Even princesses can get cancer. Last month, the world was shaken by Princess of Wales Kate Middleton’s cancer diagnosis. And just before that, actress Olivia Munn’s candid revelation of her battle with breast cancer made headlines. Their stories are a reminder that cancer does not need permission to disrupt lives.Both young mothers in their early 40s, their high-profile diagnoses have sparked conversations about early detection, as well as the effects a cancer diagnosis can have on motherhood.Know Your BreastsWhile cancer survival rates have improved over the years, cancer remains the highest cause of death in Singapore, accounting for 28.2% of all deaths from 2017-2021 [1]. Breast cancer constitutes 24.6% of all diagnoses, making it the most common cancer among women in Singapore, contributing to 1 in 6 cancer deaths among females in the country [1].Breast cancer treatments are more effective and less invasive when the cancer is found early. One key to early detection is monthly breast self-examinations. If you are aged 20 years or older, it is important to be familiar with the way your breasts normally look and feel, to stay abreast of any worrying changes.Regular breast screenings are another key to detecting breast cancer at an early stage, when it is most treatable. According to the National Population Health Survey 2022, despite 9 in 10 women in Singapore aged 50 to 69 being aware of mammograms, only 37.6% of this demographic had undergone one in the last two years. The primary reason cited for this low mammography uptake is the perception that screening is unnecessary when you are healthy [2].Munn’s cancer would have been detected later had it not been for proactive health measures, which included an annual mammogram. If there had been any further delay, her treatment options would be limited [3]. Some breast cancer symptoms may not be noticeable to the naked eye, therefore regular screenings are essential regardless of symptoms. Waiting until symptoms develop to have a mammogram may result in the cancer being detected at an advanced stage.Source: Ministry of Health Singapore [4] How Early Detection Makes a DifferenceIt is important to act early than react late.Breast self-examinations complement, but do not replace screenings like mammograms. Mammograms are instrumental in helping to detect lumps before they can be felt by touch and become worse.Another reason women in Singapore cited for not doing their mammograms is the fear of the outcome [2]. Information about your body through screening tests is key. While anxiety surrounding testing results is understandable, the benefit of early detection for improving one’s chances of survival cannot be stressed enough. Annual mammograms can reduce mortality by approximately 40% [5].The BB (Boob Bead) keychain and infographic below illustrate the differences between the size of lumps detected through breast self-examination vs regular screening. Each bead on the keychain represents different lump sizes based on the detection method. With regular mammograms and ultrasound, it is possible to detect lumps that are 2-3 mm in size, a vivid reminder of why regular screenings matter.The boob bead keychains at Solis (left) are made by survivors and volunteers, as part of efforts to educate and encourage women to be breast aware.Being a Mother and Cancer PatientBeing a cancer patient is mentally draining, as one copes with the shock of the diagnosis and is wrapped up in a whirlwind of testing, treatments and decisions to make. For mothers with young children, this mental load is exacerbated, as they also need to worry about how their children will emotionally cope.“You realise cancer doesn’t care who you are; it doesn’t care if you have a baby. It comes at you and you have no choice but to face it head-on,” says Munn [6]. The young mother of one notes that one of the hardest things when recovering post-mastectomy was not being able to carry her son (who was only one-year old then) despite his pleas [7].Studies have highlighted the emotional burden experienced by mothers with cancer. Not only do they need to grapple with the physical, mental and emotional toll of the disease, but they may also struggle with guilt from a perceived failure to meet parenting expectations [8]. Amidst additional stress from other aspects of their lives such as relationships and employment, these mothers demonstrate remarkable resilience in balancing dual roles as parents and patients.Let us make this Mother’s Day count by honouring the mothers whose strength and love light up the world. Give your mother the gift of clarity by reaching out to us to schedule a mammogram, and help spare her from the anguish of a late diagnosis.1 Health Promotion Board, “Singapore Cancer Registry Annual Report 2021” 2 Ministry of Health Singapore, National Population Health Survey 20223 People, “Olivia Munn, 43, Reveals She Was Diagnosed with Breast Cancer and Had Double Mastectomy”4 Ministry of Health Singapore, Health Screening Guidelines5 “Benefits and Risks of Mammography Screening in Women Ages 40 to 49 Years”6 People, “Olivia Munn’s ‘Terrifying’ Breast Cancer Diagnosis After Baby Joy: 4 Surgeries in 10 Months, and Medically Induced Menopause (Exclusive)”7 People, “Olivia Munn Says Not Being Able to Pick Up Son After Mastectomy Was ‘One of the Hardest Things’ (Exclusive)”8 “Mothers with Cancer: An Intersectional Mixed-Methods Study Investigating Role Demands and Perceived Coping Abilities” 

Stigma Around Breast Screening and Breast Cancer Treatment for older womenBreast cancer is one of the most prevalent cancers among women in Singapore, and early detection through screening and treatment are essential to improve outcomes. However, despite the importance of breast cancer screening and treatment, there remains a significant stigma surrounding these topics particularly among older women. This stigma can result in older women avoiding screenings and seeking treatment early, which can negatively impact their health outcomes. In this article, we will explore the stigma surrounding breast cancer screening for older women and suggest ways to overcome it. Factors Contributing to StigmaWhile breast cancer is the number one cancer among women in Singapore, only two in five women have kept up with their regular screening mammogram, according to the National Population Health Survey 2020.Some factors for the low screening rate and stigma on breast cancer screening among older women include: Perceived costs versus the benefits of breast cancer screeningPerceived high breast cancer screening costs versus the benefits of breast cancer screening among women in Singapore was identified as the most common obstacle to breast cancer screening in Singapore.Fear of breast cancer screeningAnother common factor is the fear of the screening procedure itself, such as the potential of pain during a mammogram, or exposure to radiation from mammograms, as well as the fear of potential outcomes arising from the breast cancer screening[1]. These outcomes include the fear of being diagnosed with breast cancer and the resulting financial burden of the treatment, the fear of a diminished quality of life, the fear of treatment side effects and of having to take medication for life. Personal prioritiesWomen may not place priority on breast cancer screening as there are many other commitments that are deemed as more important. Common reasons include having “no time” due to personal or professional responsibilities and the “inconvenience”[1] in having to personally attend the screening that may or may not be nearby.Modesty, embarrassment and distrust of breast cancer screeningModesty and embarrassment related to cultural beliefs[1] were frequently cited as reasons for women not undergoing breast cancer screening, as seen in several studies. The presence of male staff during the procedure, as well as previous negative screening experiences (either personal or witnessed in others) were identified as significant barriers to breast cancer screening. Perceived susceptibility to breast cancer“I’m healthy” was commonly cited as a reason for avoiding breast cancer screening among women who have not undergone a mammogram before. Malay women were found to indicate this more often as a reason to avoid screening[1] compared with their Chinese and Indian counterparts.Another common reason cited for avoiding breast cancer screening was the perception of not being at risk. Women often cited a lack of family history, feeling healthy, and having undergone a prior mammogram with normal results as reasons for exemption from regular screening. Some women also believed that actively seeking cancer screening would increase their risk of getting breast cancer1 and that getting regular screening meant that something was wrong with them.Perceived severity of breast cancerFalse beliefs, where women believe their health outcomes were beyond their control, were also identified as a significant barrier to breast screening uptake. Women aged 60 years and above were more likely to cite these false beliefs compared to younger women. [1]Benefits of regular breast cancer screeningMammography lowers a woman’s risk of dying from breast cancer. It’s recommended for women aged 50 to 69 years old to have mammograms on a regular basis[2]. A meta-analysis that combined the results from six randomised controlled trials[2] found that:Women aged 50-59 who got mammograms on a regular basis had a 14 percent lower risk of dying from breast cancer than women who didn’t get mammograms. Women aged 60-69 who got mammograms on a regular basis had a 33 percent lower risk of dying from breast cancer than women who didn’t get mammograms.For women aged 50 and above, they are encouraged to go for a mammogram screening once every two yearsunless the doctor advises otherwise. For women aged 40 to 49, a yearly mammogram is recommended.  Do consult a doctor on the benefits and limitations of doing a mammogram at this age.How to address breast cancer screening stigma Understand the importance of going for a mammogramIt’s important to know that going for regular breast cancer screening is the right thing to do. In Singapore, Breast cancer is the most common cancer among women, accounting for all female cancers between 2015 and 2019. However, the good news is that early detection significantly increases the chances of surviving breast cancer. Mammograms are one of the most reliable screening tools for breast cancer, as they can detect suspicious areas before they can be felt by hand. Mammograms are also particularly effective for women aged between 50 and 70 years old. Manage the anxiety about going for a mammogramBe prepared for the breast cancer screening by managing anxiety and obtaining all the necessary information, including what to expect and what to wear etc. The imaging centre will be able to provide a preparation list for you.  Talking to someone who has undergone breast screening previously, or consulting with a doctor[5], or breast cancer specialist, can also help to alleviate any fears or uncertainties that an older woman may have on breast cancer screening. It’s natural to feel some discomfort during the screening procedure as breast compression is required to obtain a clear image. However, the level of pain can vary among individuals. Women can share their pain concerns with the radiographer conducting the screening, who will then make adjustments for better comfort Go with a friend for the mammogramHaving someone to accompany a woman for her mammogram can help lighten the mood and keep her relaxed. Women can encourage their girlfriends, especially those who have never undergone breast cancer screening before, to get screened together with them.  Women can use this opportunity to meet up and help promote good health for everyone. Stay calm after going for a mammogramWaiting for the screening results can be agonising for some women but instead of dwelling on the outcome, try to keep calm and keep themselves busy with activities they enjoy. It’s also helpful to keep in mind the following facts:No screening test is entirely accurate, and women may be asked to undergo further tests, such as a repeat mammogram or ultrasound scan. In most cases, these additional tests will show that everything is clear. Only one in 10 breast lumps are cancerous5 so there’s no need to worry too much.  There are various effective breast cancer treatment options available today, and survival rates have significantly improved. By taking the time to get regular screening, women can catch any potential issues early, which can increase their chances of successful treatment and recovery. Breast cancer screening is a quick and mostly painless process and it could save lives. Women should not let fear keep them from taking care of their health. This Mother’s Day, women can give the gift of health to their mother by encouraging her to get a mammogram. Show love and appreciation by scheduling a mammogram for mum and joining her for the appointment. Together, let’s make women’s health and well-being a priority. References Academy of Medicine Singapore, “Barriers to breast cancer screening in Singapore: A literature review”, https://annals.edu.sg/barriers-to-breast-cancer-screening-in-singapore-a-literature-review/ Susan G.Komen, “Breast Cancer Screening for Women at Average Risk, https://www.komen.org/breast-cancer/screening/when-to-screen/average-risk-women/ Singapore Cancer Society, “Mammogram”, https://www.singaporecancersociety.org.sg/get-screened/breast-cancer/mammogram.html Health Promotion Board, “Singapore Cancer Registry Annual Report 2019”, https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-2019_annual-report_final.pdf Healthub, “5 Ways to Psych Yourself for a Mammogram”, https://www.healthhub.sg/live-healthy/1839/5-ways-to-psych-yourself-for-a-mammogram