taken care of thanks to the combination of dedicated staff, technology and experience.

Our first and most important effort was to gather a team of experienced oncologists, physicists,

staff nurses and radiation therapists who would help design a centre that allows easy access and communication between the various sections of the facility, says Dr Ahmad Kamal Mohamed, clinical oncologist at SJMC.

We then acquired the latest equipment and facilities that would allow the centre to offer complete cancer care.

This ensures patients get the care and comfort they need during the process of the treatments, adds Dr Ahmad.

SJMC also has a dedicated Breast Care Centre that offers an extensive range of screening and diagnostic imaging procedures to ensure reliable and accurate diagnosis.

Based on the information gathered from each test, consultants are able to determine the most appropriate course of action for the patient.

The services offered at the Breast Care Centre include digital mammography, breast ultrasound, breast MRI, minimally invasive breast biopsies, cytogenetics testing ,immunohistochemistry testing and breast surgery.

More than just medicalBesides providing services in

breast healthcare to ensure patients are physically healthy, SJMC also recognises the importance of being mentally and emotionally healthy.

One of the Cancer and Radiosurgery Centres activities is organising breast cancer support groups for the patients.

These sessions often also benefit the patients carers, family and friends.The support groups comprise both past and present cancer patients

This allows all participants the opportunity to share their cancer journey and experience.

Sharing and listening to one anothers personal fears, joys, triumphs as well as despair enables participants to receive psychosocial support and the strength to face this difficult part of their lives.

The centre also provides counselling services for patients and their families.

It helps them understand the issues they face and how they can cope with the changes that have

Offering quality care services

The experienced team of specialists and staff at Subang Jaya Medical Centres Cancer and Radiosurgery Centre.

Clinical oncology and radiotherapy consultant Dr Matin Mellor and a therapist with a patient in the Cancer and Radiosurgery Centres tomotherapy machine. The centre is well equipped with facilities to treat all cancers.

Dr Ahmad Kamal Mohamed.

HEALTHCARE facilities around the world strive to provide services that are safe, effective, patient-centred and valuable for all patients and Subang Jaya Medical Centre (SJMC) is no exception.

Seven months ago, the hospital released a report titled Healthcare performance measurement and reporting for SJMCs breast cancer care services, patient survival outcome 2008 to 2012.

This report highlighted the hospitals care performances and focused particularly on patients diagnosed with breast cancer.

The survival outcomes from years 2008 to 2012 were the key index of the overall effectiveness of the centre.

One of the main reasons for this study was to meet accountability criteria and bring into focus the care practices that required additional improvement.

Dr Ahmad Kamal Mohamed, clinical oncologist at SJMC, says, We believe that we have been performing well throughout the years but there was no objective way to prove this.

It was therefore important for us to measure this performance.

Besides adhering to local clinical practice guidelines, the study also adopted performance measures that were developed and used by international bodies in developed countries.

The performance and figures of the study became the benchmark

against other cancer centres locally and internationally, thus indicating how we were doing, adds Dr Ahmad.

The study population consisted of Malaysian women who were diagnosed with and treated for breast cancer in the hospital from 2008 to 2012.

The status and progress for each patient was then monitored for 12 months based on the subsequent exposure to cancer-directed therapies that were conducted in the hospital.

Data was then compiled and analysed based on the medical, operative surgery, chemotherapy and radiotherapy records.

At the end of the five-year period, the study concluded with a total sample size of 675 breast cancer patients. This number was taken after eliminating ineligible patients who had either uncertain or incomplete data factors.

The results of this study indicated that many patients were successfully treated and that there were a reputable number of survivors within the four stages of breast cancer.

The study indicated that the percentages of survival outcomes were on par with those released by well-known international healthcare centres and the national registries of countries such as Australia, United Kingdom, United States, Japan and Singapore.

risen due to the disease. In its efforts to remain as a

world-class facility, SJMC continues to build a strong collaborative team to deliver safe and up-to-date patient care and invest in appropriate technology to deliver good outcomes.

Earlier this year, the hospital released a report that measured

high survival rates of breast cancer patients at SJMC between 2008 and 2012.

These results were comparable to the rates of international healthcare facilities and national registries.

n For more information, call 03-5639 1212.

SUNDAY STAR, 4 OCTOBER 2015

breast cancer awareness 9

Womens hearts

Malaysian women have also been found to have one of the highest prevalence of hypertension in South-East Asia, even more than men.

There are also several risk factors that affect women more significantly than men in the development of heart disease, such as diabetes, metabolic syndrome (a combination of fat around the abdomen, high blood pressure, high blood sugar and high triglycerides), mental stress and depression, smoking, lack of physical activity, low levels of oestrogen (post-menopause), as well as pregnancy complications such as high blood pressure or diabetes (which increase a womans long-term risk of these conditions and the development of heart disease in both the mother and her child).

n For more information, call 03-2600 6421/6423 or e-mail contact@ijn.com.my

WHILE typically thought of as a mans disease, it must be noted that heart disease affects women as well killing as many as one in four women annually.

The total number of deaths from heart disease is reportedly 2.5 times higher than all types of cancers combined.

What is alarming is that about 64% of women who die suddenly of heart disease have no previously reported symptoms.

Women often present slightly different symptoms from men, making them more likely to go unnoticed, especially in the early stages. The older a woman gets, the more likely she is to get heart disease, especially during menopause.

Chest pain is not always severe or the most prominent symptom for women (as it is for men). Other symptoms that can be experienced by women include:l Neck, jaw, shoulder, upper back or abdominal discomfortl Shortness of breathl Pain in the right arml Nausea or vomitingl Sweatingl Light-headedness or dizzinessl Unusual fatigue

Most women tend to dismiss these symptoms as unrelated to the heart.

Traditional risk factors such as high cholesterol, high blood pressure and obesity affect both women and men. However, it has been found that these conditions are highly prevalent in Malaysian women, putting them at great risk of developing heart disease.

Sudden dizziness can be a symptom of heart disease in women.

Misconceptions can be dangerous,

so ensure you understand the facts

of breast cancer.

Myths debunkedAS with any other disease, there are numerous myths and misconceptions about breast cancer.

Here are the more common ones, and the actual facts that debunk them. Myth: Breast cancer is very painful. Fact: There is actually no pain from the

cancer itself, which is why people do not realise they have a cancerous lump in their breast.

People do not do anything about the lump they find though it gets big and nasty because theres no pain and they think its not anything dangerous or they can delay seeing a doctor, says Dr Patricia Gomez, consultant breast surgeon at Pantai Hosptial Kuala Lumpur.

The best course of action if you find a lump or any other anomaly on your breast is to seek medical advice immediately, whether there is pain or not.

Myth: You cannot eat certain foods when you have or are recovering from cancer.Fact: All healthy food is acceptable in

moderation. There are various traditional beliefs

among Malaysians that certain foods should not be consumed when you are ill.

Sometimes, people omit foods from their diets or change their diets completely (such as switching to a vegetarian or raw food diet) because of something someone told them or that they have read.

It is important to have a healthy, balanced diet, especially when you are ill, going through treatment or recovering from surgery as this is when you need as much nutrition as possible. Do not avoid protein or nutritious food when you need it most, advises Dr Chong Kwang Jeat, resident radiotherapy and oncology consultant at Mahkota Medical Centre.

Myth: Chemotherapy kills you.Fact: Simply put, chemotherapy targets

the cells in the body that are in the process of splitting. Cancer cells keep dividing until there is a mass of them and a tumour forms. Chemotherapy drugs work by damaging and destroying these cells as they divide.

These drugs also affect the healthy cells that are constantly growing and dividing, such as skin cells, hair follicles and the lining of the digestive system. This is why chemotherapy causes side effects and people think that it makes you more ill than before and even kills you.

The truth is that chemotherapy drugs work extremely well against the cancers they treat. Nowadays, there are advanced drugs to combat the side effects of chemotherapy, so going through this treatment is quite tolerable.

10 breast cancer awarenessSUNDAY STAR, 4 OCTOBER 2015

Performing self-examinations MOST women know that they should perform a breast self-examination every month.

But many do not do it for various reasons they do not know how, they do not think it is important, or they just forget.

Self-examinations, coupled with mammograms, are the best way to detect anomalies in your breast tissue; they are your first line of defence against the spread of cancer through your breast.

When properly carried out, a self-check will alert you to a lump or painful spot on your breast. When breast cancer is detected, examined, diagnosed and treated at this early stage, there is a very high chance of survival.

Regular self-examinations are important for both men and women.

Men should perform regular self-examinations as well. Though the number of breast cancer cases affecting men are significantly lower (roughly 1% of all breast cancers) as compared to women, it does not mean that you cannot develop the disease.

The symptoms, diagnosis and treatments of breast cancer among men are very much similar to those of women.

Male breast cancer is most commonly diagnosed in men between the ages of 60 and 70 but it is also possible to develop the disease at an earlier age.

Performing a breast self-examination every month does not mean that you do not have

to go for a breast screening; self-examinations are additions to regular clinical examinations.

Women in their 20s and 30s should go for a screening (usually in the form of an ultrasound) every three years, while women 40 and above should have a mammogram every year.

Men should consult their doctor about breast health when they go for their regular yearly medical check-up.

The self-examination process is similar for men and women and should be performed at a regular date every month.

Here is a guide on how to perform it:

Step 1: Look Step 2: Feel while lying down (for women) Step 3: Feel while standing

Stand in front of a mirror with your shoulders straight and your arms at your sides. Look at your breasts and note their shape, size and colour. Look for any swelling, dimpling of the skin, changes in contour or changes in the nipple. Place your hands on your hips and press firmly to flex your chest muscles. Look for dimpling, puckering or changes. The left and right breasts will not be exactly the same so look at each side carefully. Raise your hands above your head and perform the visual examination, then bend forward and do the same.

Lie down and place a pillow under your right shoulder. Put your right arm behind your head. Use your left hand to feel your right breast. Use the pads of your fingers to feel your whole breast. Follow a pattern to ensure you cover the whole breast. You can begin at the nipple and move outwards in concentric circles or you can move up and down in vertical strips. Feel all the breast tissue using different pressures light for skin and tissue just beneath the surface, medium for tissue in the middle and firm for deep tissue. Do not forget to feel the breast tissue that extends into your armpit. Feel your nipple to check for lumps and squeeze it to check for discharge. Repeat the process with your left breast.

Feel your breasts while you are standing (or sitting if you prefer). It may be easier to feel your breasts when your skin is wet so you can perform this step while you are in the shower. Raise your right arm over your head, using your left hand to examine it. Examine your entire breast using the methods described in step 2. Repeat on your other breast.

Seek medical help if you notice:l Unusual difference in size or shapel Alternation of nipple positionl Turning in of the nipplel Dimpling/puckering of the skinl Unusual rash/colour on breast

or skinl Unusual discharge from the nipplel Unusual lump or nodule on any part of the breast

Things to look out for during a breast self-examination

Source: Breast Cancer Welfare Association Malaysia

SUNDAY STAR, 4 OCTOBER 2015

breast cancer awareness 11

Immune system boostTHE best way to fight cancer is to know the possible causes of cancer and overcome it.

Our immune system and the environment are as important as our genes in determining the likelihood that we will get cancer.

Natural Killer (NK) cells recognise and destroy many types of virally infected cells. When the body is stressed or in a diseased state, the immune system can become overloaded and activities in these protector cells then become sluggish.

This is often compounded by medical treatments, which further depress the immune system.

Lentin Plus 1000 is the latest natural immune enhancing complex that gives your body extra protection against a wide range of diseases and helps maintain good health.

For general health maintenance, it helps regulate the immune system and increase immunity by destroying infections and abnormal cells.

Lentin Plus 1000 is an important modulator for prevention and treatment and also enhances cell apoptosis (programmed cell death), which is the elimination of aged, damaged and abnormal cells from the body.

Patients who have taken Lentin Plus 1000 lead a better quality of life as it does not exhibit a cycle-on, cycle-off phenomenon.

Lentin Plus 1000 is made from rice bran and broken down by the action of shiitake mushroom enzymes via a patented process.

It is a predigested fibre, which has a lower molecular weight that allows it to be easily absorbed in the digestive tract to enter the blood stream.

When taken as a supplement, it effectively

helps strengthen the immune response by increasing the activities of the bodys lymphocytes or white blood cells, specifically NK cells (300%), B cells (250%) and T cells (200%).

Lentin Plus 1000 is distributed in more than 50 countries worldwide and highly recommended to those with immune deficiencies and with personal or family history of cancer.

Usefulness as a functional food: l Immuno-stimulating action l Anti-inflammatory action l Combination therapy with a chemotherapeutic agent

Effective for:l Neuroblastoma l Irritable bowel syndromel Hepatitis

n For more information, call 03-7803 6899 or e-mail info@lentinplus.net

Educate, care and supportTHE National Cancer Society Malaysia (NCSM) was founded in 1966 when Datuk S.K. Dharmalingam, then head of oncology at Kuala Lumpur Hospital, saw a need to provide support and advice for cancer patients throughout all stages of treatment.

The first non-governmental organisation (NGO) tackling cancer in the country, NCSM educates and assists members of the public on cancer prevention, treatment and support.

Today, it has a total of seven locations around the country, including a four-centre headquarters in Kuala Lumpur.

The centres and programmes in KL, Johor, Negri Sembilan, Malacca, Perak, Penang and Sarawak are managed and run by staff and volunteers.

NCSM offers health screening services such as mammogram, ultrasound, bone densitometry, HPV vaccination and HPV DNA testing, blood and urine screening, X-ray and electrocardiography.

A team of doctors, nurses, radiologists and radiographers are available five days a week at the Cancer and Health Screening Clinic.

Unparalleled support for cancer patients is the main focus at the Resource and Wellness Centre.

There is professional and peer support for cancer patients, survivors and caregivers, including volunteer cancer survivors offering first-hand advice for patients coping with treatment and other aspects of living with cancer, says Sudhaharan Nair, general manager of NCSM.

Other centres include Nuclear Medicine Centre, which deals with medical imaging procedures, and the Childrens Home of Hope, which provides comfortable and homely accommodation for children from outstation seeking oncology treatment at Kuala Lumpur General Hospital.

All these services are offered at subsidised costs, making them more accessible to patients while encouraging the public to take preventive action against cancer.

United effortsAdvocating early education, NCSM

organises cancer prevention, anti-smoking and healthy lifestyle talks in schools, colleges and universities as well as road shows, workshops and conferences in several locations.

NCSM also organises the Relay for Life charity run, which is held annually in KL,

NCSM organises cancer awareness and education programmes and fundraisers at schools, colleges and universities, such as Project Warrior at IACT college. NCSM president Dr Saunthari Somasundram gave a speech at the launch.

Malacca and Penang.This year, the run in its ninth year united

more than 3,000 people for the common cause of celebrating survivorship as well as fundraised for NCSM to help finance its core services of preventive health screening, education and support.

NCSM will also be the host of UICCs (Union of International Cancer Controls) World Cancer Congress 2018, an international platform for information exchange on the latest issues and breakthroughs in cancer treatment.

As an NGO, NCSM depends largely on fundraising proceeds and public donations to keep its noble cause alive.

Focus on breast cancerBreast cancer is the most prevalent

form of cancer in Malaysia with more than 6,000 new cases annually based on 2012 findings of the World Health Organizations international cancer research project GLOBOCAN.

One in 19 Malaysian women have a lifetime risk of having breast cancer. The survival rate for women with breast cancer in Malaysia is 59% compared with 75% in the United Kingdom, 86% in the United States and 70% in Singapore.

In October, NCSM is observing Breast Cancer Awareness Month with collaborative activities to spread awareness on the importance of early detection and living with breast cancer.

Its clinic has been appointed as the sole screening centre for Skim Kesihatan Wanita: Mammogram Selangor (MammoSEL). NCSM is also an entry point clinic for the National Population and Family Development Board (LPPKN).

We encourage women above the age of 40 to get a mammogram, which is available at the KL and Penang centres, and all women to perform monthly breast self-examinations and go for regular screenings, says Nair.

We are also looking into acquiring a mobile mammogram bus with three-dimensional mammogram screening to support us in our outreach programme.

The bus will enable us to bring healthcare to the underprivileged and underserved women in rural and urban communities. We look forward to having corporate partners to help make this happen.

n For more information, visit www.cancer.org.my

A strong immune system is important in the battle against cancer.

12 breast cancer awarenessSUNDAY STAR, 4 OCTOBER 2015

Providing full coverageAIA Bhd has introduced a new cancer plan to protect Malaysians against the financial impact of battling cancer, which is now one of the top killer diseases in the country.

AIA considered the mid- to long-term financial needs of those fighting cancer to create a plan that supports policyholders, be it in the early or more advanced stages of fighting the disease.

With A-Life Cancer360, policyholders diagnosed with early-stage cancer will receive an upfront payment of 30% of the coverage amount or sum assured to help them seek immediate treatment.

In the sixth and 12th month of their diagnosis, they will receive 10% of the coverage amount as Recovery Reward to support them financially during the first critical year after diagnosis.

When detected early, the survival rate for breast and ovarian cancers can be as high as 90%, while the survival rate for early-stage lung cancer is 70%.

To acknowledge the high chance of recovery from early-stage cancer, A-Life Cancer360 has a valuable Power Reset feature.

If a cancer that is detected early does not advance in the first year of diagnosis, the plans Power Reset feature automatically resets the coverage amount to 100%.

This ensures that the customer can enjoy full coverage should there be a need to fight cancer again.

If cancer is diagnosed at an advanced stage, customers will receive a one-off payment of the full coverage amount.

They will also receive an annual payment of 10% of the coverage amount (called Extended Recovery Income) for the next five years to help them meet their mid- to long-term treatment needs.

A survey of our customers showed that their biggest fear when it comes to health is to be diagnosed with cancer, says Thomas Wong, chief marketing

officer of AIA Bhd. As cancer impacts the family

emotionally, physically and financially, we came up with a plan that can lighten the financial burden of families who are impacted by the disease, so that they can focus their energies on treatment and recovery.

A-Life Cancer360 also recognises that the real cost of cancer goes beyond medical bills. It factors in non-medical costs such as transportation, household help, alternative therapies, special

dietary supplements and childcare. Often, these additional expenses

come at a time when patients experience a loss of income due to their inability to work during their illness.

To celebrate the good health of policyholders who stay cancer-free or recover from early-stage cancer, AIA will pay out 100% of the sum assured when the policyholder turns 80 years old, which is when the policy ends.

Many Malaysians are unable to access the best treatments due to

unaffordability and therefore they either succumb to the illness or risk bankruptcy, says Wong.

For A-Life Cancer360, AIAs underwriting will only assess an applicants risk related to cancer, thus making the plan accessible to more Malaysians.

The flexibility of A-Life Cancer360 allows you to use the money for treatments that best fit your needs as well as for any other expenses that may arise during the course of your illness, says Wong.

To demonstrate its belief that early detection saves lives, AIA rewards policyholders who detect cancer early.

If the cancer does not advance in the first year, AIA will reset the coverage amount.

The launch of A-Life Cancer360 coincides with AIA Bhds recent project called The Health Report Card by AIA that encourages Malaysians to take control of their health amid the rising trend of lifestyle-related diseases.

The online campaign invites Malaysians to send health report cards to their loved ones after assessing their diet, physical activity and emotional well-being.

n For more information, visit www.aia.com.my

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