BY DR AMIR FARID ISAHAK
The writer recounts how his sister struggled with breast cancer before succumbing to the disease.
THIS is not just another sad cancer story, but the story of the struggles my own sister, Ilani Isahak, went through, fighting her breast cancer for three years until she succumbed to the disease in February this year. I had written a tribute to her, in which I extolled her service to the community and nation, especially her dedication in promoting interfaith harmony. She died soon after successfully establishing the national interfaith committee, a task entrusted to her by the Cabinet.
Today, I shall focus on the health/medical aspect of her story. I hope that by sharing her experience, many other women can be helped, not only to fight the cancer, but more importantly, to take steps to detect breast cancer early if it occurs. There are also lessons that all others can learn.
It would be good if we can also advise women on how to avoid getting breast cancer, but unfortunately, apart from prophylactic mastectomy (ie removal of normal breasts) in high risk women with known mutations of the breast cancer genes, there are no other proven methods of preventing breast cancer.
There are known factors that can modify the risk of getting breast cancer. Studies have shown that obesity (especially post-menopausal weight gain), lack of exercise, late menopause, and HRT (exceeding five years) increase breast cancer risk.
A diet rich in of soy isoflavones (eg genistein, which is known to have anti-breast cancer effects), reduces breast cancer risk. A nutrient-dense diet made of fruits, veggies, legumes, grains and nuts reduces the risk of all cancers.
Get every breast lump checked
My sister had Stage 3B (ie advanced) breast cancer at the time of diagnosis. Some years back, she had a breast lump that caused much anxiety, but turned out to be benign.
So this time, when she noticed another lump on her right breast, she made the mistake of not worrying about it. She was also wrongly assured by a Traditional Chinese Medicine sinseh, whom she had she trusted over the years, that it was not cancerous, and he had given some treatment to shrink the lump.
It was only when the lump got bigger and became painful that she confided in me. An examination revealed an obvious lump adherent to the surrounding tissues, which was not a good sign. I immediately sent her for mammogram, and to the breast surgeon.
Lesson #1 – Every breast lump is cancerous until proven otherwise. While most lumps are benign, you should seek expert assessment before deciding so.
Although I am supportive of the complementary practitioners’ role in healthcare, there are situations where you should always seek medical confirmation for diagnosis, as in this case. The doctors will examine and do ultrasound or x-ray mammogram (which detect the physical or morphological changes).
Other available methods include thermography, electrical impedance tomography and laser mammogram (which detect the functional changes caused by cancerous cells). If necessary, a biopsy will be done.
Nutrition support is important
Her mammogram was consistent with breast cancer, and biopsy confirmed infiltrating ductal carcinoma. After much discussion with the family, she decided to follow her doctors’ advice, as well as embark on a nutritional programme. She had a modified mastectomy, followed by radiotherapy, and six courses of chemotherapy.
She was very disciplined with her nutrition – she reduced meat intake and consumed lots of freshly-made fruit juices. She also tried several natural remedies that were claimed to be anti-cancer (eg lemon grass), and consumed various nutritional supplements.
So despite the cancer, radiotherapy, and chemotherapy, until the last one month, she actually looked much healthier than she had been in the previous 20 years. She slimmed down to her ideal weight, had better complexion, and was energetic (until the last six months when the cancer went to her lungs). She was so well externally that many were surprised how she coped so well with the cancer and chemo.
Lesson #2 – if you have cancer, take care of your nutritional needs. The body needs nutrients to fight the cancer, and to fight the side-effects of the cancer treatments. Many cancer patients die of cachexia (extreme malnutrition).
Recurrent cancers are recalcitrant
But what many probably didn’t know was that she still lost her hair, and her fingernails were blackened after the repeated chemo sessions. Soon after the initial six courses of chemo and one year of the “smart” drug ended, the cancer came back.
The extremely expensive “smart” drug she was given was trastuzumab, which is a monoclonal antibody that targets the HER2 receptors on the breast cancer cells.
So her oncologist put her again on chemo, plus the “smart” cancer drugs. But this time, these didn’t work. A re-examination of her cancer cells then showed that she was not a good candidate for trastuzumab. The first report had been inaccurate.
Other drugs were then tried, and there was some response, but internally the cancer was encroaching into her rib cage, and onto the lining of the lungs (pleura).
The other drugs she was given included bevacizumab, which is also a monoclonal antibody that prevents new blood vessel formation (anti-angiogenesis), thus preventing new cancer growth.
Back in July 2010, the US FDA had evidence that bevacizumab was not suitable for breast cancer. In December 2010, the US FDA officially revoked its approval for the use of bevacizumab for breast cancer, saying that it is neither safe nor effective in breast cancer patients. The available data shows that bevacizumab neither prolonged overall survival nor slowed disease progression sufficiently to outweigh the risk it presents to breast cancer patients.
Lesson #3 – If the cancer patient is not cured after the first course of chemo, she is unlikely to be cured at all. Cancer cells which are resistant to the first chemo are most likely resistant to further chemo. Although each subsequent chemo may drastically reduce the number of cancer cells, the tough resistant ones will multiply and manifest their presence soon enough.
Lesson #4 – Before agreeing to expensive drugs, be sure that the lab reports are accurate, and be sure that the drugs are safe and effective as claimed.
Rapid deterioration of end-stage cancer
Until the last six months of her life, my sister was relatively well, which means she had about two years of reasonably “good quality” life. Then she started to have chronic coughs.
At first, she still managed to do her normal chores, but she gradually deteriorated, and became breathless easily. A pleural effusion (fluid in the space covering the lungs) was diagnosed, but the first attempt to drain the fluid failed to relieve her symptoms.
At this time, the family considered bringing her to China to try the latest treatments being done there, as the doctors here could not do anything more to treat her cancer. Doctors in China are allowed to give treatments which are considered experimental elsewhere, and therefore not available to the public.
Unfortunately, while the planning was being done, her condition got really bad. Exactly one month before her death, she had to be admitted to the hospital, and had permanent drainage tubes inserted into both sides of the rib cage, and she required the oxygen mask continuously.
The doctors also decided that she could have palliative care only, with no further active treatment. After one whole month of suffering, she died.
My sister died because the cancer spread to a vital organ – her lungs. There was copious pleural effusion that repeated and even continuous drainage could not solve. The effusion meant that her lungs gradually collapsed.
With the reduced oxygen supply, the heart had to work harder, and soon it also succumbed. Although there were discussions to attempt surgery to seal the pleural cavity (thus preventing the formation of the effusion), by that time, her poor general condition made any major surgery unsafe.
Lesson #5 – If you plan to have treatment overseas, do so when you are still reasonably well, because there will be the added problems of being fit for long-distance travel, and having adequate assistance in a foreign land.
What about complementary therapy?
Some people asked me why I allowed my own sister to undergo chemo, when I am so critical of it? The answer is that I never interfere with a patient’s decision. I only remind them of the facts I know, and that while some cancer patients have recovered through various types of nutritional and complementary therapies, the latter lack sufficient scientific evidence, while chemotherapy is backed by many scientific studies.
What is important is that whatever their decision, they need adequate nutritional support to survive the cancer, and to withstand the chemo.
What about nutritional therapy – since I had written about certain nutritional therapies that had helped some cases? Well, cancer nutritional therapies are also expensive, and are usually taken by patients who refuse chemo, or only after they have completed chemo (some oncologists also dissuade them from having concurrent therapy as the nutritional therapy may interfere with the chemo).
I have also been asked why didn’t I help her with qigong? Actually she did learn qigong, but she was too busy to practise it enough to hope for recovery through it. Those who recovered through qigong did so after intensive and consistent practice (my advice is to start with four hours a day if possible). Even though recovery is not guaranteed, it is possible.
My only regret is that I didn’t have the opportunity to get her to try herbal medicine, as she was already trying so many things suggested by many people, and adding another therapy would certainly be overdoing it.
In conclusion, both conventional medicine and complementary therapies still do not have satisfactory answers for cancer. For the sake of the cancer patients (and many more who will get cancer in future), both sides should work together. A holistic, integrated approach is more likely to enable us to find the elusive solution.
With that in mind, I invite readers to attend the 1st Malaysian International Conference on Holistic Healing for Cancer, to be held in Petaling Jaya on June 18. It is organised by Cansurvive, a non-profit organisation that provides guidance and support to cancer patients, their families and friends. Admission is free, but you must pre-register. Please go to www.cansurvive.org.my for details.