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.