'Dying wasn't an option': How two young Hong Kong women beat breast cancer
Two local women are proof of the courage breast cancer sufferers are showing in the face of increasing rates of diagnosis
Nikki Tsang was sure the nagging pain she had been feeling in her left breast wasn't cancer. After all, the mother-of-two was just 36 years old and had no family history of the disease.
Tsang brushed off the pain as related to breastfeeding her two-year-old. Besides, her job as an assistant accountant kept her very busy, even on the weekends. She had little time for her children, who were mainly cared for by a nanny, much less to see a doctor.
But after six months of enduring the pain, it became unbearable. The shape of Tsang's left breast had also changed. During the Lunar New Year of 2013, she went to see her doctor.
A scan showed that her breast had an 8cm lump and the cancer had spread to her bones. Tsang was diagnosed with stage four breast cancer and was told she had only two years to live.
The risk of breast cancer is strongly related to age, with most cases happening in women over the age of 50. But the disease is becoming more common in younger women.
"There is an increasing trend of patients presenting with breast cancer below the age of 40 in Hong Kong and in other Asian populations as well," says Dr Janice Tsang Wing-hang, assistant dean and clinical assistant professor in medical oncology at University of Hong Kong's Li Ka Shing Faculty of Medicine.
Latest data from the Hong Kong Cancer Registry shows that, in 2012, the incidence of breast cancer in women under the age of 45 was 42.4 per 100,000 women. In 1983, the earliest data available, the rate was 17.1 per 100,000; in 1993, 26.8; in 2003, 38.7.
Overall, the crude incidence rate of breast cancer in Hong Kong women has been increasing; it was 91.7 per 100,000 in 2012. The disease has been the most common cancer among women since the early 1990s - there were 3,508 new cases in 2012, accounting for 25.8 per cent of all new cancers diagnosed in women in Hong Kong.
On the bright side, the mortality rate has remained more or less the same over the past 20 years or so, notes Dr Tsang. "Despite an increasing number of breast cancer patients, with the advancement of treatment they live long and most survive the disease," she says.
As a disease of ageing - and with an ageing population - the increasing incidence is expected. But recent research suggests breast cancer in young women is a biologically distinct disease from that found in older women.
"The disease is definitely different," says Dr Tsang. "Let's say you have two women who have the same stage and features of the disease, and the only difference is their age - say, 29 versus 92 years. The one who is younger will tend to have a faster tempo of the disease and a higher risk of recurrence."
Dr Tsang says there are two breast cancer subtypes that tend to be more common in women under 40, or pre-menopausal women: HER2-positive and triple-negative, known to be the more aggressive subtypes with a higher chance of disease recurrence.
HER2-positive breast cancer tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells. Triple-negative breast cancer tests negative for all three of the hormone receptors that fuel many types of breast cancer: oestrogen, progesterone and HER2.
Biology aside, young breast cancer patients also often face quite different challenges from those experienced by older patients. These may include disruption of career, child-bearing and family responsibilities, greater concerns about sexuality and body image, and the psychological and social toll of facing a life-threatening illness at a young age.
Chemotherapy and hormonal treatments can sometimes also bring on premature menopause in young patients, as well as affect fertility.
For Nikki Tsang, however, her relatively young age at diagnosis fuelled her hope and desire to fight the disease.
"I turned my worries about my children and career into my motivation and strength," says Nikki. "I'm a fighter; the doctor was very conservative with his prognosis, but I was sure I did not have only two years left and I was determined to find all ways to live past two years. I believe if you face the fight with a smile, anything can be overcome."
The size of her tumour meant Nikki needed to undergo chemotherapy to shrink it before surgery. But after six sessions of chemotherapy the tumour was gone. She then had 15 sessions of radiotherapy, which ended in June 2014, and was cancer-free.
Another young patient, Josephine Tsang, 39, showed similar resolve in her battle with breast cancer. In November 2013, Josephine felt a painless lump on her left breast while in the bath. The next day she visited her doctor, who diagnosed her with stage two breast cancer.
She broke down at the news, but refused to give in to the disease. "My kids were still young," says the mother-of-two, "so dying was not an option."
Josephine had a mastectomy, followed by chemotherapy. In April, she completed her breast reconstruction surgery and returned to work in June.
During her treatment, she found out about Hong Kong Cancer Fund, the city's largest cancer support organisation for patients, survivors and their friends and family. Like Nikki, she joined the organisation's CancerLink centre in Tin Shui Wai and took part in its free workshops and wellness programmes, such as yoga and baking classes, which helped lighten her spirits.
She also made friends with a group of breast cancer survivors of similar age who supported one another. The increasing trend of young women being diagnosed with breast cancer has also been noted in Britain by a 2013 Cancer Research UK report, and in the US in a 2013 study cited in the Journal of the American Medical Association.
The exact reasons why are not known, but scientists have suggested multiple contributors, including exposure to synthetic hormones (such as parabens in personal care products), having children later in life, or taking birth control pills.
Dr Tsang says risk factors for breast cancer in women under the age of 40 include family history, hormonal factors such as early menarche, not having children or having them at an older age, never breastfeeding, and lifestyle factors such as lack of exercise, smoking and alcohol consumption.
To reduce your risk of breast cancer, Dr Tsang advises young women to keep a healthy, well-balanced lifestyle, think positive and, most importantly, be proactive - conduct breast self-examination once a month.