Best to seek treatment early, again!

From the New Straits Times:

If you’ve been diagnosed with breast cancer, be sure to get the right treatment in the early stages, writes Kasmiah Mustapha. A preference for alternative treatment, letting others make the decision and fear of surgery — these are among the reasons why more breast cancer patients seek treatment late (stages 3 and 4).
[onedayMD commentary: This article reminds me of Steve Jobs]

According to University Malaya Medical Centre (UMMC) consultant breast surgeon, Professor Dr Yip Cheng Har, some women believe that alternative treatments such as taking herbs or animal parts, will cure their condition after hearing the “success” stories of others. They believe these methods can cure them without pain while conventional methods are painful and will make them suffer more.

Due to the misinformation, women who have been diagnosed with breast cancer have refused to undergo treatment which includes surgery, chemotherapy or radiotherapy.

“These treatments are not painful. Unfortunately, some women who have undergone the treatment tell other patients that chemo is awful, scaring them off. Yet they themselves have gone through the treatments and are now healthy.”

Dr Yip says some patients allow their husbands, parents or siblings to decide on their treatment method. Some husbands refuse to allow their wives to undergo surgery without giving reasons. Also, some women have refused surgery because they are afraid of losing their husbands if their breast is removed.

She says at the UMMC, Malay women make up the highest number of patients with late stage breast cancer — 40 per cent compared to 20 per cent Indian and 15 per cent Chinese.

Some patients were diagnosed early but did not come back for treatment.

“If you come in for treatment at the late stages, survival is slim. The survival rate depends on stage presentation, and effective treatment. If you refuse treatment, your chances of survival are not good even if the disease is detected early. We are focusing on early detection and optimal treatment for better survival rates. Optimal treatment means you need to undergo all procedures which include surgery, chemotherapy or radiotherapy,” she says.

Based on the National Cancer Registry data from 2000 to 2005, the five-year survival rate for breast cancer in the country is estimated to be only 49 per cent. This is lower than that of developed countries. The five-year survival rate in the US is now at 80 per cent.

Breast cancer occurs in one out of 20 women, making it the most common here. It is estimated that there are around 4,000 new cases every year with the highest incidence among the Chinese, followed by Indian and Malay. One third of women with breast cancer are between 40 and 49 years of age and about 14.1 per cent are under the age of 40.

In a survey of women with breast cancer at UMMC in 2009, it was found that 5.8 per cent of the patients did not seek any form of treatment after being diagnosed. However, it was not certain whether this was due to financial, communication or logistic problems (lack of transport and childcare).

“They also find the waiting period difficult. Usually the average waiting period between diagnosis and surgery is six weeks, which is normal. There is a waiting list for surgery in government hospitals but it is not that bad. Of course they are anxious but we tell them that waiting for three weeks for the surgery is not going to cause any difference because breast cancer does not grow that fast.”

Dr Yip says treatment for breast cancer requires a multidisciplinary team comprising surgeon, pathologist, radiologist, oncologist, plastic surgeon, breast care nurse and psych-oncologist for optimal outcome. Unfortunately the teams are not available in most parts of the country. Some government hospitals do not even have an oncologist or radiotherapist.

Oncology services with radiotherapy facilities are only available at Hospital Kuala Lumpur, UMMC, UKM Medical Centre, Hospital Universiti Sains Malaysia and government hospitals in Johor Baru, Kota Kinabalu and Kuching.

For early detection, a mammogram is the only screening method proven to reduce mortality from breast cancer, she says. The effect would be significant for women between the ages of 50 and 74 and they should do it every two years. It can also be considered for women between 40 and 49 if they are at increased risk of breast cancer.

“Women between the ages of 40 and 49 have the highest risk of breast cancer.
But mammogram screening is not sensitive enough to detect lumps in women whose breasts are dense. Because of this, we are encouraging breast self awareness which includes teaching them the signs of breast cancer and how to examine and be aware of changes in their breasts.”

Women with breast cancer need knowledge to cope with their condition as they will experience anxiety related to their diagnosis and side-effects of treatment. Social support, whether tangible, informational or emotional, is essential for such women to help them cope. Unfortunately, there is a lack of psychological support due to a lack of clinical psychologists, breast care nurses and patient navigation system.

Dr Yip says: “Women with breast cancer have to go through a lot of appointments such as for mammogram, biopsy, CT scan and admission and each may be at different parts of the hospital. Sometimes they get fed-up of having to go through it all and give up.”

She will do research on the economic impact of cancer on households under the Asean Costs In Oncology (Action) study. The research, to begin early next year, involves 1,000 cancer patients across the country. Dr Yip will be conducting the study with Dr Nirmala Boo Pathy from the Health Ministry’s Clinical Research Centre.

While cancer care is available at hospitals nationwide, the cost of treatment at government hospitals (about RM3,000) is relatively low compared to private hospitals (about RM40,000).

It is estimated that almost 50 per cent of medical expenses are “out-of-pocket” as they are not covered by employers or medical insurance.

“We are looking at adult cancer of all stages. We will follow them throughout the first year of diagnosis. We will ask them to fill in questionnaires and give them a cost diary to determine the actual cost of their treatment.”

The study will be conducted simultaneously in Cambodia, Indonesia, Laos, Myanmar, the Philippines, Thailand and Vietnam, with the co-operation of Sydney-based George Institute for Global Health. It is sponsored by Roche Asia Pacific Regional Office.



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