Saturday, May 10, 2008

Why breast cancer patients in Kelantan present late ?

I have been asking this question to my patients and to myself regularly in an attempt to understand their attitude towards this deadly disease. Some of them found the question insulting, others didn't mind sharing.

1. In Bahasa Melayu, cancer is 'barah', breast cancer is 'barah payudara' . In Kelantanese dialect, there is something called 'barah susu'. This is not breast cancer, but it is used to describe lactating breast abscess. If you ask a patient whether she has a family history of barah, she might say yes, you ask what happen to the patient, you will get: 'OK sembuh dah, tak payah buat operation pun!" and this is misleading. When I was working in Penang, a friend of mine told a Chinese patient that he had a barah, the man jumped off the then newly-built Penang bridge. He knew exactly that he had a grave disease that he took his own life prematurely. Now I never use the word barah when communicating with my patients, I use 'kanser'. Tak faham juga, I said; penyakit yang membunuh our ex-No.1 lady. Ohh... baru faham. Bagus juga if some well-known peoples get certain diseases, boleh buat contoh. Anyway, I used Kylie Minogue's name to explain breast conservative surgery.

2. Even if the lady understands that she has a breast cancer, and she knows that she needs to remove the breast in order to save her life, she may not in a position to decide on that. You might laugh on this, but I have seen cases after cases where the ladies said no because the bloody husbands said no to mastectomy. In 1998, a man told his wife(my patient); if you consent to the surgery I am going to divorce you! Somehow she agreed to the mastectomy which I did. When a nurse asked me where to put the specimen, I told her to send it to the man so that he could do whatever...(He divorced the poor lady a as soon as she went home after the operation) Of course not all husbands are the same; there was man who told his wife; I love you with or without your breasts!

3. BOMOH - This is an irritating element in the society. They offer to treat all sorts of diseases, usually without surgery. Of course the poor patients fall to their trick, and in the end the patients come to seek your help with a locally-advanced or metastatic disease.

This experience has thought me to offer breast reconstruction to patients undergoing mastectomy surgery; either immediate or late reconstruction. And whenever possible, I will always offer them breast conservative surgery.


Mastectomy - surgery where the whole breast is removed

Metastasis - cancer that has spread to distant organs

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