Wednesday, January 30, 2008


First published in The Jakarta Post, January 30, 2008


Alpha Amirrachman, Contributor, Jakarta

When Supraptini was diagnosed with breast cancer in 1986 she felt as if she had been sentenced to death. "I was two month's pregnant," she told The Jakarta Post. "My doctor gave my family a difficult choice: save the mother or save the baby. But my husband insisted that he wanted to save both."

Supraptini and her husband decided to have her wait until she delivered her daughter before receiving an operation to remove the tumors. The treatment included 25 courses of radiation treatment and six cycles of chemotherapy.

Although Supraptini's breast cancer was already at an advanced stage (stage three), her immense courage and positive attitude allowed her to overcome the disease. The years which have passed since her cancer went into remission have been blessed. With tremendous support from her family, Supraptini has been able to watch her daughter blossom to maturity.

"Although I could not breast-feed my daughter, her IQ reached 146," explains Supraptini. "She recently graduated cum laude from the School of Medicine at the University of Indonesia."

Since 2000, Supraptini has shared her experience with others diagnosed with breast cancer by becoming a breast cancer survivor volunteer in YKI's (Indonesian Cancer Foundation) Reach to Recovery program.

Reach to Recovery was formed in 1997 by the YKI under the service and rehabilitation division of the foundation. The program coordinates volunteers who have survived breast cancer to provide counseling to recently diagnosed breast cancer patients.

"I have talked to at least 100 breast cancer patients, through visit or phone, counseling them during their hard time," said Supraptini. "I feel relief and accomplishment when I can help patients to regain their self confidence so that they may focus and make a well informed decision for proper medical treatment.

"But there are, however, cases that have made me sad," she said, citing an example of a patient who insisted on alternative treatment when her breast cancer was at stage one, but failed desolately after the tumor became uncontrollable.

Speaking of the obstacles which hamper breast cancer, Supraptini specifically addresses the high costs of the medicines which are usually needed to treat breast cancer.

These expensive medicines are not all covered by state-run insurance scheme ASKES or ASKESKIN, and have therefore forced many to pursue an alternative treatment. AKSES is a government-sanctioned health insurance mainly for civil servants, while ASKESKIN is for the poor.

"The tax is incredibly high since the medicine is still imported and classified as luxury goods," explains Supraptini. She added that it is time for the government to change its policies with regard to import duties imposed on life-saving medications.

Another survivor to participate in the YKI Reach to Recovery program is Agustia Ludbariana, who was only diagnosed with breast cancer once it had already advanced to stage three. Augustia explains that a close friend had urged her to consistently undergo medical treatment.

In 1996, Agustia received a successful operation which was accompanied by radiation and chemotherapy. Recognizing the strong influence that her friend had in giving advice to seek treatment, Augustia decided to become a volunteer counselor for the Reach to Recovery program.

The experience of helping others in their time of crises has been filled with emotional highs and lows. Augustia recalls counseling one breast cancer patient who happened to be a doctor.

"She seemed angry and decided to opt for 'spiritual' healing instead. Maybe because she knows 'too much'," said Agustia.

Despite helping cancer patients to cope with the psychological stress of the illness, patients who pursue spiritual or holistic avenues for treatment alone have a diminished opportunity to fully recover from the disease.

Besides Reach to Recovery, Augustina is also a member of Cancer Information and Support Center (CISC), another support group that facilitates her visits to Dharmais and Cipto Mangunkusumo hospitals to provide patients there with direct counseling.

Another survivor, Martini Lim recalls that when she was diagnosed with stage two breast cancer, she quit all her social activities." I confined myself to my room," said Martini.

Upon advice from colleagues and support from her husband, Martini decided to call the YKI and learn more about Reach to Recovery from its program coordinator Dr. Rebecca N. Angka who urged her to talk to survivors.

Martini's successful 2003 operation was followed by six cycles of chemotherapy. She has subsequently become a volunteer for the Reach to Recovery program. She regularly helps to conduct meetings and workshops among the survivors who are willing to help lift the burden of others.

Celebrities who are also breast cancer survivors such as Rima Melati are often invited to attend the workshops. Additionally Reach to Recovery also involves oncologists, psychologists and other specialists including communication experts.

Dr. Rebecca said that of the 100 survivors who received counseling from the program, about 50 became volunteers for Reach to Recovery.

Many of the planned events are restricted however due to the program's inadequate budget. Reach to Recovery relies mainly on the financial contributions from the survivors and a few pharmaceutical companies.

"One of the challenges of the program is to find permanent donors who can give full support to ensure the continuity and expansion of the program," said Dr. Rebecca. "While YKI branches in Surabaya and Bandung have run Reach to Recovery programs, much work is still required to expand the service to remote areas."

Early Diagnostic Center's Indonesian Cancer Foundation (YKI) Jl. Lebak Bulus Tengah No. 9, Cilandak, South Jakarta Tel. 021-7690704, email:


First published in The Jakarta Post, January 30, 2008


One day when Nuraini was taking a shower, she felt a hard lump on her left breast. It was like a tiny, moving ball trying to break out from below the skin.

She went to visit a doctor at a nearby Puskesmas (community health center) and was told the lump was nothing to worry about. Luckily her husband insisted she get a second opinion at a hospital.

"It turned out it was a benign tumor at stage one," Nuraini said.

Breast cancer usually develops in stages, from stage one to stage four.

A month after the tumor was diagnosed, Nuraini underwent an operation, which was followed by radiation and chemotherapy. Now she is in remission from the illness that could have killed her.

However, Nuraini was lucky. Many women suffering from the symptoms of breast cancer delay paying a visit to the doctor.

"About 70 percent of people diagnosed with breast cancer are already at stage three or four, which is usually considered too late for medical treatment to be effective," oncologist and surgeon Sonar S. Panigoro from Cipto Mangunkusumo Hospital said.

Breast cancer occurs when cancer cells attack glandular breast tissue. Most cases of this type of cancer are found on the upper part of the breast closest to the arm.

Breast cancer can spread by way of the lymphatic system or blood stream to the lungs, liver, bones or other organs, or can spread directly to the skin.

It can also occur in men, although cases are very rare. In Indonesia, only one man diagnosed with breast cancer died in 2006.

Breast cancer is the world's fifth most common cause of cancer-related death, after lung cancer, stomach cancer, liver cancer and colon cancer. Breast cancer resulted in 502,000 deaths (7 percent of cancer-related deaths and almost 1 percent of all deaths) worldwide in 2005.

"Here it is estimated that between 18 to 20 percent of women may be diagnosed with breast cancer. It ranks second after cervical cancer," said Sonar.

Sonar said when breast cancer is at stage one or two, operations can be performed, followed by a combination of radiation therapy, chemotherapy and hormone therapy.

"However, if breast cancer is at stage three or four, the adjuvant therapies are pursued first before an operation is attempted. But in many cases, it is too late for an operation," he said.

Depending on each patent's age and the type of cancer they have, cancer cases are divided into various categories from high risk to low risk. Each category of cancer is treated differently. Treatment possibilities include radiation therapy, chemotherapy, hormone therapy and immune therapy.

Early detection is the best way to deal with breast cancer. However, in many cases slow-growing breast tumors may not be detectable by touch for up to eight years.

Women can examine their own breasts regularly by pressing each breast firmly and carefully using three fingers. It is best to do this one week after menstruation.

However, it is more reliable to seek a mammogram (x-ray), USG (ultrasonography) or advanced MRI (magnetic resonance imaging) to check for breast cancer.

With technology improving rapidly, breast cancer cases are increasingly being detected early before any symptoms are present.

"The mammography is recommended for women over 40, while the other early detection methods are best for women under 40," said Sonar.

While the cause of breast cancer remains to a large extent unknown, many risk factors have been recognized. These include gender, age, hormones, a high-fat diet, alcohol intake, obesity and environmental factors such as tobacco consumption and radiation.

Psychological aspects should also be taken seriously as not all breast cancer patients cope with their illness in the same way.

Many larger hospitals are affiliated with cancer support groups, which help patients cope with the issues they may face in a supportive environment.

In Indonesia, the Reach to Recovery support group was formed in 1997 by the Indonesian Cancer Foundation (YKI).

The support group is made up of breast cancer survivors who voluntarily provide counseling to people diagnosed with breast cancer.

"The volunteers ensure patients that medical treatment is the best way to treat their illness. In many cases, patients listen to the volunteers more than their doctors," said program director Rabecca N. Angka, who also works at the YKI's Early Diagnostic Center in Lebak Bulus, South Jakarta.

However, she said temptation among breast cancer patients to try alternative treatments remains high.

Sonar said many breast cancer patients try alternative treatments before seeking medical advice because of what they see on television.

"They say traditional healers can transfer the disease to an animal. Sometimes patients even come to believe that breast cancer is the result of black magic," he said.

--Alpha Amirrachman