Clinic sessions are often very busy, but the following two patients have stood out and left a deep impression on me.
The first is Mdm S, a lady in her thirties. She is a full-time homemaker, who juggles housework with being the sole caregiver to a 5-year-old son and a little girl under 2 years old, who was still being breastfed. When the breast lump first appeared, she attributed it to mastitis, which is common during breastfeeding, and did not pay much attention to it. However, the lump did not resolve, but got even bigger over the next few months. This was when she sought medical attention. She was diagnosed with breast cancer after investigations and a biopsy of the lump.
It was particularly agonizing for me when breaking the bad news to her, with her husband and young children right before my eyes. The news was shocking for them as she was young and did not have a family history of breast cancer at all. After a detailed discussion, we decided for chemotherapy, followed by mastectomy and reconstruction.
I suggested genetic counselling to check if she harboured a BRCA 1/2 genetic mutation. This genetic mutation increases the risk of breast cancer eight to ten times, as well as that of other cancers like ovarian, fallopian tube and peritoneal. Hollywood actress, Angelina Jolie, was found to have this mutation and underwent a prolific prophylactic double mastectomy in 2013 and raised awareness of this condition. Mdm S was found to be positive for BRCA 1 genetic mutation. She plucked up courage to undergo a preventative mastectomy on the unaffected breast at the same time as surgery for the breast with cancer, so that she would not have to constantly worry about when another breast cancer would strike. To support her cancer treatment journey, her husband took no-pay leave to take on the role of the main caregiver. Ultimately, she recovered well and was also satisfied with the outcome of the surgery and reconstruction.
The next patient is Mdm L, a 65-year-old lady, who worked tirelessly most of her life with her husband to manage their food stall in a school canteen. She had also recently become a grandmother. She first noticed the breast lump 3 months ago; but like many women, she had hoped it would disappear with time and put off seeing a doctor. She finally sought attention after much encouragement from her loving husband.
After mammography, ultrasonography, and biopsy of the lump, she was diagnosed with breast cancer. I explained that there were options besides mastectomy, which is a complete removal of the entire breast. Many elderly patients have the misconception that mastectomy is the only surgical option available for breast cancer. In fact, given her early disease, and small tumour size, she was suitable for breast conserving surgery. This is when we remove a rim of healthy tissue around the tumour and re-shape the remaining breast tissue to obtain good cosmesis. After discussion with her family, Mdm L underwent breast conserving surgery which was successful. She has since gone back to work alongside her husband and to enjoy the company of her grandchild.
The care and concern of family is a key factor in defeating cancer. Allow me to take this opportunity to remind every lady that it is important to do breast self-examination monthly and to see a doctor if there are any anomalies felt. For those 40 and above, mammography screening is essential to detect any early changes, for prompt treatment!
