SINGAPORE — Even though she has a family history of cancer, Lim Sok Choo had not been screened for breast cancer for several years.
In August, she saw a flyer advertising a free mammogram at the lift lobby of her flat in Anchorvale and decided to sign up.
A few days after her mammogram at Sengkang Polyclinic in September, she received a call to do a re-test in October. A biopsy later found she had Stage Zero breast cancer, which is localised within the breast ducts.
"I had no lump, no pain, nothing at all," said the 67-year-old, who worked part-time in sales before her diagnosis.
But after surgery to remove the tumour inside her breast ducts, a further test found the cancer to be Stage One, as it affected lymph nodes close to her left breast. She went for a second operation, and is due to begin radiation therapy once her wound from surgery heals in order to destroy any remaining cancer cells.
Madam Lim is one of two cases of breast cancer picked up by a new breast cancer screening programme by the North East Community Development Council (CDC). Started in May 2023, the one-year programme aims to help lower-income women in the district with early detection of breast cancer, and to support those diagnosed. It is the only such programme among the five CDCs.
Some 600 residents have gone for the free screening, with two per cent — or about 12 cases — flagged for follow-up tests.
Under the programme, those diagnosed with breast cancer are entitled to a total of $10,000 in financial aid, including $5,000 in cost-of-living assistance and up to $5,000 in out-of-pocket assistance. Of the out-of-pocket assistance, Lim has received $469 so far to help reimburse her medical expenses.
"It’s definitely helped me be less worried, that we will get help and won’t incur humongous charges."
North East CDC collaborated with SingHealth on the North East Cancer Warrior Support Scheme.
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North East District Mayor Desmond Choo said the initiative came about as breast cancer is the most prevalent cancer among Singaporean women, forming almost a third of new cancer cases diagnosed between 2016 and 2020.
"We wanted a fresh look at potential solutions to improving screening rates," he said, adding that the council wanted to develop an initiative complementary to breast cancer awareness programmes by the National Cancer Centre Singapore and Health Promotion Board (HPB).
"[The programme] focuses on encouraging women to take charge of their health… It also aims to alleviate fears and misconceptions surrounding the screening process," he added.
He cited challenges to getting some women to get mammograms, such as religious beliefs and modesty concerns among Muslim women, and older women associating radiation from X-rays with cancer, or believing that mammograms are unnecessary without a family history of breast cancer.
"We’re targeting groups of residents where mammogram screening rates are historically low. And now that we’ve encouraged them to come on board, even if the test is negative, now they know there’s a process of helping them and I hope they can make it a way of life."
North East CDC worked with community partners such as Masjid Darul Ghufran to bring a mobile screening bus into the mosque to make it easier for Muslim women to do their mammogram screening after their prayers.
Arrangements were made for those with caregiving duties or shift work to get screened on weekends.
The programme aims to have another 400 residents get mammograms in the next six months.
"We’ve gained good insights from the programme that we’ll share with HPB. We’re building up knowledge that will allow us to extend the programme and scale up," Choo said.
Lim’s doctor Benita Tan, who is a senior consultant with Sengkang General Hospital’s breast service, said among women who do not go for screenings, breast cancer cases are usually detected at Stage Two or beyond, when lumps can be easily felt.
While more than 95 per cent of women with Stage One breast cancer are likely to be alive five years after diagnosis, this falls to 89.5 per cent for Stage Two, 73.3 per cent for Stage Three, and 27 per cent for Stage Four, she said.
"Patients with Stage Zero breast cancer have a mortality rate of less than one per cent to two per cent, meaning the chance of cure is excellent," added Associate Professor Tan, who is also the chairman of the hospital’s surgery division.
Assoc Prof Tan said recurrence rates for treated Stage Zero breast cancer stand at about five per cent to 30 per cent.
She recommends monthly breast self-examination for women from the age of 20, and mammograms for women without known or increased risk every two years from the age of 50.
Lim is now focusing on recovering from surgery, and dreading the next step: Radiation therapy. Her husband had prostate cancer in 2022 and went through this treatment.
"I thought it was quite traumatising going for radiation because I saw him, a big-sized man, going through it – he lost weight and he was half-dead."
She had not wanted to tell her son — who is 36 and working as a physiotherapist in Brisbane — for fear of worrying him. But having accidentally found out, he and his wife are coming back to Singapore to give her moral support.
Madam Lim is optimistic about the odds of recovering. "My friend comforted me because she has been through breast cancer — she said 'Don’t worry. Just chiong ah (Hokkien for go all out). Be a warrior.'"
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This article was first published in The Straits Times. Permission required for reproduction.