It is important to conscientiously practice breast self-examinations so that we are aware of any changes/abnormalities and seek medical attention early. Early medical intervention increases one’s chance of recovery. In this edition of Best Advice from Women, for Women, we speak with breast cancer survivor Jill Koh, who helps us quell some of the misconceptions that many women have about breast cancer. Questions What kind of breast health issue did you face? I was diagnosed with invasive lobular carcinoma (stage 3 as it had spread to the lymph nodes in my right arm) in January 2021. How did you discover it? I was in Bangkok on personal business and as I was lying sideways in bed, I found a lump in my right breast as I did my own routine check-up. I went to a local hospital the next day. The doctor did an ultrasound and mammogram for me and told me it was highly likely breast cancer but as my flight home was in three days, she said to continue with the treatment in Singapore. After I served my two-week quarantine, I went to see a breast specialist where we did a biopsy and the cancer was confirmed. What was your biggest revelation after you were diagnosed? Two years prior in 2019, I had a lump removed in the same breast after the initial sample biopsy showed presence of cells that could turn cancerous. However, the lump and its surrounding tissues were benign and no traces of the earlier cells were found in the final biopsy. My doctor and I agreed to check regularly to be safe but I think that had already prepared me mentally that I could be at risk. So when I was really diagnosed with cancer in 2021 , I was quite prepared to accept it and move on immediately to treatment. Not much emotional upheaval involved. What is one thing you wish you knew before you started treatment? Breast cancer is not just “one type of breast cancer” but there are many variations and most of them can be controlled as long as we receive treatment soonest. I was undergoing treatment at the same time as a friend and while my cancer was hormone receptive, hers wasn’t and our treatment was thus different. Our experiences with chemotherapy and radiation were somewhat the same in general (baldness and occasional fatigue), yet it was also vastly different as it depended on the type of chemotherapy treatment administered, our own physical limits, resilience and outlook  as well as family/friends’ support. Hence, we can’t just believe what we watch on TV that hair drops once you start chemo (takes about a fortnight actually) and you would get sickly and weak – this is true for some but not all! It really depends a lot on various factors starting with what type of breast cancer we have, what stage we are at and treatment options. My skin was absolutely glowing during treatment as I drank so much fluid to flush the chemotherapy medication out after each treatment! What has the journey of dealing with or managing this issue been like for you? I am generally an optimist and fairly active person. Not sporty, just a fidgety type of active. I can’t really sit still, and I am always on a project or another. So I tried not to worry too much about the entire process from start to end and I definitely did not try to google and self-diagnose every side effect etc. It is good to be informed but it is unnecessary to be a cyberchondria. I placed full trust in my doctors to provide me with the best medical options and care. My family and friends who knew of my condition were also supportive and nobody treated me “differently”. My husband would insist I get out there almost daily for short walks, fresh air and we would continue to gallivant after dropping my daughter off school in search of good food. I continued with housework and cooking (although I had to delegate the taste test to the kids as the treatment affected my sense of taste somewhat) and we worked to maintain as normal a routine as possible. I felt blessed that I found my lump (which was supposedly fairly buried under the areola) by chance and managed to get treatment quickly, that I had good doctors and I responded quite positively throughout the treatment with mild side effects. So I cannot be upset about or blame anything really. Just be positive and look towards the end of treatment. Before this cropped up, what was your attitude toward breast health? My step grandmother had a mastectomy and I remembered as a kid how she had a sponge pad for her bra. My aunt had stage zero breast cancer and my mom has had a few scares. I had a lump removed in 2019 too. So I have been exposed to the topic of breast cancer for a long time. And I used to head up the Pinktober project in my child’s school (when we were based overseas) to fundraise and provide the school’s contract staff with regular medical, breast and PAP smear check-ups. We would also have nurses come into the school annually to educate all local staff on the importance of breast check ups. So breast health has always been important to me even before my diagnosis. Did this journey change that attitude? I think it further reinforced the message that women have to take responsibility for their breasts and health. In fact, 5 months before my diagnosis I had a full check-up as part of my insurance package (for ladies). It was a manual check by the doctor and she did not notice any anomaly then. When I was diagnosed and I shared the news with my family and friends, it triggered a wave of check-ups among them as many were indeed procrastinating and until it happened to someone close, I guess it felt like “oh, it won’t happen to me” to many. And that push factor was a positive as since then 2 more friends had been diagnosed early during their check-ups. What do you think women in general feel about breast health? I can’t comment on the general attitude in Singapore, but among family and friends, I know they are educated and aware of breast health. However, many have prioritised themselves last, putting the needs of their children, families and work ahead, and procrastinating on the check-ups or not scheduling them at all. Based on my experience with the lower income local staff in my child’s previous school overseas, their concerns were different. They would rather be ignorant so that they can continue to work, have an income to support the family and not worry/think about medical costs for treatment as many did not have proper insurance coverage. What are your thoughts when it comes to general awareness/education in this area? Perhaps because I am a breast cancer survivor, I am more aware of all the advertisements, events and activities that are organised by Breast Cancer Foundation, and various medical bodies and support groups to promote breast health. They pop up on my Facebook feeds, in support group Whatsapp chats and the intensity ups in October during Breast Cancer Awareness Month. However, for others who have not had the opportunity or time to think about it, they may not consciously sight or notice these efforts to educate. And what they learn through watching dramatic soap operas about breast cancer might just give them the wrong impression – that everyone MUST have chemotherapy, radiation, then go bald, sit and look withered in a wheelchair, or that breast cancer makes one less of a “woman” if she had to undergo mastectomy. It could be refreshing for a TV soap series to for once portray a positive case! What advice would you give women about breast health? I don’t drink, smoke and I keep an active lifestyle. I try to eat healthy and breast-fed both kids for 18 months each from birth. Even when I was diagnosed, I had no obvious textbook symptoms like orange peel skin, pus, pain, fatigue, loss of appetite etc. Cancer does not choose its victims because “it is their lifestyle that caused it”.  It happens, so always dedicate some time to care for yourself, do your annual check-up head to toe. Don’t hesitate to seek treatment. Also, if you can afford it, invest in a good insurance package. Since diagnosis my treatment has probably cost $200,000 plus minus and most of it has been covered by my insurers thankfully, so that really helps as it is one less thing to worry about – finances. Practice good breast health habits, and stay positive! If you have any questions on breast health but were too afraid to ask your doctor, let our Solis doctors help you.

In our new series, Best Advice from Women, for Women, Ms Jayde Simpson, an expatriate from the United Kingdom shares with us on finding out about her breast cancer diagnosis, coupled with the discovery of a high-risk gene. What kind of breast health issue did you face? I was diagnosed with Stage 2 Breast Cancer, which was ER+ PR- and HER2. How did you discover it? I felt a lump whilst on vacation that didn’t go away. Upon my return I scheduled an appointment with a breast specialist who performed an ultrasound. Within the week I had a mammogram, MRI and a PET scan which confirmed the suspicion. However, it wasn’t until a biopsy was conducted that it was confirmed as breast cancer. What was your biggest revelation after you were diagnosed? I did a gene test and discovered that I have a gene that makes my risk of breast cancer higher than the general population, although only a small number of cancers are hereditary.  Lifestyle and other factors influence an individual’s risk profile. What is one thing you wish you knew before you started treatment? Understanding the type of breast cancer (ER/PR/HER2 positive or negative) can lead to different recommendations on the type of treatment you should get.  I was upset when I had to get chemotherapy, believing what I had seen in the movies about the side effects from it.  However, I sailed through this.  A friend had recommended doing something nice around chemo and for me what stood out during my treatment was celebrating the end of each chemo with a lunch with a friend. My chemo duration had plenty of nice lunches and different friends supporting me throughout. What has the journey of dealing with or managing this issue been like for you? The absolute worst part was receiving the diagnosis as I did not truly believe this would happen to me and that all the tests would show this was a false alarm.  The biopsy I received confirmed this was not the case.  After that I did everything that I could to take a holistic integrative approach. I had a great breast surgeon and oncologist who partnered to give me the best medical treatment and tailored my treatment specific to me, e.g. my oncologist added a chemo that is shown to have more effect for people with the gene that I had, while my breast surgeon helped to add regular ultrasounds so we could measure the impact the chemo was having on reducing the tumour. This helped alleviate any anxiety on whether the treatment was working or not.  I focused on ensuring that I did everything at home that I could to help – diet, exercise and I worked with a naturopath to identify supplements that would help me through the treatment. After the chemo I had a double mastectomy with immediate reconstruction and whilst this was a challenging decision, I did everything I could to minimise any future risk.  I believe all of these things helped me to achieve a ‘pathological complete response’. The cancer diagnosis gave me the discipline I needed to prioritise me and ensure that I focused on a diet and exercise regime to best support my treatment. Despite the numerous rounds of chemo, I never once felt ill and felt stronger and fitter throughout.  I had the odd tired day and some other limited symptoms. However, the treatment was nowhere near as bad as I expected. Before this cropped up, what was your attitude toward breast health? Sadly, I had a close friend who passed away from Breast Cancer and so I was very much aware of the need to do regular self-exams.  The earlier you identify an issue, the more likely you have the chance of successfully dealing with it.  I was aware of how my breasts would change during my regular cycle and so managed to self-identify the lump early enough to have a very successful outcome. Did this journey change that attitude? It only strengthened it.  I am more in tune and aware of my body and if anything doesn’t feel right.  I take care to watch stress levels and not overreact and am focused on ensuring that I have balance in my life with adequate sleep, exercise, supplements and focusing on what I eat (80% of the time). What do you think women in general feel about breast health? Whilst I was aware of the importance, I think I still thought of myself as being invincible and that something would not happen to me.  I think women in general put other family members first and neglect to prioritise themselves.  These two things together can mean that they neglect breast health.  I also think sometimes people can feel embarrassed about seeking help or not wanting to expose themselves, or think “it’s probably nothing, I don’t want to bother anyone”. What are your thoughts when it comes to general awareness/education in this area? I hear of friends who tell me they don’t really know how to do a self-exam, or they skipped the last mammogram because they had to do something else and forgot to reschedule.  I think they are missing the 2 most important factors here:  1. prevention is always better than cure (focusing on healthy lifestyle can reduce your risk) 2. the earlier you catch these things, the better your outcome.  Whilst it’s rare, the tumour I had was not present on a mammogram but could be seen on the ultrasound, MRI and PET scan.  My advice would be to listen to your body and if something doesn’t feel right, advocate for yourself and seek a referral to a breast specialist who can help allay any fears or help ensure you get treatment early. What advice would you give women about breast health? The risk is too high so early identification will give you more chance of success.  Previously I did not prioritise myself, making excuses that I needed to attend to work, husband, children and that I had limited time.  I now consider that prioritising my health means I will be around longer to enjoy time with my family.  Ensuring I take steps to monitor my health and raising any concerns to my doctor means I’m around longer to enjoy my family.  The earlier you detect something the more chance of success you have.  Everyone I met throughout my journey was empathetic, caring, listened to me and addressed any concerns; the only downside is not acting early.