SINGAPORE — In September 2021, Kwa Lay Teng, then 25, was nursing her four-day-old baby girl during confinement in her mother's home when she got a call from her doctor.
"He told me: 'Hi Lay Teng, I'm so sorry it is breast cancer. You need to stop breastfeeding now.' I couldn't stop crying. My husband was beside me, I didn't even have to tell him what happened, he knew it was bad. He called my mum who came and took the baby away from me."
She also had to induce menopause as her hormones fuelled her cancer, a rude shock to her dreams of raising a family of five with her husband.
"I was in denial... I worried if I would ever be normal again," she said.
Almost two years on, her cancer is in remission but her fear — now of relapse — remains.
In October 2022, Kwa joined a four-session emotional well-being programme her oncologist, Dr Karmen Wong, started a year earlier for breast cancer survivors, where she learnt to manage her fears.
The Zoom sessions are facilitated by breast cancer survivors and have helped 85 women in three runs since the programme was launched.
Dr Wong, who has worked with breast cancer patients for 30 years, said: "They are willing to go through a lot of treatment and lose their breasts and hair to live longer. After diagnosis, they say they are not the same as before, physically, emotionally and mentally... If you don't deal with it, you will spiral down."
Breast cancer is the most common cancer among women in Singapore, where one in 13 will get breast cancer in their lifetime. Most of those diagnosed are above the age of 40.
At least 30 per cent to 40 per cent of early breast cancer cases face a high risk of recurring, according to Professor Lee Soo Chin from National University Cancer Institute, Singapore.
The course Dr Wong started teaches breast cancer survivors exercises to help them process their fear and grief, improve self-esteem and set habits to move forward in life.
Its lead facilitator, Wendy Chua, who is trained in psychology, said she holds focus group sessions with the women, and introduces processes to help them open up and tell their stories, as well as acknowledge and reframe negative thoughts.
To some, like Kwa, sharing what she has been through has not just helped her cope, but has also given her the satisfaction of giving other survivors strength. At first, she struggled to accept the fact she had stage 2B cancer.
She found lumps in her breast when she was 38 weeks pregnant and went for an ultrasound scan, but thought this was due to clogged milk ducts.
"I was resentful and afraid. I resented the fact that I have cancer... I was afraid that I might not wake up from closing my eyes. I was afraid that I'll very soon not be there for my baby girl," she shared on social media in March about how she felt when she heard the diagnosis in September 2021.
About a week after receiving the diagnosis, she was thrust into eight months of chemotherapy, radiotherapy and surgery.
Chemotherapy left her exhausted and unable to take a walk or carry her baby for more than 10 minutes at one time. She experienced bouts of nausea, her hair fell out, and her fingernails turned black.
She hid her condition from coworkers till her friend accidentally shared a photo of her bald head on social media on Christmas.
"The last thing I wanted was sympathy," she said.
"I had a lot of doubt in my mind. Everyone said I can do it, medicine is very advanced, I'm still young, it'll be alright... but I doubted if I'll be able to survive this journey, if I am as strong as what others think," she wrote in the post.
"I know that I am strong but at that point in time, I couldn't help but feel weak and small," she added.
"When going through treatment I didn't acknowledge my feelings, and kept telling myself it's no big deal," she said.
"But my closest friend told me it was a big deal."
The friend suggested she could use her story to spread awareness.
More than a year after she was diagnosed, she finally mustered the courage to open up about her condition, not just to loved ones but to the world through social media.
Kwa said: "The programme gave me tools to help me manage and understand my emotions... It was also comforting to meet people going through the same problems as me."
She used to work long hours as a senior fund accountant at a global financial services firm.
After her treatment, she left her job in June 2022 and became a financial consultant.
The three months between jobs ate into her savings, but she wanted to prioritise her health and raise awareness of critical illnesses among young adults, such as at a health seminar.
Julianne Danielle Lim, another survivor and programme participant, was head of change delivery in private banking at Standard Chartered when she was diagnosed in 2020 with breast cancer at age 38.
"I always wanted to climb the corporate ladder, and when I got cancer, I had to ask myself: 'Who am I really without corporate work, not being able to run, to work out, to wine and dine?'" she said.
She learnt to define success differently after her cancer diagnosis.
"Now, it's about how much fun I'm having in a day, how free I feel to do what I love... not to feel like I have to be in control of everything."
Lim, 41, left her job and started Strong Bold Grateful Inc in October 2021, a company to share stories in companies and at events on overcoming adversities such as the loss of a child.
"Friends and family should allow people the space to talk about (their struggle with disease) and not treat it as a taboo and avoid the topic... it is important to articulate how we actually feel," she said.
Reflecting on the treatment process, Kwa said: "If I were to go back in time, I would take more pictures and post them online to let other people know what I was going through. I would try to embrace the process and not be beaten down by the journey."
Dr Wong said: "The experience is so traumatic, life becomes so unpredictable that it forces them to ask if (the life they are leading) is what they really want. People always push aside these thoughts if nothing happens, and they need to live for their child, their husband... But when such a serious thing happens right in their face, they think 'I might want to live for myself.'"
Those interested in joining the programme for breast cancer survivors can sign up here.
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This article was first published in The Straits Times. Permission required for reproduction.