Twenty-eight year old Penkhra Jitjamnong found the lump in her breast when she was on a cold Phuket beach two years ago. "I touched it by accident, and knew something was wrong," she says. "I had also been eating a lot, but not putting on any weight." Despite her doctor telling her she was probably far too young to have cancer – most women diagnosed are aged over 40 – her test results showed otherwise.
Jamaican-born Liza Chang, 46, knew that she had fibrocystitic disease, a very common but usually benign condition where the breasts tend to feel lumpy and can be prone to developing cysts. When a cyst she had for more than a year seemed to be getting larger, she insisted it be removed despite doctors telling her it was probably nothing. That was October last year, and she was subsequently diagnosed with breast cancer. Following a lumpectomy in Singapore, she is currently undergoing chemotherapy in Bangkok.
There are no hard and fast rules with breast cancer. In Thailand, it is the second most common form of cancer in women after cervical cancer; globally, breast cancer is in the lead. According to the World Health Organization, more than 1.2 million people around the world were estimated to be diagnosed with breast cancer last year, while 700,000 women were expected to die from it.
Accurate statistics on the incidence of breast cancer in Thai women are elusive. "There’s a problem with reporting," confirms Boonpanore Na Songkhla, a former oncology nurse who worked for 12 years in the US and is now customer service manager at BNH. "Often on the death certificate it will say that someone died say, of heart failure, when the underlying cause was breast cancer."
For Bangkok, where statistics are probably the most reliable, it’s estimated that around one woman in every 5,000 will be diagnosed with breast cancer – a rate higher than the rest of the country, but similar to rates in developed countries.
The most important key to surviving breast cancer is early detection and treatment. According to the American Cancer Society, when breast cancer is detected and it remains confined to the breast, the five-year survival rate is almost one hundred per cent.
And although self-examinations are important, they are not enough to ensure early detection. "If you can feel a lump in your breast, there’s a fifty per cent chance that it may spread through your system," says Dr Pornthep Pramyothin, a surgeon at Samitivej Hospital.
Mammograms, on the other hand, can detect lumps that you can’t yet feel yourself. So should you head off and have one?
"Guidelines for when to start screening for breast cancer vary between different national cancer bodies around the world, and between hospitals," says Connie Larkin, co-ordinator of the Bangkok Breast Cancer Support Group (BBC), which was founded just two years ago. "We tend to promote the American Cancer Society’s guidelines because they are the most conservative."
These suggest that:
· self-examinations be done monthly from the age of 20;
· a clinical breast exam be done every three years until age 39; and
· an annual mammogram and a clinical exam be done from the age of 40.
The majority of women, however, are still reluctant to be tested. "There are now facilities all over the country, and we have the technology to detect breast cancer in its early stages," says Dr Sankiat Vayakornvichit, a gynaecologist at Samitivej Hospital. "The problem is getting people to go and be examined. Please have a physical exam once a year – not just for a pap smear, but for a breast exam. It’s an integral part of a woman’s check up."
Thai women are not tested as commonly as those in western countries for two reasons. Firstly, there’s a cultural tendency to be very modest about one’s body and put off seeing a doctor – who is still usually male – until it’s too late. "Thai women are not open about their bodies, so they don’t like seeing a doctor for a checkup," says Boonpanore. "And they don’t like to self-examine themselves."
The second reason is simply a lack of health education, but this is something the Ministry of Public Health is working to improve. In the past, the ministry campaigned using brochures to encourage women to self-examine and have regularly check-ups, but they weren’t very successful. "So instead they switched to holding local concerts, and they now get popular singers [such as Apaporn Nakhonsawan] to encourage women to have both pelvic and breast exams," says Boonpanore.
Whether you find a lump and get it checked out, or you’re just going for a routine check-up, there is always the possibility that you may have cancer. "When diagnosed, women often go into shock," says Boonpanore. "Get yourself together, stop and think before making decisions about your treatment. You need to get some support – this could be your family, your loved ones."
The treatments available in Thailand are the same as those in western countries, but the treatments sought are not, largely for economic reasons. In the public system, economic conditions mean that doctors take care of essential problems only. "Chemotherapy is probably not used as much as in the west. It’s very expensive, so surgery is popular instead," says Boonpanore. "In the States, breast reconstruction is common, but here, they don’t even talk about it in the public system."
If you have the money then, you can take care of the medical side of the things. But whether you can afford the best medical care or not, you still need to be mentally and emotionally strong if you’re going to beat cancer.
"In America, support groups are very prevalent," says the BBC’s Larkin. "Even in a couple of other places in Asia, but not Bangkok." That’s why, when several of her friends were diagnosed with breast cancer, she took matters into her own hands and started the BBC. Now the group is providing inspiration to more and more women – but they are facing some obstacles when it comes to actually reaching out to the women they want to help.
Penkhra, for instance, asked nurses on numerous occasions about whether there were any support groups for people like her. Eventually a nurse gave her a brochure about the BBC. "I’m so happy I found out about them. They’ll tell you about what to do if you lose your hair, how to feel good about yourself and stop thinking about being sick."
Penkhra has now recovered and is returning the favour to other patients by remaining active in the BBC. "If there’s someone new, I want to help her. I lost my hair – if someone is going to lose their hair, I’ll tell them to look at me," she says, indicating her now healthy locks.
Liza woke up after her lumpectomy in Singapore surrounded by a group of women she had never met. "They greeted me, told me they were from the [Singaporean] Breast Cancer Support Group. They had all sorts of information for me, but I had to tell them I was leaving in two days for Bangkok."
So Liza began her search here for a similar group, but to no avail. "Three weeks after I was into chemo, my husband told me to not leave the hospital until I had an answer!" Liza says. Finally, she was given a BBC brochure.
"It’s been fantastic," Liza says. She finally found out where to buy a wig, and met people she could discuss treatments with. "And people just call out of the blue to see how you’re doing."
Health professionals agree that talking about your problems, and getting emotional support from people who have gone through similar experiences can be beneficial. "The mind/body connection is very important," says Boonpanore. "Once you get your mind onside, once you know that other people care, that these people support you, you’re given hope. The support group helps women obtain hope. Without hope, everything falls apart."
Nevertheless, Boonpanore thinks that it might take some time for the idea to catch on for women around the country. "Around the world, a woman is a woman, and when a breast goes, you know something is different. We all feel the same. But the way Thai women cope and express their feelings can be different. Women haven’t really come together here yet to fight for things for women. The support group – it’s a start, a good start."
Samitivej Hospital: 392 0011
Bumrungrad’s Horizon Regional Cancer Centre: 667 1020
The Bangkok Breast Cancer Support Group: 300 3245