In support of Breast Cancer Awareness Month this October, we turn the spotlight on cancers affecting Singaporean women
Each year, up to 1,800 women are diagnosed with breast cancer. Of this number, over 400 women will succumb to the ravages of the disease, according to the Singapore Cancer Society. All is not lost, however, as new cancer treatments are paving the way for the future. “Certain subtypes of breast cancer, which were considered to have a high mortality risk 15 years ago, are nowadays being conquered with a combination of early diagnosis and advanced treatment,” says Dr Tan Yah Yuen, Breast Care Surgeon at Mount Elizabeth Hospital, “and many women with these aggressive cancers are now being cured!” Here, we’ve outlined the basic facts that every woman must know about breast health and the symptoms of other reproductive cancers.
Fact: One in 11 women will get breast cancer in their lifetime. Also fact: The chances of survival increases with early detection. “Women between the ages of 40 and 49 should have a breast exam every year,” says breast care surgeon Dr Tan Yah Yuen, “while women who are 50 and older should have one every two years unless there are risk factors such as family history or mammographic calcifications.”
She adds that breast self-examinations at home should be done once a month, after Egg freezing has increased my chances of having my own children in the future the menstrual cycle is complete, and that women should look out for any dimpling or puckering of skin, redness, swelling and rashes or discharge emanating from the nipple. Yet, despite the age-old adage that prevention is better than cure, Noor Quek, President of the Breast Cancer Foundation, says many women still dismiss the importance of early screenings. “When I speak to people abroad, their attitude towards cancer is completely different from ours in Asia. Many women here are still afraid to talk about cancer and lack understanding towards the disease,” she says.
Breast cancer is curable if treated early. Here are some symptoms to look out for:
→ A lump in your armpit
→ One breast becomes larger than the other
→ Unexplained back pain
Pole dancing helps Melissa stay strong and positive.
'Egg freezing has increased my chances of having my own children in the future'
– Breast cancer survivor Melissa Yamboa, 33 (right)
"When I was diagnosed with Stage 1A breast cancer in January 2015, the process of childbirth and motherhood hadn’t even crossed my mind when discussing my treatment options with my doctor. But when he brought it up, I shuddered at the thought of not being able to have my own children. I immediately contacted Dr Ann Tan of Women Fertility & Fetal Centre so I could get started on my egg-freezing journey. Now, I have more than 20 eggs frozen and I know this increases my chances of having at least two babies if I can’t bear kids naturally. I have heard friends talk about feeling guilty when science interferes with the miraculous process of producing life, but medical procedures like egg freezing and IVF do not make this process any less miraculous. What all these procedures aim to do is to give women the chance to experience motherhood. I feel that I’ve bounced back from cancer stronger than ever and have even taken up pole dancing as a way to stay positive. I hope my story will encourage other mastectomy and cancer patients to do the same." – Melissa Tamboa
Data from the Singapore Cancer Registry lists ovarian cancer as the fifth most prevalent form of cancer in the country and though it’s not as common as breast cancer, ovarian cancer is still the deadliest of all reproductive cancers. What’s worse is that there are no standard or routine screenings for women who do not have any risk factors for the disease. Still, an ovarian cancer diagnosis does not mean a death sentence. Treatment is still based on surgery and chemotherapy, but clinical trials are producing promising results for new treatments that can provide an improvement to the quality of life. “There have been so many advances in learning about cancer, especially at the genetic level, that treatments are becoming more targeted to each person’s tumour,” says Mt Elizabeth Hospital’s Dr Tan Yah Yuen. Other experts concur. “On the whole, there has been great progress in the field of cancer research, which would certainly be cause for optimism,” adds Dr David Tan, a Consultant with the Department of Haematology-Oncology at the National University Cancer Institute of Singapore (NCIS).
Ovarian cancer is not a silent killer. Here are the things to look out for:
→ Feeling full after eating a small amount
→ Increased abdominal size or persistent bloating
→ Needing to urinate frequently or urgently
'My stomach was so bloated that it looked like I was 32 weeks pregnant!'
– Ovarian cancer survivor Jennifer Teh, 29 (top)
"I went to see a doctor in December 2014 after experiencing sharp abdominal pain, nausea, vomiting and constant bloating. I also gained a lot of weight, my stomach was so bloated that it looked like I was 32 weeks pregnant! After a second opinion, a thorough scan and an X-ray, doctors found a 4.8-kg tumour in my abdomen that was about the size of a basketball. I remember crying when I was told and thinking that I was going to die. In March 2015, I had surgery to remove the tumour and after that I was diagnosed with Stage 3 ovarian cancer. I had to go through four excruciating cycles of chemotherapy that even caused my eyelashes to fall off. I didn’t give up though, my family and boyfriend supported me throughout the process. No one in my family has ever had cancer before so I never connected my earlier illness with the big ‘C’, but now I realise that cancer doesn’t discriminate, it can happen to anyone. Afterwards, I completely overhauled my lifestyle and diet, opting to drink lots of water and eating home-cooked meals and fresh fruit. If there’s one thing I regret about my life before, it’s that I took spending time with my family for granted. I thought I had all the time in the world, but cancer has reminded me that life is short." – Jennifer Teh
Cancer of the uterus is the most common cancer of the female reproductive organs and in Singapore, it’s the fourth most prevalent cancer among women overall, behind breast cancer, colorectal cancer and lung cancer. Fortunately, every cloud has a silver lining and in the case of uterine cancer, that lies in its high cure rate. “The majority of patients who are diagnosed with the disease at the stage where it is still confined to the uterus have a greater than 90 per cent five-year survival rate,” says Dr David Tan of NCIS, “but this drops significantly to about 15 per cent for women with Stage 4 endometrial (uterine) cancer”.
He adds that risk factors for uterine cancer include increasing age, late menopause, prior use of oestrogen therapy, obesity, diabetes, polycystic ovarian syndrome, and a family history of endometrial, ovarian, breast, or colon cancer. “There are also genetic predisposition syndromes that increase the risk of developing uterine cancer, for example Lynch Syndrome, which is caused by mutations in the gene responsible for DNA repair.”
Uterine cancer begins from abnormal cells in the uterus lining. Here are some signs to look out for:
→ Postmenopausal bleeding
→ Prolonged spotting
→ Irregular, heavy periods
Increasing evidence shows that the foods we eat may help lower the risk of developing cancer. Add these to your diet.
CANCER & EGG FREEZING
Freezing a woman’s eggs,
scientifically known as oocyte cryopreservation, is a process that
involves in-vitro fertilisation and then the cooling of said eggs to
sub-zero temperatures for later use. In Singapore, it is illegal for
single women to freeze their eggs unless medically necessitated. The
procedure can only be approved if a woman, like our reader Melissa
Tamboa, needs to have chemotherapy or radiotherapy for cancer, which
could damage their eggs. Under these rules, elective egg freezing would
not be considered an option for women who feel the need to buy time for
their ticking biological clocks.
Dr Ann Tan, Consultant
Obstetrician & Gynaecologist at the Women and Fetal Centre, Mouth
Elizabeth Hospital, says, “It is a controversial topic as while some
women believe that their fertility window can be lengthened by saving
their eggs in a bank, other women and men frown upon it as being a
delaying tactic and unnatural.”
There are medical experts who are pro egg freezing and Dr Tan counts herself among them. “I believe Singapore should strongly consider allowing women to have the right to save their fertility by freezing their eggs once they are adequately counselled,” she says. “This is particularly important for those women who have lost significant ovarian function due to ovarian cyst accidents, severe endometriosis or early ovarian cancer.”
Most women are also aware of the fact that their eggs deteriorate in both quality and quantity with age, which is why the option of freezing their eggs until they’re ready to use them seems particularly promising. Dr Tan explains that “fertility is the one thing we cannot take for granted will happen when we want it to. I have seen many women in their late 30s with poor egg reserves and some are newly-married too, so getting pregnant becomes even more stressful as they get older”.
For now, the Ministry of Health is cautious about egg freezing, saying it is still at an experimental stage with limited data on clinical outcomes.