The Story of a Cancer Fighting Lecturer at 43

Something bothered Yolanda’s mind when a lump appeared on her right breast at the end of November 2018. The lump, said Yolanda, was getting bigger and bigger.

The woman whose full name is Yolanda Stella Rosa immediately rushed to seek information through internet. She was worried if the lump became a malignant or cancerous tumor. While seeking for information, the lecturer and Deputy Rector of LPSR Communication and Business Institute Vice also went to the doctor to examine the lump in her right breast.

Unfortunately, she had to spend one month before managing to see a doctor, due to very tight schedule of examinations.

“Finally at the end of the year, I had a surgeon to examine me. Incidentally, it was the last day of the doctor’s practice,” Yolanda recalled in a virtual talkshow “YKPI Goes to Campus: Early Detection of Breast Cancer, When to Start?” held by the Indonesia Breast Cancer Foundation (YKPI) on Friday (8/21).

The doctor asked Yolanda to immediately perform a mammography and Ultrasound examinations. However, the result could not be immediately known, because the doctor was in year-end leave.

Only after two days after the 2019 new-year, Yolanda received the news. The doctor advised her to do a surgical biopsy.

“If it was a malignant tumor, it will immediately be mastectomized because the size has reached 3 cm,” the doctor said.

Yolanda was shocked. In the midst of her grief, she sought a second opinion from another surgeon on January 4th, 2019. Yet the answer was just the same. Yolanda needed a biopsy.

“Finally on January 15, 2019, the surgery was performed. I am grateful that the God still gave me a second life after being diagnosed with stage two of breast cancer at the age of 43 years,” said Yolanda.

“I have determined at that time that I had to fight and make friends with cancer, because I still have two children that I want to accompany until their adulthood,” added Yolanda.

After the surgery, Yolanda had undergone six chemotherapy sessions. She admitted that it was not easy to get through this phase, remembering that she had experienced severe allergies.

“That is why I was always worried about the next chemotherapy. Fortunately, Thanks God, it went well. I am still undergoing hormonal therapy until today,” she said.

Yolanda encouraged public, especially the women to carry out early detection. According to her, if cancer can be detected at an early stage and immediately followed by medical action, then the recovery rate is very large.

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CEO of LPSR: My Mother had Breast Cancer at 75

Jakarta, YKPI – Founder and CEO of LSPR Communication and Business Institute, Prita Kemal Gani has a sad story when her mother was diagnosed with breast cancer at the age of 75 years.

Prita who had three children at that time, was very afraid that the cancer would take her mother away. Understandably, since her father had passed away when she was only five years old, so that Prita no longer wanted to lose the mother she loved so much.

“I thought the fear would go away when I grew up and became independent, but apparently the feeling did not fade away because I had always been depending on my mother. I had to ask my mother for her opinion on every choices I would take,” said Prita in the virtual talkshow “YKPI Goes to Campus: Early detection of Breast Cancer, When to Start?” held by the Indonesia Breast Cancer Foundation (YKPI) on Friday (8/21).

But Prita did not give up. She always provided support and accompanied her mother’s treatment against cancer.
“I also always asked God not to take my mother away,” recalled Prita.

Learning from this experience, Prita believes that breast cancer survivors need support from their family and surroundings.

Therefore, Prita also believes that the Supporting Pillar of Pink Ribbon Survivors and Warriors is very important to instill the belief that cancer is not the end of everything.

“I can feel how painful it is when a child has to lose his/her beloved mother. We lose true love,” said Prita.

“We must unite to support the cancer survivors so that they can recover, be happy, active and productive. And no more children should lose their parents. Everyone must fight to get well and be healthy,” Prita emphasized.

She also encourages women to take care of themselves by adopting a healthy lifestyle, eating healthy food, exercising, and avoiding stress by getting closer to God.

“And we pray to God to be given the rest of life that is useful for everyone,” she ended.

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Be Aware, Breast Cancer May Attack Young People

The Dharmais Cancer Hospital Jakarta, as the national center for cancer, has treated breast cancer patients aged 16-21 years. This confirms that breast cancer does not attack adult women only. Men of all ages could also develop breast cancer, despite the number of patents is relatively small. Dr. Bob Andinata SpB(K)Onk said it to around 500 participants of the YKPI-LSPR Goes to Campus virtual talkshow.

Delivering the presentation titled “Early Detection of Breast Cancer; When to Start?”, the doctor who is currently the Head of Early Detection & Health Promotion Installation at the Dharmais Cancer Hospital, encouraged participants to take early detection at a young age.

“Because if it is detected early, breast cancer can be treated before it spreads to other parts of the body. We may not know the cause of cancer, but the signs and symptoms can be easily recognized, such as the presence of a painless lump in the breast or nipple. Even so, not all lumps are the signs of breast cancer,” he said.

As dr. Bob said, no one knows for sure about the cause of breast cancer in young women. However, there are several contributors that create a possibility for young women getting breast cancer, such as due to hormonal factor, unbalanced lifestyle, or heredity. Furthermore, dr. Bob explained that the incidence of cancer under 30 years old is relatively small.

“We mostly found painless lumps or benign tumors. If it is ignored, it will get bigger. And if it is not examined, the lump may develop into malignant tumor,” said dr. Bob.

According to dr. Bob, there is no other way but surgery to remove benign tumor. “But the surgery technique surely upholds aesthetics factor, so that the wound line is hidden between the areola line,” explained the specialist who frequently promotes the importance of early detection.

He further said that beside painless benign tumor, there is also lump with pain. Since the patient will feel pain, it allows the patient not to be ignorant and immediately seek treatment.

“But again, not all lumps in the breast are confirmed to be cancer. It must be checked first,” he emphasized.

To recognize the presence or absence of cancer, we must know the risk factors of breast cancer. “There are two risk factors. The first is factors that can be modified such as unmarried woman, not breastfeeding, have no baby, or obesity. While the second is factors that cannot be modified, such as family history of breast cancer or ovarian cancer,” explained dr. Bob.

Based on Globocan 2018 data, breast cancer is the highest incidence of cancer in women in Indonesia, with an annual incidence of 58,256 cases. “If it is calculated, then there are 6 women per hour are developing breast cancer in Indonesia,” said dr. Bob.

This worrying condition can actually be prevented as early as possible by doing BSE (Breast Self-Examination) and clinical breast examination. For BSE, it can be done every month on days 7-10 from the first day of menstruation.

“If (your menstruation period) is not regular, you may use the birth-day. While for clinical breast examination, it can be done in accordance with age due because it uses equipment both for USG and mammography. For young women whose age under 20 years, just do it once,” explained dr. Bob.

If another lump is found around the breast after being removed through surgery, according to dr. Bob, there is no need to worry. He advised not to delay medical examination in order to find out whether the lump is malignant or not. Pandemic should not be considered as a barrier for seeking treatment.

“Of course, stay alert by choosing hospitals that are not Covid-19 reference. The point is to do early detection and screening as early as possible, because the earlier it is known, then the chance of a cure is 100 percent,” ended dr. Bob.

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HIGH BREAST CANCER CASE DUE TO IGNORANCE

Oncology surgeon at the Dharmais Cancer Hospital (RSKD) Jakarta, dr. Walta Gautama SpB(K)Onk said that the high number of breast cancer cases in Indonesia is because it is often ignored by the community, women in particular. As the matter of fact, most women realize that early breast cancer screening is very important in order to prevent advanced stage of breast cancer.

“Knowledge alone is not sufficient to encourage someone to take the right action. The first action taken by women is always a denial, they think it must not be cancer,” said dr. Walta in the “Virtual socialization: Early Detection of Breast Cancer in Insufficient Facilities and Surgical Oncologist” for Eastern Indonesia, August 19 2020.

According to him, there are many patients who still look for other doctors after being diagnosed with breast cancer, until they find someone who states that it is not cancer.

“If all doctors say it is cancer, they will look for an alternative opinion, and seek for any other ways to avoid going through surgery,” said dr. Walta.

Breast cancer surgery is still a scourge for most women, because they are afraid of losing the breast which is considered crown for women.

dr. Walta ensures that not all breast cancer surgeries will perform breast removal. There are currently other techniques in breast surgery.

“Nowadays, Reconstruction Technique is being developed. Some use fat or muscle from the other part of the patient’s body to be shifted, or to shift the breast tissue whenever possible,” explained dr. Walta.

He further said that early detection is undoubtedly important so that breast cancer does not continue to an advanced stage. When it has already been in advanced stages, the recovery rate is getting lower.

“For breast cancer, patients who come with stage one and then she postpone until stage three, the treatment will be different; the therapy is not the same. The one with stage four will also be different,” dr. Walta emphasized.

In general, the recovery rate for breast cancer will remain high on the condition that the patient takes early detection, gets the right diagnosis, and take the right therapy.

The “Virtual Socialization: Early Detection of Breast Cancer in Insufficient Facilities and Surgical Oncologist” for Eastern Indonesia was held by the Indonesia Breast Cancer Foundation (YKPI), and directly opened by YKPI Chairperson, Linda Agum Gumelar.

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HOW TO HAVE MENTAL TOUGHNESS DURING PANDEMIC FOR SURVIVORS

The Covid-19 pandemic around the world has left serious mental health problems for people, especially cancer patients and survivors.
Clinical Psychologist for Medical Rehabilitation at the Dharmais Cancer Hospital Jakarta, Nelly Hursepuny, M.Psi said that the uncertainty of the pandemic raised psychological problems such as stress, feeling burdened, irritability, as well as anxiety which trigger a decline in immune system and vegetative symptoms.

“Also appear the effects of pain and headache that can make people difficult to sleep. Some people also experience disturbances in their diet, and have no appetite. Even if the person has always had no appetite since a long time ago, this time is not like usual,” said Nelly in the YKPI webinar series themed “Mental Resilience of Breast Cancer Patients and Survivors during the Covid-19 Pandemic” recently.

Therefore, it is important for the patients and survivors of breast cancer to have mental resilience. Nelly explained mental resilience is a person’s ability to rise from worse conditions.
“Like a ball when we throw it on the ground, it will bounce back up. So is a person with mental resilience or mental toughness. When his/her physical and psychological, social and economic condition deteriorates, the person will succeed in rising up, thanks to his/her mental toughness,” explained Nelly.

Then, what constitutes mental resilience?
The first is ‘I Am’ or individual strength that is formed within oneself, such as feelings of empathy, caring for others, or feeling proud of what has been achieved.
“This has to be maintained. If I can say ‘I am proud to have achieved all of these, it means I have undergone a long series of treatments, which then I am able to survive,” said Nelly.

The second is ‘I Have’. It means external supports gained from the surrounding environment, such as family, friends, colleagues and relatives.

The third is ‘I Can’, which means the ability to communicate and solve problems, and to express thoughts and feelings well.

In her presentation, the psychologist who is also member of organization committee in research and medical department shared seven tips to develop mental resilience during pandemic.

7 tips to develop mental resilience during a pandemic:

1. Have a good self-efficacy
Believe that a person has an ability to overcome difficult situations, by seeing the strengths he/she has.

2. Practice your emotional regulations
Practice to stay calm and keep the mind focused, even under stressful conditions.

3. Impulse Controls
Recognize your inner desires and drives, and learn to control those desires before making decisions.

4. Optimistic
Think and have positive perspectives in any situations.

5. Be Empathetic
Be quickly responsive in responding to other people’s conditions.

6. Strengthen Relationships
Increase closeness and relations with family, friends and community by joining online meetings.

7. Learn to Adapt
Accept the changes that occur as part of life.

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THESE TWO BREATHING TECHNIQUES ARE EFFECTIVE TO REDUCE STRESS

Jakarta, YKPI – Controlling breathing is an activity that is closely related to yoga exercises. However, who would have thought that breathing techniques are useful for relieving stress.

Urologist at the Dharmais Cancer Hospital Jakarta, dr. Rachmat Budi Santoso, Sp.U mentioned two breathing techniques to relieve stress, namely Ha Breathing, and Deep Breathing.

Ha Breathing is a breathing technique which is done by making ‘ha’ sound out of the mouth. It aims to prevent sympathetic nerve system from taking domination, thus the parasympathetic nerve can control the situation.

“This is a very helpful technique under an emergency situation. For example, if someone in front of you suddenly slaps you in the face – which means it’s an emergency situation, you may breath out ‘ha’ to control your anger,” explained dr. Santo in the webinar titled “Smart Healing: Healing Tips and Techniques for Cancer Patients”, last week.

The second is Deep Breathing or regulation of breathing. This technique is done by inhaling for a count of six, and exhaling for a count of six.
“If we are able to do this, emotions will not control us like crazy,” said dr. Santo.

dr. Santo emphasized that stress is basically important to test how strong a person is in addressing certain situations. However, excessive stress can affect the immune system.

“There are thousands of chemical events occurred when we are under stress. If all of our energy is drained into the stress, then which energy is for the immune system,” said the alumnus of the Faculty of Medicine, University of Indonesia.

In addition, when a person is under stress, the production of cortisol and adrenaline will increase. Conversely, the immune system is decreased.
“Our thoughts may affect the immune system. If we are able to control emotions and thoughts, then our immune system will be better,” he continued.

Dr. Santo further said that it is very important for cancer patients – particularly breast cancer patients, to avoid stress during the stages of treatment. Only by having positive thoughts, the body’s immune system will get stronger, which in turn will speed up the healing process.

“A person who gets cancer will definitely be stressed or emotional. At that time, biochemical metabolism in his/her body will change completely compared to normal people. This resulted in the reduction of drug’s effectiveness because the patient is under stress or being emotional,” closed dr. Santo.

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THE IMPORTANCE OF SELF-HEALING FOR BREAST CANCER PATIENTS

Jakarta, YKPI – The human body is designed in such a way to have the ability to heal itself (self-healing), as said by the urologist at the Dharmais Cancer Hospital Jakarta, dr. Rachmat Budi Santoso. Despite its ability to do self-healing, dr. Rachmat emphasized that cancer patients also need treatment to overcome physical disorders.

“If it is true that medicine heals, then everyone who gets the same medicine should get cured. The reality is not all of them are healed,” said dr. Santo in the webinar titled “Smart Healing: Healing Tips and Techniques for Cancer Patients” on Friday (8/7).
“Some of the patients seeing doctor are cured, some other are not. This is why smart healing is important,” continued the alumnus of the Faculty of Medicine of the University of Indonesia.

There are a number of things to pay attention in order to do self-healing. The first is the awareness that there is no sudden illness.
“There is no such thing as sudden heart attack, because six months before the heart attack, the body has signaled there is something wrong, whether it is pain or discomfort. We have to learn so that the body gives these signals,” explained dr. Santo.

The second is to believe that body and mind are integrated. Therefore, during taking the treatment, patients should be able to control their emotions and keep away from stress.
“When getting stressed, biochemical metabolism in the patient’s body will completely change from normal people. Thus, the medicine which should have been effective will be less effective, because those who are treated are experiencing stress or emotional problems,” explained dr. Santo.

The last one is to keep the immune system strong. The reason is, the immune system is the stronghold that can cure someone from any illness.
“The system is very substantial not only to protect us from illness, but also to help us recovered from any illness,” closed dr. Santo.

The webinar was held by the Indonesia Breast Cancer Foundation (YKPI) in collaboration with the Dharmais Cancer Hospital Jakarta, and attended by 300 participants from all over Indonesia. It was directly opened by Chairperson of YKPI, Linda Agum Gumelar, who really hoped that self-healing materials would help cancer patients in controlling their emotions.

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Differences between Breast Cancer Screening and Early Detection

Jakarta, YKPI – Screening and early detection are two terms that are often used in cases of breast cancer. Although both terms are similarly aimed at preventing breast cancer, screening and early detection have significant differences.

Surgical oncologist DR. dr. Sonar SoniPanigoro, SpB.K.Onk MARS MEpid said there are six stages of breast cancer, starting from healthy cells to death. The six stages are healthy cells, abnormal cells, pre-invasive cancer, invasive cancer, cancer spread, and death.

Dr. Sonar explained that screening is an examination carried out before there are any complaints. Through the process of screening, patients may find out breast cancer while it is still in the stage of healthy cells, abnormal cells, or pre-invasive cancer.

In contrary, early detection is an examination carried out after there are complaints, and the size of the cancer is usually more than one centimeter.

“Ideally, it would be very great if we can detect the cancer in healthy cells area. It can predict that a person can become cancerous. This kind of examination is being developed. While the breast ultrasound and mammography can only detect cancer whose size above 1 centimeter,” said dr Sonar.

“What we already have today are USG and mammography, which is only until the stage of invasive cancer. Thus, we have the term of early diagnosis or early detection.”

According to Dr. Sonar, early detection is a type of secondary prevention, while the primary prevention of breast cancer is to avoid risk factors. Among the risk factors for cancer include obesity, lack of exercise, alcohol, use of hormonal drugs, not breast feeding, genetic, and increased age.

Unfortunately, avoiding the risk factors is practically quite difficult. Yet according to Dr. Sonar, it is very effective for preventing breast cancer.

“For example: the genetic factor. If we are able to find this gene, we can prevent nearly 85% of breast cancer. The problem is that the gen called BRCA is not much. There is usually only 5-10 % among women population,” said the former Managing Director of Dharmais Cancer Hospital Jakarta.

Meanwhile, the Chairperson of YKPI, Linda Agum Gumelar emphasized that the efforts to prevent breast cancer are very important because the number of breast cancer cases in Indonesia ranked number 2 after lung cancer.

“About 70% patients come to see doctors after their illness is in advanced stages. As the matter of fact, if it is known earlier and since the beginning, their life expectancy could be higher,” said Linda.

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Breast Cancer Does Not Occur Spontaneously

Jakarta, YKPI – Surgical oncologist at the Dharmais Cancer Hospital (RSKD) Jakarta, Dr. dr. Sonar SoniPanigoro, SpB.K. Onk MARS MEpid said that breast cancer does not occur spontaneously. Breast cancer takes a dozen to tens of years before normal cells finally turn into malignant cells.

“Even breast cancer cells in size of 1 centimeter need three to five years. Thus, there is no sudden breast cancer,” said Dr. Sonar in the “Breast Cancer Webinar Series: How Early is the Handling of Breast Cancer?” Friday (7/24). The webinar was conducted by the Indonesia Breast Cancer Foundation (YKPI) in collaboration with doctors at the Dharmais Cancer Hospital Jakarta, and attended by 500 participants from all over Indonesia.

Cancer cells development takes dozens to tens of years, therefore Dr. Sonar urged Indonesian people to do early detection of breast cancer.

There are various types of early detection methods, ranging from breast self-examination (BSE / Sadari), clinical breast examination, mammography, MRI, USG, CT Scan, to PET.

“MRI is the best. However, the weakness is that MRI takes up to an hour, the cost is expensive, and the availability is still limited,” explained the alumni of the Faculty of Medicine of University of Indonesia.

If it is possible to choose, Dr. Sonar recommended mammography and USG. “The question is how effective is it? It is not 100 percent, but it’s still more accurate compared to checking it yourself,” added Dr. Sonar.

Dr. Sonar emphasized that checking breast cancer while it is still in stage zero (0) and stage one (1) is very helpful for the patient’s recovery. According to him, if breast cancer was found in the early stages, the chance of recovery is almost 100 percent.
Dr. Sonar further said, if breast cancer can be detected in stage zero (0) or stage one (1), there is a greater chance for recovery.

“In addition to high survival rate, there are also other benefits. For breast cancer patient with stage 0 or 1, almost no radiation or chemotherapy is required. And if the cancer cells do not spread to lymph, then there is no need to remove lymph nodes, thus reducing the possibility of lymphedema,” said Dr. Sonar.

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