Part 1: I Can’t Believe That By Just Taking Tamoxifen, The Cancer Will Not Come Back Part 2. The Cost of Diagnostic Procedures and Mastectomy in Hong Kong
Part 3: Suffered Menstrual Problems for 34 Years. CA Care Therapy Helped Her
Olive (not her real name), a 46-year-old lady from Hong Kong, had many lumps in her right and left breasts. She underwent various diagnostic procedures before undergoing a total mastectomy.
1. 3D mammogram and ultrasound scan of both breast. This was done on 13 September 2022. This is the report.
As shown above, there are many lumps or masses in both the left and right breasts.
Left breast: Of the 6 lumps in the left breast:
- 2 of them are highly suspicious of being malignant. They are 1.6 x 0.7 x 1.4 cm and 1.0 x 0.7 x 1.1 cm in size.
- 2 of them have low suspicion of malignancy. That is to say, may or may not be malignant.
- 2 of them are thought to be benign.
Right breast: Of the 3 lumps in the right breast:
- 2 are benign.
- 1 has low suspicion of malignancy.
In view of the above, Olive immediately proceeded to do an ultrasound-guided core biopsy.
2. Ultrasound-guided Core Biopsy.
3. Whole body PET-CT scan. This was done on 17 September 2022.
Two small hypermetabolic nodules at 12 o’clock and 1 o’clock positions of left breast are consistent with biopsy proven malignancy.
A group of several minimally FDG avid tiny irregular nodules in left lung are more likely inflammatory than neoplastic judging from their distribution.
Small hypermetabolic focus in right corn of uterine cavity can be inflammatory change, but malignancy is not excluded. Gynecological evaluation is recommended.
Otherwise, no metabolic evidence of distant metastasis.
4. Blood test. Olive did a blood test before undergoing mastectomy. The results of her full blood picture, liver function and renal function were all within normal range. Her CA15.3 was 17.2 which is also within normal range.
The histopathology report indicated cancer, left breast:
- at 12 o’clock (size 1.2cm) and
- at 2 o’clock (size 0.9 cm).
Invasive ductal carcinoma, NST
Breast Cancer Biomarker Studies:
- Estrogen receptor positive
- Progesterone receptor positive
- HER2 oncoprotein negative.
6. Oncotype DX test. This is a genomic test that analyzes the activity of a group of 21 genes from a breast cancer tissue sample. The results from this test we would be able to know how a cancer is likely to behave and how it would respond to treatment.
For women age 50 and younger:
- Recurrence Score of 0-15: The cancer has a low risk of recurrence. The benefits of chemotherapy likely will not outweigh the risks of side effects.
- Recurrence Score of 16-20: The cancer has a low to medium risk of recurrence. The benefits of chemotherapy likely will not outweigh the risks of side effects.
- Recurrence Score of 21-25: The cancer has a medium risk of recurrence. The benefits of chemotherapy are likely to be great than the risks of side effects.
- Recurrence Score of 26-100: The cancer has a high risk of recurrence. The benefits of chemotherapy are likely to be greater than the risks of side effects.
Based on the test, Olive had a her recurrence score was only 11. So her oncologist said she does not need to undergo chemotherapy. Taking tamoxifen is good enough.
To do this, your breast tissue has to be sent to the USA for analysis. And this costs a bomb! For RM 22,313 this is what you get.
Cost of Diagnostic Procedures and Mastectomy
Olive shared with us the cost of all the diagnostic procedures and mastectomy (table below) she incurred.
1. The cost for breast cancer surgery in Hong Kong is most shocking. Since I have never lived in Hong Kong and do not have many patients from Hong Kong, I can’t say much. But the reality that I have just learned is that Olive had some lumps in her breast. The only logical way to save herself is to undergo a total mastectomy. Yes, that is the correct decision. But it did not occur to me that it cost so much money to do just that – more or less a quarter million Hong Kong dollars.
I wonder how many people in Hong Kong has that kind of money to spend?
2. Malaysians be grateful! In Malaysia, these are what our patients had to pay for a mastectomy.
a) Lucy (not her real name), 58-year-old, had an irregular 2.6 x 3.6 x 3.2 cm lesion in her left breast. There were few enlarged axillary nodes. On 13 July 2019, she underwent a mastectomy at a private hospital in Kuala Lumpur. The total cost of the surgery was RM 14,999.70, made up of:
- Hospital charges = RM8,684.20 and
- Doctors fees = RM 6,315.50.
Take note that these figures may not be valid anymore. The surgery was done in July 2019 – three years ago!
b) Dahlia (not her real name), 40-year-old, had a 4 cm lump in her left breast. She underwent a mastectomy in Hospital S, in Kuala Lumpur. The surgery cost RM 13,000. Before the surgery, she did a PET scan which cost RM2,300. So in all Dahlia only spent RM15,300 – this is almost 10 times cheaper than what Olive had to pay in Hong Kong.
c) A 56-yar-old Indonesian lady found a lump in her right breast. She came to Hospital E in Penang. A biopsy confirmed it was an invasive carcinoma. She immediately underwent a mastectomy with axillary clearance. According to the patient, she paid a total of only RM12,000 for this treatment.
d) Lian, 65-year-old, underwent the following diagnostic procedures at a private hospital in Penang:
(1) Blood tests.
(4) PET scan and
The total cost of these procedures came to RM10,817. She underwent a total mastectomy of her right breast and removal of another lump in the left breast. The total cost of this surgery was RM16,538.98. In all she spent a total of RM27,355.
3. Find simple ways to solve a complex problem. I spent 26 years teaching in a science university and I spent most of my time there doing “biological research”.I have learned that there are two ways to solve a problem. One way is to make things complicated or more complex. We go round and round trying to find a solution to our problem. In this way, we feel we are “really smart or educated” to do things that nobody understands. Another way is to find a simple and effective solution to our complex problem. Not impressive for the ordinary mind but it works!
Indeed, to some people getting cancer could be a complex problem. Olive had small 2 cancerous lump in her left breast. Their sizes were comparatively small – 1.6 x 0.7 x 1.4 cm and 1.0 x 0.7 x 1.1 cm. She went round and round talking to 4 surgeons before she had a mastectomy. In addition, she had to perform an USG, mammogram, biopsy, PET scan, blood test and oncotype DX test. The result – she lost her left breast and piled up a hefty medical bills of almost RM150,000.
Compare that to the 56-year-old Indonesian lady who had a big lump in her right breast. She came to Hospital E in Penang. A biopsy confirmed it was cancerous. She immediately underwent a mastectomy. The result – she lost her right breast but she paid a total of only RM12,000 for this treatment.
Similarly, 40-year-old Dahlia had a mastectomy to remove the 4 cm lump in her left breast . Result – she lost left breast but the surgery cost only RM13,000. But before the surgery she did a PET scan which cost RM2,300. So in all, Dahlia only spent RM15,300 to solve her problem.
4. More tests provide more information. In modern, advanced society we could justify that by doing sophisticated tests we can be “more sure” of what we are doing. For example, by doing PET scan we will be able to know if the cancer has already spread. By doing the genetic test (that cost RM22,313) we would be able to know the chances of recurrence, etc.
My question to that argument is: With that extra information, what can you do about the real problem? For example, PET scan showed there are nodules in the lungs and a “hot spot” in the uterine cavity. So what did the surgeon do about this “finding or knowledge”? The surgeon did nothing since her/his job is only to cut off the breast! Also, how sure are you that these “extra information” can really save your life?
In order not to offend any party, let me not comment further. But let me share with you the story of Ina, a 51-year-old lady from Penang.
In July 2012, Ina felt a lump in her breast and called me for advice.
- Find out exactly what it is.
1. She went for an USG – not CT scan or PET scan.
2. Like Olive, both of Ina’s breasts had many lumps – some appeared benign while others appeared to be cancerous.
- Setting the bearing right.
1. If the lump is cancerous, are you ready to have surgery to remove the whole breast? Ina said yes.
2. After the mastectomy, do you want to undergo chemotherapy, radiotherapy or take tamoxifen, etc.? Ina said no. Many of her friends / customers suffered from such treatments and eventually died.
- Go shopping for a “right” surgeon.
Ina consulted a few surgeons and wanted them to agree to do the following for her:
1. Do a biopsy and a mastectomy at the same time.
2. While lying in the operation theatre, the surgeon would remove the suspected cancerous lump(s).
3. The lump(s) is immediately sent to the laboratory to determine if it is cancerous or otherwise.
4. If the tumour is cancerous, the surgeon will immediately proceed to remove the whole breast.
Ina was fortunate to find a surgeon who agreed to the above.
- Unfortunately, the biopsy indicated it was a cancer. The doctor immediately performed a total mastectomy.
- Histopathology report showed a 2.0 x 1.5 x 1.2 cm cancerous nodule. Three of 18 axillary lymph nodes were infected with cancer.
- Like in Olive’s case, the tumour was positive for estrogen and progesterone receptors but negative for Her-2. It was a Stage 2 cancer.
- Declined further medical treatment.
After the mastectomy, the doctor suggested follow-up treatment with chemotherapy. Ina flatly refused the treatment and opted for CA Care Therapy.
- Ten year on, still doing great!
It is now December 2020 – ten years since her mastectomy. Ina is healthy and did not encounter any problem. Since she is a fashion designer, her illness was a well guarded secret. She did not go bald and her customers did not even know that she had cancer!
Just think for yourself – how do you want to solve your problem? In a simple, straight forward way like in Ina’s case or in a complicated, round and round way that looks and sounds rather complicated and “scientific”? For your information, as of this writing February 2023, Ina is still doing very well.
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