Jane (not real name) is a 42-year-old Indonesian from Surabaya, Indonesia. About two months ago she felt a lump in her right breast. She went to consult a doctor in a private hospital in her hometown. An USG indicated a 32 x 30 x 18 mm solid mass at 10.30 o’clock of the right breast. The doctor suspected cancer which had probably spread to the lymph nodes of the arm pit. Her left breasts was normal.

A biopsy was done on 5 September 2016 and the results suggested:

1. Infiltrating ductal carcinoma, right breast.
2. Suspicious lymphadenopathy right axilla.

The doctor in Surabaya suggested that Jane remove her whole right breast. She decided to seek a second opinion and came to consult a doctor in one of Penang’s cancer hospital. A CT of the body was done.

Impression:

1. There is a 5.7 x 3.2 cm enhancing lesion in right breast, suggestive of breast tumour.
2. Right axillary lymph nodes.
3. Uterine fibroids.

The doctor in Penang also suggested surgery to remove her breast. In early October 2016, Jane came to seek our advice.

These are what we told her this morning:

1. The scan and the biopsy confirmed that this is malignant. The best option is to have the right breast removed.
2. To avoid, unnecessary problems later, a mastectomy should be done — not a lumpectomy. The tumour is too big for a lumpectomy any way.
3. In fact, Jane should not have gone to the “cancer hospital” when she first came to Penang. This cancer hospital only offers chemo or radiation to patients, besides scanning. So why incur unnecessary cost? Jane should have gone to a hospital that has doctors to do the surgery (which the “cancer hospital” does not offer).
4. What hospital to go to and which surgeon should do the surgery? This is what Jane wanted to know. Based from the feedback of our patients, we suggested the following:
5. Go and see Dr. Y at Z hospital. He is cheaper and can do a good job.
6. If Jane prefer another doctor, then Dr. C from D hospital is another option. He is a breast specialist. But the cost of the procedure would be higher.
7. Bring the USG, biopsy and CT scan to the surgeon and discuss with him what he can do to help. Make a request that the surgeon go ahead with the surgery. To save cost, ask not to undergo anymore scanning or biopsy again. Anyway, there is a lump in her breast — whether it is cancerous or not, Jane must have it removed.
8. Based on the meeting with Jane and her doctor, she should decide which doctor or hospital is more suitable for her. If she is not happy with the doctor during the consultation, then our advice is go and find one who is more caring and compassionate. Don’t worry. There are many doctors in Penang! So make your right choice.
9. It is better that Jane do the surgery in a hospital in Penang than in Surabaya. Costs of treatment in a Penang hospital is far cheaper than that of the hospitals in Indonesia. In addition, patients told us that Penang hospitals are cleaner and more organised.
10. Our final advice — go and talk to the surgeon. Then make up your own mind, who and where you want to do the surgery. Even though we advised Jane to see Dr. Y and/or Dr. C we made it clear to Jane what we do not benefit from this advice. We don’t get any “referral fee” and we also do not know these doctors personally. We do this purely out of our desire to help another fellow being in need.
11. Our “consultation fee” this morning for talking almost an hour is “zero”! God bless.

We shall give you an update if Jane comes back to see us again after her mastectomy.