Breast cancer is not a death sentence: Survivors share why emotional strength is important

“Congratulations” isn’t the usual first response to a cancer diagnosis, but that’s what Sophia Chin said to a friend who had reached out to share the news.

“I said, ‘Congratulations for going to the doctor, because that took courage,’” shares Sophia, 45, who is undergoing treatment for Stage 2 breast cancer herself. “There was a lump, you were suspicious, and you took action. That’s a good thing.”

This is in stark contrast to some of the responses she got when she broke the news of her own diagnosis in 2022. “People on the whole were very supportive, but some said things like “‘What happened?’ ‘What did you do?’” she says. “It makes you feel very guilty, like, ‘What did I do wrong?’”

The mother of two doesn’t mince words when it comes to the disease and the treatment process – “horrible” – but is equally emphatic when it comes to stressing a point that many medical professionals concur with: “Breast cancer is not a death sentence.”

“They say one in 13 women gets breast cancer, and it made me realise, if it wasn’t me, it would be someone I know. You can’t run away from it. So we need to realise that it is not a death sentence. There is amazing support out there, and we need to talk about it more,” she says.

Dr Elaine Lim, senior consultant from the Division of Medical Oncology at the National Cancer Centre, Singapore, notes: “With early detection, breast cancer is not a definite death sentence. Even with metastatic breast cancer nowadays, survival rates [of certain subtypes] have improved.”

The fear of cancer treatments

Breast cancer is no trivial matter – the incidence of the disease has tripled over the past 50 years to 74 cases per 100,000 women, one of the highest in Asia. It is also the most common cause of cancer deaths in women (followed by cancer of the colon and rectum) in Singapore.

Yet, according to the National Population Health Survey 2021, only about one-third of female respondents between 50 and 69 years old reported that they had gone for a mammogram within the last two years. Screening rates are also lower among women with secondary (26 per cent) or primary education (25 per cent), compared to women with post-secondary education (42 per cent).

This is not for a lack of awareness; instead, associate professor Tan Ern Yu, senior consultant and head of Breast Surgery at Tan Tock Seng Hospital, believes it is because most women are “not convinced they have a problem when they feel fine and well”.

Moreover, misleading reports of radiation dangers have also deterred many women, even though “radiation exposure from a mammography is very low” and people are exposed to radiation from the sun daily, says Prof Tan. Cases of over- diagnosis – where mammography picks up an abnormal lesion that turns out not to be cancerous after further tests – have also led some women to view the test as “unnecessary trouble”, she adds.

Yet early detection is key to improving survival rates. For example, genomic assays – essentially, tumour biomarker tests – have shown that many women with early stage node negative hormone responsive cancer do not need chemotherapy, and a good prognosis can be achieved with endocrine therapy.

“The earlier the cancer is diagnosed and treated, the less likely a woman will need aggressive treatments,” Prof Tan points out.

And while cancer treatment, particularly chemotherapy, inspires dread for its tough side effects, advances in medical science also mean that treatments on the whole have become better tolerated than before, says Dr Lim. “Even the supportive medicines, such as the anti-vomiting medication, are so much more advanced.”

Taking control

Even though the thought “why me” flashed through Sophia’s brain when she heard the news, it was quickly followed by, “Ok, so what next? I don’t want to die.”

Having seen friends with cancer tackle the disease, she felt less fear than most would expect. “I have two friends who have had cancer themselves…Molly, [is] one of my bestest friends, we’ve known each other for 23 years. She pulled through cancer 10 years ago, and re-examined her life – it was very inspiring for me,” she shares.

Moving decisively, she had a lumpectomy surgery in December 2022, about a month after her diagnosis.

There were definitely lows – Sophia found the aftermath of her lumpectomy manageable, but chemotherapy was a whole other story. “It was traumatic. It’s not just the physical effects, it was also the emotional side of things. Losing your hair...

I didn’t realise that hair was such a defining part of my identity. And the exhaustion is existential. I couldn’t even watch TV, or scroll on my phone. That’s how exhausting it was,” she reveals.

But the care and support she found amid loved ones and fellow survivors helped. Friends sent gifts like lipstick and cake, while others advised her to take little steps – like tattooing her eyebrows – to cushion the blow of side effects like hair loss.

She also credits her doctor for informing her clearly what her options were, and what were the pros and cons: “I felt very in control. That feeling of having control was what kept me going. It felt positive, even though it felt so horrible."

She adds: “I think what surprised me was that even though the experience was horrible, it was also enriching and empowering. It’s like going to the beach. The waves look big, but you can actually surf on this big wave.”

“And you come out a different person. You don’t take things for granted anymore. It’s not like, yay, I ‘beat’ breast cancer, but you do want the clarity that comes with it. You feel more purposeful.”

Breaking the culture of silence

Although breast cancer is common in Singapore, a culture of silence and stigma still surrounds the disease, say survivors and doctors.

“My mother did not tell anyone that I had cancer,” says Sophia, adding that her mother was surprised that she posted about it on social media. “She told me I was very positive.”

Lim Lay Hoon, 57, a nurse who had a double mastectomy after her diagnosis in 2012, understands the fear of speaking out. The mother-of-two was stressed about the cost of treatment, and worried about her diagnosis affecting her job.

“I thought, ‘What if my company no longer wanted to employ me?’” she says.

According to Prof Tan, some women feel self-conscious, and feel that people may treat them differently when they learn of the diagnosis. “Many people have good intentions, and want to show support and concern for someone diagnosed with breast cancer, but sometimes, this can be seen as intrusive or confusing for someone who has been diagnosed and is still coming to terms with the cancer diagnosis,” she says.

Lay Hoon’s experience spurred her to help start and manage a support group for breast cancer patients at Tan Tock Seng Hospital. “When I heard the news, I had a meltdown… So many of us put on a brave front because we need to, but actually, it was very tough. I felt like I was melting away, like melting ice,” she reveals.

The support group provides a space for women to be around other women who “speak the same lingo” of cancer and share advice. “It’s not good to journey alone… sometimes, you just need emotional release,” she shares.

Last year, Lay Hoon found out that her cancer had returned, and she had to have part of her lung removed and start chemotherapy. “To me the word ‘death sentence’… it is still in me,” she says. “But (what matters) is how we move on, and how to stay positive.”

Her support group has helped her to stay purposeful. “The first time, I was ‘semi alone’, and the support was not as established, but this time, it’s much, much better. I have a role to play, and it helps me stay strong,” she says. “I am focusing on things that add ‘happy life’ to my years.”

She adds: “And this time, I am sharing more too, with my colleagues, and not just the friends in my chat group.”

Sophia acknowledges the realities around cancer – “the uncertainty will always be there” – but feels that the culture of fear around it may stifle conversations that encourage women to seek help. “I think we know about the scary parts of [breast] cancer, but we need to hear more about the highs,” she says.

“[Breast] cancer is not the end… there may even be something in there for you to learn from.”