"I Have Breast Cancer, This is My Journey" - Ng Mei Theng, A Mother of 1

October is Breast Cancer Awareness Month. With the country battling the third wave of Covid-19, it is timely to be reminded again of how precious life is, and what we must do to ward off the calamities that threaten it ─ whether it’s cancer or the coronavirus. The incidence of cancer has risen in Malaysia. This year, the country recorded an 11.3% hike in new cancer cases ─ that is from 103,507 in 2007-2011 to 115,238 in the 2012-2016 period, our Ministry of Health had said in their latest Malaysia National Cancer Registry Report (MNCRR) 2012─2016 released in January. And of all the cancers, breast cancer is the most common and the No: 1 form of cancer affecting women in Malaysia. It is also on the rise. From the above report, about 34 women out of 100,000 got breast cancer from 2012-2016 as compared to 31 women in 2007-2011. Breast Cancer Highest among the Chinese This means that about one in 27 Malaysian women have a lifetime risk of getting breast cancer. It starts striking women from the age of 25, becomes prevalent for those between the ages of 40 to 60 and peaks at ages 60 to 64 before reducing after age 65. Grouped by ethnicity, the report shows that the Chinese have the highest risk and the Malays the lowest. In the Chinese, one in 22, Indians one in 23 and Malays, one in 30 women had breast cancer. These statistics, however, do not paint a personal picture of what it is like to be afflicted by breast cancer, more so when a woman is at the prime of her life and at the start of her motherhood journey. Ng Mei Theng ─ a breast cancer patient and a strong advocate for early detection and treatment. otherhood.com.my had the rare opportunity to speak with Ng Mei Theng, mother of one little girl and a breast cancer survivor currently still under targeted treatment for HER2-positive Grade 2 invasive ductal carcinoma of the breast. The shock, the strain, the fear, and the abrupt disruption to life plans and dreams…this is her story. 1. Motherhood: Please introduce yourself, tell us what you do and all about your child. Mei Theng was overjoyed when she had a successful pregnancy conceived through IVF. Mei Theng: I am Ng Mei Theng and I am a 35-year-old mother to a little girl who will be turning four years old this November. She is my only living child. After waiting for four years, during which I had other fertility treatments; being pregnant with my little girl gave me indescribable joy and I truly embraced all aspects of being pregnant. I attended hypnobirthing and breastfeeding courses which I also enjoyed very much. I gave birth to her by Caesarean section in November 2016. It was earlier than the estimated delivery date, because she was still in breech position when I started labouring. Being a second-generation business owner of a contracting construction company, I started working from home after delivering my baby so that I could care for her full time. The first two months after giving birth were really tough because there were still many matters at work that were not yet delegated as I did not anticipate going into early labour being a first-time mother. As I made better recovery from my surgery and adapted to my new role, I became a hands-on mother who adopted most of the attachment parenting practices including co-sleeping. Soon, I fell in love with babywearing my baby and decided to start Sunshine Bliss in October 2018 to help other parents in their babywearing journey. In October 2019, I became a certified babywearing consultant. Additionally I also became a breastfeeding peer counsellor in December 2018. 2. Motherhood: Were you breastfeeding at the start of your baby’s birth? Tell us about your breastfeeding journey. Celebrating her daughter’s full moon in 2016. Mei Theng: While I did breastfeed my little girl from birth, we had a difficult first two weeks before breastfeeding could be established. I had flat nipples and she was unable to latch properly. That tough and tiring period was filled with hand expression, pumping and feeding her by cup. We had to have infant formula on stand-by at that time because she had jaundice. However, our priority was to always let her try to latch first, then feed her my expressed breast milk followed by infant formula if it was still necessary. Two weeks later, she began to latch on very well and we were able to breastfeed without issue since. When she was six months old, I discovered nursing while baby wearing by accident, and from then on, it became easier for me to continue breastfeeding by direct latch while working, performing household chores and even traveling. My little girl was conceived with the help of IVF (in vitro fertilisation) treatment. When she was 16 months old, I found myself unexpectedly pregnant spontaneously/ by natural means but it ended with a miscarriage around Mother’s Day 2018. After losing that baby, I decided to continue breastfeeding my girl until she weans herself off. As it pans out, I had to decide to abruptly wean her off breastfeeding on 18th December 2019 when she turned 37 months old because that day, I received my breast cancer diagnosis. 3. Motherhood: When and how did you discover the lump in your breast? What was its appearance like? Was it painful? Celebrating her daughter’s first birthday in 2017 Mei Theng: In my 20s, I would perform a self breast examination from time to time. It was not consistent as I thought my risk was very low. My first breast ultrasound was in 2012 when I was 27 while wanting to get a fertility check. I did not follow up with another breast ultrasound after that. After becoming a mother, I neglected to perform regular self breast examination although I was touching my breasts more frequently due to breastfeeding. Sometime during July last year, I did ask my gynaecologist if I should have breast ultrasound as I was nearing my mid-30s. He advised me to check only after I stopped breastfeeding because the ultrasound images while I was still breastfeeding would be inaccurate. Earlier December last year, my aunt (who is not genetically related to me) passed away from metastatic breast cancer which was only diagnosed two weeks before her death. On 12th December 2019, I decided to do a self breast examination while in the shower and to my surprise, I felt a hard painless lump measuring 3cm located above my left nipple. As I was already breastfeeding past three years at that time, I knew that the lump was definitely not a blocked milk duct. I have learnt to accept that I am a patient undergoing active treatment and therefore living with side effects i.e. chronic pain is my new normal. 4. Motherhood: What did you do next? You consulted your ObGyn? What did he say? Mei Theng: My only sister, who works as an ObGyn trainee in Ireland, was home for Christmas at that time and I immediately told her about the lump. She felt pretty sure that it was a benign breast lump based on palpation as it was mobile and has smooth edges, and told me to observe its presence around the same time in my next period cycle. I told my husband next. Since then, the presence of the lump was constantly on my mind even as I continued to promote babywearing to parents at a hypnobirthing event a few days later. As my sister was returning to Ireland on the day after Christmas, I felt that I needed her presence by my side when I see a doctor about this lump. 5. Motherhood: Where did you go to get diagnosed? Mei Theng: On the morning of 16th December 2019, I first called National Cancer Society Malaysia but was informed that the sonographer would be unavailable that afternoon. Next, I called the breast care centre at Gleneagles KL and Pantai Bangsar but was informed that both centres were fully booked until January 2020. At this point, I almost gave up contacting more places to get checked until my husband encouraged me to. My reason was to avoid unnecessary spending because of the upcoming expenses for the Chinese New Year celebration and my girl was also starting preschool. Finally, I contacted Sunway Medical Centre and was informed that out of the two breast surgeons in the hospital, only Dr Ng Char Hong was available. That afternoon, I went to see Dr Ng accompanied by my husband, my daughter and my sister. I used to think that being a parent is life changing because now there is one life that is dependent on you to survive. Now I realise that having a cancer diagnosis is even more life altering. 6. Motherhood: What was the examination like? Did you do a biopsy? Were you still breastfeeding? Mei Theng’s first babywearing moment after she stopped breastfeeding upon diagnosis. Mei Theng: First, Dr Ng assessed the lump by palpating it and had the same opinion as my sister. However, upon further examination with a bedside ultrasound, he decided to get a radiologist’s opinion of the breast ultrasound images. We received the radiology report shortly after and Dr Ng then offered me the option of having a needle biopsy the following day or three months later. I immediately chose to have the procedure the next morning (17th December 2019). The procedure was simple and quick with a very brief pain. As I went to the hospital that day with my sister while my husband stayed at home with our girl, I had the opportunity to discuss my private thoughts with her in the event the result is positive for cancer. The number one concern I had was regarding my fertility. Deep inside me, I still harboured the hope that the lump would not be cancerous. So the next afternoon (18th December 2019), I went to the hospital with my parents, my sister and my daughter while my husband went to work. We had planned to meet up later at IKEA Cheras to pick up a Christmas tree and decorations. Even up to that point when my name was called by Dr Ng, we still expected a negative result. That was how my mom ended up in the doctor’s room with my sister and I while my father took care of my girl outside. Upon hearing, “it’s cancer” from Dr Ng, all three of us went into shock and cried. My sister was the first to recover from that shock and immediately took control of the situation for me. I am forever grateful to her because Dr Ng was already discussing the next step of management which would be a surgery before Christmas and she quickly informed Dr Ng of my fertility issues and my desire to have more babies. I was, at that time, in my Day 4 of the menstrual cycle. Dr Ng immediately placed a call to Dr Kannappan from the fertility clinic to see me right away. From that point on, the rational side of me took over and I knew I had to start on IVF no matter what, even when I had yet to discuss the matter with my husband. I continued to breastfeed on demand even after discovering the lump. But that same night I received the cancer diagnosis, I decided to stop breastfeeding because I was too traumatised at that time with the events of the day. The next morning (19 December 2019), I went to the hospital again with my sister for a mammogram. It showed that I only have one tumour lump. Therefore, I was suitable for a lumpectomy with sentinel lymph node biopsy. Dr Ng also discussed with us about the possibility of receiving intra-operative radiotherapy during the surgery. We fixed the surgery date for 6th January 2020. During that week up till I had my egg retrieval by Dr Kannapan, I could think rather rationally when I was not on my own. I knew that I will first initiate the steps for IVF, and then have the surgery followed by radiotherapy. Only after the surgery, we would know whether I will need chemotherapy or not as at that time, the staging and other details of the breast cancer cell type were not established yet. I believe that knowledge is the key to empowerment. So I had my sister show me information about breast cancer from her medical books. I asked her questions that I forgot to ask Dr Ng. I was thinking rationally and was strangely calm when I took in all these information. However, when I was alone such as when taking a shower, I would burst into tears. The uncertainty over my cancer status made my frame of mind a scary place to be in. Surgery & Final Diagnosis On the evening of 5th January 2020, I was admitted into the hospital to prepare for surgery the next morning. A day after surgery, we finally had a clearer picture of the extent of my breast cancer. The final diagnosis was Stage 1A HER2-positive Grade 2 invasive ductal carcinoma of the breast. To be honest, it was a relief to be diagnosed at an early stage because I was expecting Stage 3 due to the lump size I felt. At the same time, it was mind-boggling to hear about HER2 because it being positive means I have to accept chemotherapy as part of my cancer treatment. I had a chemoport implanted under my collar bone on 10th February 2020 to save me from enduring repeated cannulation as my veins are poorly visualised and felt. I then began my first chemotherapy the next day. It takes much conscious, mindful effort to remain positive when confronting one’s mortality. 7. Motherhood: What did Chemo feel like? First babywearing after surgery. Mei Theng: My chemotherapy regimen was six cycles administered once every three weeks. I had the chemotherapy infusion through the chemoport implanted under my collar bone. Each treatment session went smoothly. I’m glad I had my husband with me for every session because I was too tired to drive home after the sessions. The first three cycles consisted of a cocktail of three chemotherapy drugs which mostly affect the gastrointestinal tract. So on the day of chemotherapy itself, my appetite was severely affected; I could barely finish less than a scoop of rice in soup. I had very minimal vomiting because I followed the anti-nausea my oncologist, Dr Christina Lai, prescribed for all six chemotherapy cycles. Besides the loss of appetite, I experienced a change in my tastebuds, constipation, fatigue and low energy. If I push myself to complete a task, I would find myself close to fainting. The low energy and fatigue reminded me of The Spoon Theory by Christine Miserandino. These side effects were always severe in the first week of chemotherapy, then improved by second week and gone by third week. By then, it was time to have another chemotherapy cycle. Hair fall began at third week of first chemotherapy cycle. The next three chemotherapy cycles had another drug. While it did not affect my appetite at all, it gave me painful joint pain followed by muscle ache. The first time I experienced it, I felt like I was being electrocuted. I tried painkillers but they did not reduce the pain much. So I learnt to bear with it by practising self-hypnosis (I listen to Steven Halpern’s work). By the time I experienced the next onset of joint and muscle pain, I had gotten used to it. The joint and muscle pain meant that it was more difficult for me to stand and walk for as long as I used to. I really feel that my joints have aged 20 years. I still experience the joint pain because the targeted treatment also caused this side effect. I have learnt to accept that I am a patient undergoing active treatment and therefore living with side effects i.e. chronic pain is my new normal. 8. Motherhood: Did you go into depression? At her first chemotherapy session in February 2020. Mei Theng: My aunt died from metastatic breast cancer early last December. Then her husband, my mom’s brother, passed away from Stage 2 oral cancer late last February. It was during the third week of my first chemotherapy cycle. I went to his funeral and there I met other relatives whom of course asked about my well-being. There we were attending the funeral of a person who died from cancer and some chose to share unsolicited stories of people they knew who suffered side effects described horribly, or even committed suicide because they could not withstand the side effects. As someone who had just started chemotherapy, it put me in a dark place. It took talking to another breast cancer survivor and a friend whose child was diagnosed with cancer a few months before myself to get myself out from that dark place. Since then, every time I heard of someone who died from cancer or had a recurrence, it shook my optimism about my cancer journey. It takes much conscious, mindful effort to remain positive when confronting one’s mortality. So far, I have yet to seek any counselling. There are a few friends whom I know will hold space for me when I ask. I do believe that once I complete my treatment, I will need to seek counselling to help me overcome this traumatic stage of my life and to manage my anxiety during the follow-up period. 9. Motherhood: What were your feelings when you received the diagnosis? What kinds of thoughts raced through your head? Hair fall started at the third week of the first chemotherapy session. Mei Theng: I was definitely shocked. I thought by breastfeeding, I had lowered my risk of breast cancer by a whole lot and I had been breastfeeding for 37 months when I received the diagnosis. Next, I thought of my very young child. How will she cope? Then I saw broken dreams. My plans for year 2020 were to attempt IVF again, and to pursue my own career by upgrading my knowledge and skills to be a lactation counsellor and to offer regular babywearing classes for expectant parents. It was and still is difficult to accept that perhaps my life will not be as long as I had expected it to be. 10. Motherhood: How did your husband feel? What did you both discuss? Mei Theng: As a couple, it was a very difficult period of time for us because we were celebrating our 8th wedding anniversary then. I can still remember the moment when he burst into tears when I wished him “Happy Anniversary” just before leaving to the hospital for my mammogram. My husband is a stem cell scientist who had worked with Majlis Kanser Nasional (MAKNA) in his 20s. When he first heard from Dr Ng on the phone that my biopsy results showed cancer (he was still in office at that time), he immediately looked up the survival rate of breast cancer patients. Due to his knowledge and working experience, he understood that once a person is diagnosed with cancer, it is akin to living with a time bomb in the body which will shorten one’s lifespan. It was a matter which needs time for one to process. He is a type of person who will control the things he can and so immediately took over most of my parenting duties even to the point of taking time off his work. It was him who later requested my sister to postpone her return to Ireland until after my surgery because my diagnosis was simply too much for him to bear with at that time. I would say that we did not have to discuss a lot about my diagnosis and breast cancer in general. He understands my character very well and with my experiences in clinical research, he knew that I would not be afraid of undergoing the cancer treatment. It was and still is difficult to accept that perhaps my life will not be as long as I had expected it to be. 10. Motherhood: Please tell us about your diagnosis: HER2-positive. What does that mean? In June of 2020, one month after chemotherapy, just before the start of radiotherapy. Mei Theng: The human epidermal growth factor receptor 2 (HER2) is a protein located on the outside of the breast cancer cells that promotes growth. Therefore, a HER2-positive breast cancer means that the breast cancer cells have a higher level of HER2 proteins which causes the cells to grow even more aggressively than a HER2-negative breast cancer. This status is made known with immunohistochemical stains (IHC) which is then further confirmed by fluorescent in situ hybridization (FISH) techniques. So even though officially my case is being categorized as Stage 1A breast cancer/ early stage breast cancer due to actual size of cancer lump (being less than 2cm across) in the removed 4cm lump, I had to undergo chemotherapy in addition to a targeted treatment which targets the HER2 protein. Therefore, if I had not discovered the lump last December and continued to live without acknowledging its presence, the breast cancer will continue to progress rapidly to endanger my life. 11. Motherhood: Tell us more about your treatment journey. Mei Theng: I underwent six rounds of chemotherapy with two different chemotherapy drugs which was administered once every three weeks (one cycle). During my fourth chemotherapy cycle, the targeted treatment began for 18 rounds (same treatment frequency) – I am halfway through it now. A month after chemotherapy ended, I had fifteen rounds of radiotherapy administered every weekday for three weeks. The entire treatment journey will take almost 18 months to complete. 12. Motherhood: Have you explained anything to your daughter? What is her response? How is she and you coping? Hair donation to Locks of Hope. Mei Theng: My little girl, Xin Yan, was 37 months old at that time. As she was with me when I first saw the breast surgeon, I explained to her the reason for the visit while allowing her to feel the lump. At the same time, I also informed her that I will be away to the hospital again the next day for the biopsy. Even when she was younger, we would give her a briefing so that she would have an opportunity to digest the given information. I would say that my cancer diagnosis was traumatic for her because on the day I was diagnosed, I abruptly stopped her night feeding. I still remember how she tried to convince me to latch her on my right breast; the one without a lump. At that age, she had yet to sleep through the night. So every time she woke up for a dream feed like she used to, she cried and my husband would carry her to comfort and coax her back to sleep. The next night, I gave her a glass of warm milk before sleep. By the second night, she began sleeping through the night. That first week when I went to the hospital almost daily, she would sit on my lap in silence with her head resting on my chest once I was home. Sometimes she fell asleep for a nap, sometimes not. The next traumatic event for her was when I had to admit myself into hospital the night before my surgery which coincided with her first day at preschool. She had never slept at night without me and suddenly she wasn’t having me at bedtime for two straight nights in a row. I still remember later after discharging from hospital, she would tightly hug my right arm to sleep for several nights. Since I already had a confirmed treatment plan at that time, I was searching for ways to tell my girl about my illness. I did not intend to keep it a secret from her because I do not want to encourage her to keep secrets from her parents. Fortunately I have a friend who collects books from all sorts of genres and she had three children’s books centred on the topic of a parent having cancer. She lent them to me and I read them to Xin Yan. It was not easy for me to read them without tearing up. Our favourite book was You Are the Best Medicine by Julie Aigner Clark. Because of my surgical wounds on my left side, she was very aware that she could possibly hurt me. So she chose not to cuddle or hug. One day, on 2nd February 2020, we went to Genting Highlands for a trip and as I offered to carry her in a baby carrier, she asked me if I am better now and then told me she missed me carrying her. Oh my sweet child..! A beautiful picture of mother and child in 2018, long before cancer ever became a part of their lives. Perhaps it was the books we were reading ─ she touched my hair many times when I was carrying her. I decided to have a buzz cut on 8 February 2020 in a salon and planned to donate my long hair to Locks of Hope. She did not understand the need for the drastic hair cut and kept saying that I no longer look pretty. Cancer has taken so much from me that I feel the need to take back the control by deciding when my look will change. The thought of waking up and seeing clumps of hair on my pillow would traumatise both my little girl and me. Besides that, I also did eyebrow microblading so that I would not be taunted by my eyebrow-less look. When I began my chemotherapy on 11th February 2020, she began to express signs of separation anxiety. Perhaps it was because I was so weak from chemotherapy. She simply refused to go to school. For two days, my husband had to forcefully take her to school. Her teachers told me that she would start crying if someone mentioned the word “mommy” or “ibu”. Worried for her mental health, we took her for a play therapy session. The therapist concluded that while her bond with her daddy and grandparents were also good, her bond with me is the strongest and me being sick had shaken her sense of security. As I moved into the second week of the first chemotherapy cycle, I gradually felt better and this perhaps helped her in accepting being away from me to attend preschool. Whenever I need to go to the hospital, she will get upset when I first inform her about it. Then she will wait for me to come home. From time to time, she will ask me if I am better. If I say yes, the happy face she makes is heart breaking. I cannot wait for the day in the future when I can tell her that I am cancer free! Whenever I need to go to the hospital, she will get upset when I first inform her about it. Then she will wait for me to come home. From time to time, she will ask me if I am better. If I say yes, the happy face she makes is heart breaking. 13. Motherhood: Is your cancer in remission now? Mei Theng: I am still under active treatment using HER2 receptor targeted treatment although I have begun my follow-up with my breast surgeon on 1st October 2020 to monitor the cancer progression. This close monitoring period will last for two to three years and will alternate between tests performed by the breast surgeon and the oncologist. 14. Motherhood: What are your thoughts for the future? Mei Theng: I used to think that being a parent is life changing because now there is one life that is dependent on you to survive. Now I realise that having a cancer diagnosis is even more life altering. Suddenly my time is more precious than it used to be. I began to learn to say no so that my needs can take priority first. I have put in more effort to contact my friends and even to reconnect with my friends from long ago. I even challenge myself to pick up new skills; for example, I have learnt to loom knit in the middle of my chemotherapy treatment. For the amount of time I have left, I want to spend my time with the people who matter and to continue to volunteer my skills to the society I am in. And I want to continue to share the story of my cancer journey to raise awareness on breast cancer. 15. Motherhood: Can you tell us more about your blog? What is its mission? Posing under the colourful decor of Christmas back in 2018. Mei Theng: My social media accounts for Sunshine Bliss were originally intended to share my passion for babywearing and breastfeeding. After I shared my cancer diagnosis with many women near and far, I realised that there are many people who thought breastfeeding eliminates the risk of breast cancer rather than reducing the risk. Then there were also many women above 40 who were skipping their mammograms because they heard that their breasts will hurt during mammogram. Since then, I decided to announce my health status on social media and to share about my cancer journey from time to time. I am happy that I did because there have been several mothers who contacted me for advice or just to share their thoughts with someone like me. For me, the willingness to be open about my breast cancer diagnosis is just a small step that will increase awareness on this disease and hopefully increase the survival rate of Malaysian women diagnosed with breast cancer. Early detection can truly save lives. 16. Motherhood: Do you plan to have more children? Mei Theng: Yes, I intend to have more children. This desire is strengthened by the miscarriage I experienced. I considered myself blessed because I could immediately begin the IVF process on the day of my cancer diagnosis to safeguard this desire. But whether I will truly have more children is unknown at this moment. I can only console myself that I have tried my best and have no regrets. For me, the willingness to be open about my breast cancer diagnosis is just a small step that will increase awareness on this disease and hopefully increase the survival rate of Malaysian women diagnosed with breast cancer. Early detection can truly save lives. 17. Motherhood: Is there anything else you'd like to tell all women? A picture of mother and daughter as they are now. Picture taken in September 2020. Mei Theng: Many have told me that I have been very brave in my cancer journey. I know how it is to feel fear to know one’s health status. For me, ignorance is not bliss. By knowing that I have cancer allows me to make arrangements for my loved ones and to spend even more time with them so that I can leave them with beautiful memories. When it is time for me to leave this world, it is those I leave behind who will suffer. So no matter how old you are, I encourage you to take proactive steps towards your health. All pictures courtesy of Ng Mei Theng Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner. 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