Survivors Speak, Our Hearts Listen: Real and Inspiring Stories & Advice from Cancer Survivors

WORDS LIM TECK CHOON

THE DOCTOR’S STORY

Dr Zahrina Azian Zohadie’s world changed irrevocably when she was diagnosed with stage 4 colon cancer.

Since the cancer is at stage 4, it means that the cancer cells had spread from the colon to other parts of the body.

Staying strong for her children

“My cancer treatment was indeed challenging, but I had no other choice. I had to go through it,” Dr Zahrina said during a recent cancer survivor event at Columbia Asia Hospital–Bukit Rimau. “My children needed their mother. Despite the harsh effects of chemotherapy on my body, I persevered. In my mind, all this hardship will be worth it for those I love and those who love me.”

Once you have cancer, you have no option but to fight it

This was Dr Zahrina’s belief.

“The cancer is already in our bodies, so we must move forward because there’s nothing else we can do,” she elaborated. “We must continue with treatment.”

She was blessed to have encouragement and motivation from a close friend and colleague, an oncology specialist.  “Her advice, no matter the situation, is to keep going with the treatment. Her words of encouragement have been very helpful to me,” she said.

Having survived, she now offers her strength to others living with cancer

As a cancer survivor, Dr Zahrina felt that it was her vocation to offer her support to other cancer patients, bolstering their spirits with encouragement and support similar to what she received during her own cancer journey.

“During treatment, I felt like I was facing this painful challenge alone. But over time, I realize there are many others like me,” she shared.

Dr Zahrina is presently a member of the KanWork Cancer Support Association (link opens in a new tab).

THE BREAST CANCER SURVIVOR’S STORY

Norhaisnah Naian is a breast cancer survivor and a volunteer at KanWork.

Recalling her breast cancer journey, she shared: “In those days, I diligently sought information on how to get assistance from organizations like MAIS, Baitulmal, Lions Club, and many more.”

“When I attended chemotherapy sessions, I met other cancer patients from all walks of life,” she continued. “Naturally, I share information with them like where to find resources related to cancer. This is how I help other patients.”

Seek the company of supportive people with positive energy

“I fully understand how painful the experience of a cancer patient can be,” Norhaisnah said. “My advice is to find friends with positive energy and positive vibes.”

She pointed out that the volunteers at KanWork sought to be these allies for people living with cancer.

“I’ve been with Kanwork for over a year. We meet many former patients and current cancer patients whom we continue to motivate,” she told us.

A MEDICAL OFFICER REMINISCENCES ABOUT HER EXPERIENCES
FEATURED EXPERT
DR HEMA DARSHINEE JOHNSON
Oncology Medical Officer
Columbia Asia Hospital–Bukit Rimau

Dr Hema Darshinee Johnson revealed that a doctor’s approach to cancer patients is not as straightforward as prescribing medications.

She explained: “As doctors, we give treatment plans, and we tell patients to take certain medicine. On top of that, we tell them the side effects. Sometimes we tell them up front. But for them, even trivial things like brushing teeth can eventually become difficult at some point. It is always easier to say, ‘Be positive!’, but we will never understand what it’s like to be in their shoes. Their life turns upside down. That’s why it amazes me to see how they find the strength to continue.”

Grit and determination 

She recalled a domestic helper that had to travel back and forth to the hospital for treatment. “This lady took an 8-hour bus ride starting at midnight to arrive early at KL Sentral, then took a Grab to the hospital and then back. She knows the costs beforehand, so she cleans more houses to be able to afford the trip.”

Dr Hema felt humbled by these courageous people. “At the end of the day, my role as a doctor is only to assist them. I am only providing some form of lifeline, but they are the ones who are holding on to it and swimming across. It is all them.”

A reason to keep fighting

“It is beyond me to understand the grit they have but it is always about the ‘why’,” she mulled. “Everyone will have a reason to continue fighting whether it is their spouse, parents, children, or just not wanting to take life for granted and to give it their best. When you have found your reason; this journey becomes that much more purposeful. Together, we can surely win this.”

OVERCOMING THE STIGMA

Rozita Shafei, who has stage 1 cervical cancer, shared that people living with cancer often become stigmatized by others.

She said, “At first, I felt down. Friends distanced themselves because they fear they may get cancer. I felt isolated but thankfully, I received much support from my children and husband.”

She emphasized that emotional support is crucial for someone undergoing cancer treatment.

“My advice to those undergoing cancer treatment is to stay positive, strengthen your spirit, and believe in yourself.”

Her advice was echoed by Nurul Balqis, who was diagnosed with breast cancer since September 2023.

“All my children understand is that Mama always goes to the hospital. If I don’t go for a few days, they ask, ‘Mama didn’t go to the hospital today?'” she shared, adding that their concern strengthened her determination to continue her treatment.

“Besides that, I try to look forward and stay positive,” she further said.

RECOGNIZING THE RESILIENCE AND COURAGE OF CANCER SURVIVORS

This sharing session was held in conjunction with Cancer Survivors Month in June.

Additionally, Columbia Asia Hospital—Bukit Rimau announced a 3-year partnership with the Breast Cancer Welfare Association (BCWA) through a memorandum of understanding.

This partnership aspired to empower volunteers from KanWork, who are cancer survivor themselves, to provide emotional and moral support to cancer patients.

The ceremony was attended by guest of honour YB Puan Jamaliah Jamaluddin, the Selangor State Health & Environment Exco.

“Today, as we celebrate Cancer Survivors Day, we honor those who have fought and survived cancer, acknowledging their resilience and strength,” she said in her speech.

 

How Combining Anti-Hormone Treatments & CDK4/6 Inhibitors Can Benefit Women with Certain Breast Cancers

WORDS DR KILEY LOH WEI-JEN

FEATURED EXPERT
DR KILEY LOH WEI-JIN
Consultant Medical & Breast Oncologist
Penang Adventist Hospital
30-40% OF MALAYSIAN WOMEN PRESENT WITH ADVANCED BREAST CANCER

These women either have a very high risk of relapse or are already experiencing cancer that has spread to other parts of the body.

Unfortunately, cancer that has spread outside the breast and surrounding lymph nodes is mostly incurable.

For these women, the focus is how we can help them live well and longer.

THERE ARE DIFFERENT TYPES OF BREAST CANCERS, EACH WITH VERY DISTINCTIVE TREATMENTS

The types of breast cancers are usually assessed by a laboratory test called immunohistochemistry for the presence of oestrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor 2 (HER-2) receptors.

Breast cancers that are positive for ER and PR and negative for HER2, also termed hormone receptor-positive HER2 negative breast cancers, are the most common type, making up about 70% of all breast cancers.

The female hormone oestrogen mainly drives these breast cancers and is usually treated with anti-hormone treatments in combination with a targeted treatment called CDK4/6 inhibitors.

LET’S LOOK AT THESE TREATMENTS IN MORE DETAIL

Anti-hormone treatments block breast cancer cell’s ability to use oestrogen within a woman’s body, while CDK4/6 inhibitors work by blocking the proteins CDK4 and CDK6 that help cancer cells to divide.

Both these treatments are usually given as tablets.

However, premenopausal women usually require additional anti-hormone treatments to render them menopausal, either through anti-hormone injections or surgery to remove the ovaries.

Research-based evidence

Studies have shown that a combination of anti-hormone and CDK4/6 inhibitors effectively controls advanced breast cancers and helps these women live longer.

Smaller studies suggest that men with hormone receptor-positive HER-2 advanced breast cancers benefit equally from these treatments.

Additional studies have also shown that they are more effective and tolerable than traditional chemotherapy. As patients may be on treatment for an extended period, sometimes over many years, side effects must be considered and managed well.

Recent studies have also now shown that anti-hormone treatments and some CDK4/6 inhibitors also work in people with high-risk, early-stage hormone receptor-positive HER-2 negative breast cancers, as well as reducing the risk of the cancer relapsing.

Potential side effects

Anti-hormone treatments can potentially give rise to low oestrogen symptoms, such as hot flashes, joint stiffness, dry skin and vaginal dryness, all of which tend to dissipate over time.

CDK4/6 inhibitors can commonly cause fatigue, low blood counts, and appetite changes, which are manageable with dose changes and tend to dissipate over time.

HOW ABOUT THE COST OF TREATMENT?

Despite the importance of anti-hormone treatments and CDK4/6 inhibitors for people with advanced or high-risk early-stage hormone receptor-positive HER-2 negative breast cancers, access remains a problem in Malaysia due to the cost of treatments.

Most people who are insured are able to access these treatments, but access through the public healthcare system is limited due to cost issues.

Nonetheless, financial support for these treatments can sometimes be available through some charitable organizations in Malaysia.

Asia Pacific Women’s Cancer Coalition Releases Important Data on Women’s Cancers

WORDS LIM TECK CHOON

The Asia-Pacific Women’s Cancer Coalition recently launched a report called Impact and Opportunity: The Case for Investing in Women’s Cancers in Asia Pacific.

WHAT’S IN THE REPORT?

Published by the Economist Impact and supported by the pharmaceutical company Roche, this report presents a detailed examination of the burden of women’s cancer, specifically breast and cervical cancer, in 6 countries in the Asia Pacific region: India, Indonesia, Malaysia, the Philippines, Thailand, and Vietnam.

The report includes detailed snapshots of the breast and cervical cancer burden, incidence, and mortality in each of the 6 countries mentioned above. Readers will access the following information:

  • Current cancer care capacity status
  • Existing policies and planning
  • Prevention and screening measures
  • Diagnosis and resource capacity
  • Quality of treatment and access
  • Levels of awareness and education about breast and cervical cancer

The report furthermore identifies the gaps and opportunities for relevant stakeholders to improve the provision of assistance to women dying from these cancers every year in Asia Pacific.

THE MALAYSIAN SNAPSHOT

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If you experience this issue, to get the full-size image (warning: these images are huge), click on each thumbnail and then save the image or open it in a new tab.

THE REPORT IS ONLINE—READ IT HERE!
Click here for the full report at the Asia-Pacific Women’s Cancer Coalition website. The link leads to a PDF file.

How Much Do You Know about Male Breast Cancer? Let’s Find Out!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR NIK MUHD ASLAN ABDULLAH
Clinical Oncologist
Sunway Medical Centre
BREAST CANCER AFFECTS MEN AS WELL AS WOMEN

Breast cancer in both men and women share many similar attributes.

The most common kinds of breast cancer in men are the same kinds that are present in women, namely:

  • Invasive ductal carcinoma
  • Invasive lobular carcinoma
  • Ductal carcinoma in situ (or DCIS)

Dr Nik Muhd Aslan Abdullah says that breast cancer is, however, rare among men.

WARNING SIGNS

According to Dr Nik, many of the most pressing early warning signs of breast cancer in men are also similar to those found in women, such as:

  • Lumps in the breast tissue
  • Skin dimpling or puckering
  • Nipple retraction
  • Unusual discharge from the nipple
HORMONAL CHANGES CAN GIVE RISE TO BREAST CANCER

One reason why breast cancer is rare among men is that the hormone testosterone inhibit the growth of breast tissue, while oestrogen stimulates breast tissue growth.

While men and women have both hormones in their bodies, men have higher levels of testosterone compared to women. On the other hand, women have higher levels of oestrogen.

Some breast cancer cells have special structures at the surface, called hormone receptors. These cells are called hormone-receptor positive (HR positive for short). Oestrogen can bind to these receptors to cause the growth of these cells. Dr Nik explains that men have a higher possibility of developing breast cancer cells that are HR-positive, when compared to their female counterparts.

“Breast cancer cells in men are sensitive to hormonal imbalances,” Dr Nik explains, “so any factors or conditions that can lead to an excess of oestrogen and a lack of testosterone will increase their risk of developing breast cancer.”

What can cause the raise in oestrogen levels in men?
  • Klinefelter syndrome, a rare genetic condition in which a male has an extra X chromosome and produces lower levels of androgens
  • Injury to the testicles
  • Use of androgen inhibitors
  • Liver cirrhosis (scarring of the liver)
  • Obesity 
Family history also plays a factor

About 1 out of 5 men with breast cancer is found to have had a family history of the disease.

This is because men can also inherit a mutation in the BRCA1 or BRCA2 genes or in other genes, such as CHEK2 and PALB2. These mutations will highly increase their risk for breast cancer.

“Unfortunately, we do not have a say in the types of genes we inherit,” Dr Nik says.

He recommends that men with a family history of cancer should consider seeking counsel from their doctors about going for genetic screening tests as soon as they can, especially those over the age of 50.

Genetic screening tests involves taking a blood sample for analysis. A genetic counsellor will then advise the person, based on the results given, on what the next best steps would be for him.

How to conduct self-breast examination for men. Click the image for a larger version.
MEN WITH HR-POSITIVE BREAST CANCER ARE MORE LIKELY TO RESPOND TO HORMONE TREATMENTS

Dr Nik explains that hormone therapy can be used to help lower the risk of the cancer cells spreading or treat cancer that has come back after treatment.

Why then do men with breast cancer have lower survival rate compared to their female counterpart?

“Through many of the studies that I’ve seen, men who are diagnosed with breast cancer have a 8-9% lower survival rate than women,” Dr Nik says.

He attributes this to the fact that men with breast cancer are often diagnosed late.

“Men will sometimes wait too long to seek out a diagnosis for the symptoms they may be experiencing,” he explains, “or not recognize the warning signs of breast cancer in their bodies.”

As a result, they delay seeking help, and tend to do so only when the cancer has become advanced and spread to other parts of the body.

Dr Nik encourages men to seek a doctor’s opinion if they find themselves experiencing any of the mentioned symptoms related to breast cancer. “Breast cancer can be cured, and it is very treatable if detected early on,” he says.

How Breast Ultrasound & Mammogram May Save Your Life

WORDS LIM TECK CHOON

FEATURED EXPERT
DR WINNIE NG NYEK PING
Consultant Clinical Oncologist
Subang Jaya Medical Centre
NO FAMILY HISTORY OF BREAST CANCER = NO PROBLEM? WELL, THINK AGAIN!

“Even if one has no known family history of cancer, external factors such as environmental exposures, prolonged exposure to female hormones and lifestyle features may contribute to an increased relative risk of breast cancer,” says Dr Winnie Ng, a consultant clinical oncologist.

“Aside from genetics, there are numerous underlying possible causes of breast cancer,” says Dr Ng
  • Alcohol intake
  • Smoking
  • Prolonged exposure to female reproductive hormones such as oestrogen, such as in women that reach menstruation at early age, women that have never been pregnant, women on oral contraceptive pills, women that experience menopause late, and woman that have their first full-term pregnancy at a later age
  • Postmenopausal women on hormone replacement therapy
  • Obesity

Therefore, even if you have no family history of breast cancer, Dr Ng recommends that still going for breast cancer screening.

“The easiest method of screening is by self-examination of the breast,” she adds.

How to perform a breast self-examination. Click on this image to view a larger version.
AS WE STILL DON’T HAVE A CURE FOR BREAST CANCER, SCREENING REMAINS THE MOST PRACTICAL SOLUTION TO DETECT BREAST CANCER EARLY

Dr Ng recommends that:

  • Women below 40 should undergo a breast ultrasound.
  • Women above 40 are advised to go for a mammogram.

You should consult your doctor about your risk factors and how often you should go for breast cancer screening.

“A breast cancer diagnosis is not a death sentence. Self-tests and regular screenings can save lives,” says Dr Winnie Ng.

Keep the Hope of Pregnancy Alive in Spite of Breast Cancer

WORDS LIM TECK CHOON

FEATURED EXPERT
DR CHRISTINA LAI NYE BING
Consultant Clinical Oncologist
Sunway Medical Centre
WHY IS BREAST CANCER SO PREVALENT AMONG YOUNGER WOMEN THESE DAYS?

Aside from unhealthy diet and exposure to cancer-causing chemicals or carcinogens in the environment, Dr Christina Lai Nye Bing shares that one possible factor is that women are choosing to marry and have children at a later age.

This somewhat paradoxical concept can be explained by the link between breast cancer and the female sex hormone oestrogen.

“Breast cancer is a hormone-related cancer, and high levels of oestrogen in the body increases the risk of breast cancer as it encourages cancer cells to grow by promoting cell division and reproduction,” Dr Christina explains. “Women in the previous generation who get married and have children earlier have a lower risk of breast cancer, as the oestrogen in their body decreases when they are pregnant and choose to breastfeed.”

FEATURED EXPERT
DR HOO MEI LIN
Consultant Gynaecologist and Fertility Specialist
Sunway Medical Centre
IS PREGNANCY IMPOSSIBLE AFTER CHEMOTHERAPY?

Given that chemotherapy plays a big part in the treatment regime of many women with breast cancer, this raises the concern of whether the dream of having a family in the future an impossible one for them.

The unfortunate truth is that chemotherapy affects a woman’s fertility, with a 40% to 80% chance of early menopause.

The ovaries stop producing eggs upon menopause, so with that, the dream dies… or does it?

While Dr Hoo Mei Lin admits that the damage to the ovaries due to chemotherapy is irreversible, there is still a glimmer of hope.

“Patients can plan ahead, as conservation methods such as embryo freezing, egg freezing, and ovarian tissue freezing are available to enable patients to fulfil their wish of having children,” she shares.

Egg and ovarian freezing are suitable options for women that do not have a partner prior to having to undergo chemotherapy.

KEEP THE DREAM ALIVE

Dr Hoo advises breast cancer patients to have an open mind about their future and even consider having children.

After all, breast cancer patients under the age of 45 have an 80% survival rate after treatment!

“With the rapid advances in medical technology today, there is hope for breast cancer patients and survivors to plan their future. Technologies like egg and embryo freezing gives them the opportunity to have children in the future,” she says.

When it comes to cancer diagnosis, the focus is often about treating it, making fertility an afterthought. However, with the advancement in medical technology, surviving a cancer diagnosis is becoming increasingly successful hence, it is important to speak to your doctor as there are ways to help preserve fertility.