ONE day in 1989, 34-year-old Wong Mei-king put on her best clothes and assembled her family for a series of photographs, resigned to losing her breast to cancer - and maybe her life. Four years and five operations later, she is smiling, beautiful and full of life. ''The scars still hurt sometimes but I hardly consider myself ill anymore,'' she says. Every year, 900 women in Hongkong will learn they have breast cancer, according to Department of Health figures. It is the most common cancer to strike women and deaths have increased threefold here since the 60s. Three hundred and thirty-three women died from the disease in 1991. But breast cancer is not always fatal. Compared to the biggest killer, lung cancer, it is often treatable. Three women who have survived breast cancer to lead full and active lives are Wong Mei-king, Pong Kam-hing and Mak Yin-ling. The trio met through CanSurvive, a self-help support group for cancer sufferers and their loved ones. Recently, they volunteered to take part in the formation of a group to welcome newcomers, with the hope that more women will be able to benefit from the mutual support they have enjoyed. Ms Pong, 45, recalled how joining the group helped her to rebuild her life after she underwent a mastectomy nearly two years ago. ''When you first find out about the illness, you think that's it - the end of the world. But once you realise you are not alone and you meet others who have survived, you change your outlook,'' she said. The most difficult hurdle for the women was facing up to the fact they had cancer. ''I never thought it would happen to me,'' they all say. A further obstacle on the road to recovery is the stigma attached to cancer generally, and breast cancer in particular. Unlike Western countries, Hongkong's cancer patients are sometimes forced to suffer in silence because of a cultural reluctance to mention illness and death. Acclaimed Hongkong author XiXi broke the taboo by writing a book chronicling her own voyage through the illness and on to recovery. The book - its title translates as Mourning for the Breast - was warmly received. Anecdotal and informative, it is candid, sad, funny and always human. But despite a wide readership, XiXi's efforts also provoked criticism. ''This sort of book is rare in Hongkong. In Chinese society you are supposed to bear your illness privately and get on with life . . . Some have criticised me for being petty and nagging,'' she says. However, the positive response it received convinced her it was worthwhile. ''Medical students have written to me to say they were pleased to see what it was like from a patient's perspective . . . and patients have written to express their appreciation.'' MS Wong said she was surprised by the number of friends and acquaintances who avoided her after she told them she had breast cancer. ''For some, I think it was a fear of death, of being associated with death. But I also think some people don't know how they should react to you once they know, and this is understandable.'' She is no longer afraid of dying and it is something she can talk about freely: ''If you are not afraid of death, there is nothing to be afraid of.'' Breasts are integral to many people's concepts of womanhood and femininity and women who have lost a breast often report feelings of inadequacy: ''I felt so conspicuous, I couldn't hold my head up high or walk tall,'' says Ms Mak. But with the help of the support group and her prosthesis, she is now doing both. Her reaction is normal, according to Dr Polly Cheung Suk-yee who specialises in treating breast cancer. Breast cancer is a physical disease, which has considerable psychological effects, she says. But this is often overlooked by the local health services. ''Very few doctors in Hongkong offer ready advice on prostheses or breast reconstruction to patients, although both are readily available in other countries.'' It was the lack of such services in Hongkong that prompted CanSurvive's Chinese group co-founder, Virginia Wu, to set up the territory's first prosthesis shop five years ago. She was inspired to do so by the services she saw offered in Canadian cancer clinics. There, patients were given choices of prostheses in a relaxed atmosphere, along with a wealth of information, advice and counselling. A far cry from Hongkong where no such services are provided. ''Hospitals provide no counselling and little in the way of information,'' says Agnes Chow of the Hongkong Cancer Fund. The women's experiences confirm this: ''Nobody told me I was not supposed to lift heavy weights. I got really painful swellings and had to rest my arms for a long time,'' said Ms Pong. It was only when they joined the support group that the women began to find out more about breast cancer, about how they could best avoid a recurrence of the illness and about where to purchase a prosthesis. They also believe doctors can be dismissive of women patients who complain of lumps in their breasts. All three went to their respective doctors when they discovered lumps, only to be told there was nothing to worry about. In Ms Wong's case, 10 months elapsed between her discovery of the lump and her first operation. Yet early detection and treatment makes a vital difference both to the type of treatment needed and survival rates afterwards. For patients who receive treatment during the earliest stages of the cancer, there is a 90 per cent rate of survival for the five years following it. It is possible to perform a lumpectomy in some early cases, which leaves most of the breast intact. The rate drops to between 30 and 40 per cent in the later stages of discovery. Later treatment also means mastectomy is usually followed by either chemotherapy, radiotherapy or both. Recent years have seen Hongkong women coming forward earlier and about 50 per cent are treated at Stage I and Stage II of the disease where post-mastectomy survival rates are 80 per cent and 60 per cent respectively. Dr Cheung believes the Government should be doing more to promote awareness of breast cancer and encourage women to have mammograms and carry out monthly self-examinations to ensure early detection. She was one of the first to introduce screening programmes to Hongkong when she worked at the Well Woman Clinic in Kwong Wah Hospital. Dr Cheung is convinced screening can reduce mortality rates. Although it is not known what causes breast cancer, experts have identified certain factors which are related to its onset including a family history of the disease, age and personal history. About 75 per cent of breast cancer cases occur in women over 50 although there is now a trend for younger women to be affected. Not having children, not breast-feeding and having a first pregnancy after the age of 30 increases the possibility of developing breast cancer. It is also becoming apparent that diet plays a major role. Dr Cheung says that with the advent of Western-style fast food, fat consumption by Hongkong women has increased from 70 grams a day in 1975 to 82 grams a day for a basic Chinese diet and 152 grams a day for a junk-food diet. She argues that these figures point to a direct relationship between increased fat consumption and the increase in mortality from breast cancer. Diet is one of the issues which women from the group discuss, exchanging both information and ideas. Surviving cancer has also helped the women to value their friends and family, more. ''You can see very clearly who your real friends are and I am very grateful to the people who have supported me,'' says Ms Pong. Ms Wong spoke for all three women when she said she was living a fuller life, with a higher awareness and appreciation of the things which she values. They hope to share their message of hope and optimism with other women who have felt their worlds collapse around them on discovering they have breast cancer.
