Wednesday, January 30, 2008


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

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