What I Tell Mums Who Have No Time For Breast Cancer

When I tell a mother she has breast cancer, she doesn’t ask me if she is going to die. She asks about time, or more specifically, time management.

When is the scan? When is the surgery? Can they still fetch my kids to and from their activities once treatment starts?

Some have even asked if they could postpone treatment till the following year because they had a post-PSLE holiday planned.

I completely empathise. As a mother of two teenagers who are also competitive swimmers, I know how much time goes into being there for your children. The school runs, the training sessions, the family plans – these commitments don’t disappear when you receive a diagnosis.

Breast cancer treatment becomes another thing to fit into an already full schedule.

Which means that, in my clinic, my job goes beyond giving medical advice. Sometimes, we have to start by looking at the family calendar.

Let’s work out what can wait

Every time a patient tells me she can’t possibly find time for treatment, I ask for her schedule and we go through it together. 

We identify the activities she can carry on with and those she can postpone or adjust. Sometimes, a long-haul holiday can be swapped for a shorter trip nearby. Other commitments can be handed over to someone else.

There may be more room to make changes than she first imagined. We work out those changes together, alongside her treatment plan.

I also try to make the appointments themselves easier to manage. At our centre, the clinic, imaging, biopsy and day surgery facilities are all in one place. A test can often be done the same day, right next door. With such convenience, there is no excuse to delay appointments.

The fact is that an untreated tumour can grow and spread. That’s why I want us to work out how treatment can fit into her life, rather than keep putting it off until everything else is settled.

We are over-responsible and over-competent

Caring for these women for over two decades brought home the importance of delegating tasks at home. 

We mothers often feel responsible for everything, to the extent that sometimes, nobody else at home does anything because they are waiting for us.

But when we start letting go of some control, we may find that our families are more capable than we give them credit for.

I have seen this in consultations with patients and their spouses. Husbands are often happy to take on more so their wives can prioritise treatment. Children may relish the opportunity to take public transport on their own instead of being driven everywhere.

When we insist on doing everything, we rob our families of the chance to grow. 

Letting them carry more of the load gives us time for our health. It also gives them a chance to look after us.

Don’t brush off changes as part of having a baby

Screening is especially crucial in the years after childbirth because postpartum breast cancer – cases diagnosed within five to 10 years after giving birth – has been found to be more aggressive, with poorer outcomes.

While having babies and breastfeeding continue to confer long-term protection against breast cancer, experts believe that the cancer risk arises during the period when breastfeeding stops and breasts return to their pre-pregnancy stage. During this time, the immune and inflammatory changes involved may spur a tiny, undiagnosed tumour to grow and spread.

This is a greater concern for those who have children later, from around age 35. So if something feels different, investigate. 

Don’t automatically put a change down to pregnancy or breastfeeding, or wait until family life is less busy to get it checked. 

Good imaging techniques these days can either give you peace of mind or help you get ahead of a tumour.

There’s room for hope in my clinic

While a cancer diagnosis isn’t ideal, there is one thing I always hope to leave a newly diagnosed patient with: “You’ll be fine.”

”I don’t say this flippantly. Breast cancer is one of the most treatable and curable cancers, with therapeutic advances happening very quickly. Even at stage four, we have seen patients live for 10 years.

Often, by our third consultation, patients and their families begin to feel less overwhelmed. By then, the scans are back and we have a clear picture of the cancer’s extent and the recommended treatment plan. Early-stage treatment can be over in as quickly as a month. For advanced cases, treatment will take a minimum of six to nine months.

In the process, I ask respectfully of my patients’ husbands, children and elderly parents: don’t treat her as though she is ill. 

During chemotherapy, patients tend to feel unwell for a week or so, but they can return to most of their usual activities after. 

She should continue to be kept involved in daily life as a mother, a wife, a person with her own interests. A diagnosis should not make her feel less of a person.

Patients often ask me, “Why are you so positive?”

It’s not that I’m not serious. I just know there is a solution.

Cancer is a road hump. When you’re at the bottom, it can feel hard to get over. But you will surmount it and you don’t have to do it alone.

Let your family carry some of the weight too, for your benefit and theirs.

Dr Esther Chuwa is a senior consultant and breast surgeon at Solis Breast Care & Surgery Centre, and a mother of two teenagers. She has a special interest in the management and research of breast diseases and oncoplastic breast-conserving surgery.