Do you remember what life was like at 28?

For many of us, it was a time when the foundations have been laid, and new castles were in the air.  You’ve hit your stride and ready to embark on new adventures. At the age of 28, I completed my higher exams in internal medicine and just started my training as a cancer specialist.  My first child, Yvonne, was born that year.

Life ahead was full of exciting promises.

Last month, I saw two patients with stage 4 cancers. I saw the patients one day apart and what struck me was that they were both born in 1984 – both are 28 years old this year.

For Ms Chen, her cancer story started in April 2010 when she first noticed a lump in her right breast. She saw her family doctor, who reassured her that it was unlikely to be anything serious.

Six months later, the lump had grown in size and further tests, including a mammogram and biopsy, confirmed that it was cancer.

As the tumour was 5 cm and considered large, the recommendation was for her to receive chemotherapy first before going for surgery.

After eight cycles of chemotherapy, she underwent surgery to remove the afflicted breast.  This was followed by radiotherapy and more treatment with Herceptin, an antibody against a genetic target found in her cancer cells.

By Christmas of 2011, Ms Chen completed all her treatment and was looking forward to resuming her normal routine. But her plans were disrupted by a nagging pain in her bones.

Her oncologist did not think much of it initially but when the pain persisted and became worse, scans in September 2012 confirmed that the cancer had recurred and spread to the bones. It was stage four.

At that point, she decided to see me.

My other patient, Ms Tay first complained of back pain in August 2012.  She went for massage but instead of getting better, the pain became worse.  An MRI of the spine confirmed that there was a tumour affecting one of the bones in her spine.

A biopsy of the tumour confirmed that it was cancer which had spread from some other part of her body.

When she saw me, a PET-MRI confirmed that the cancer had most likely originated from her lung and had already spread to the lymph nodes, liver and bones.  The diagnosis was confirmed on a repeat biopsy taken from a lymph node under her armpit. Ms Tay had stage 4 lung cancer.

At 28, both of them had stage 4 cancers, one originating from the breast and the other from the lung. The question that strikes me is why?

Why are there so many cancer patients? Why are there more young people with cancer? Why do the young ones seem to have more serious disease?

When I completed my training in medical oncology in 1990, I was the fifth registered medical oncologist in Singapore.  In the Singapore Medical Council Annual Report 2011, there are now 82 registered medical oncologists in Singapore with 35 of them in the private sector. There are more of us now, but we are all kept busy.

Part of the reason why we see so many cancer patients is the ageing population.  There are also many foreign patients with cancer, who come to Singapore to seek treatment.

But I suspect that our lifestyle has a big part to play in the increasing numbers.  Our diet, our fast pace of life, with its accompanying stress, must be taking its toll on our body’s immunity.

It is perhaps time for us to take pause in our hectic lives, to slow down. This is something easier said than done, but something we should all do.

I could not find a good reason why these two young adults should have cancer.  The only significant finding was that Ms Chen’s paternal grandmother had breast cancer. Ms Tay had no family history of cancer.

That both presented with advanced stage disease is no surprise.  There tends to be delay in diagnosis for young patients with cancer, largely because most doctors would think of other possibilities rather than cancer.

In a young patient, a lump in the breast is more likely to be a benign tumour than breast cancer and backache is more likely to be due to over-use and traumatic injury.

It is also my experience that in young patients, the cancers tend to be a lot more aggressive – growing faster, greater propensity to spread early and more resistant to treatment.  As such, I tend always to err on being more cautious in screening for metastases and more aggressive with the treatment.

Both young patients have started on treatment.  After one cycle of chemotherapy, Ms Chen’s cancer markers have returned to the normal range and Ms Tay’s bone pains have resolved.

I pray that their relative youth and never-say-die spirit will stand them in good stead. Like many young people, they are at a time where the goal is to build a good life – but theirs is a battle with far higher stakes.



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