October is Breast Cancer Awareness Month. One year ago, Josephine Foong discovered a lump in her breast. It turned out to be stage 2 cancer. Now, after her double mastectomy and treatment, her desire is to support other cancer patients through City Harvest Church’s Cancer Care Group.
Josephine Foong, now 38, had been through a decade of unsuccessful fertility treatments when she discovered a lump in her breast in February 2021.
“Last March, I had a medical appointment scheduled with my fertility doctor, and I told her about the lump,” Josephine, a software quality assurance tester recounts. “Immediately she referred me to the (KKH) breast centre for an ultrasound, mammogram and biopsy to test for cancer. Within a month, the result confirmed that I had Stage 2 breast cancer, with a BRCA2 genetic issue.”
It was not news that any woman ever wants to hear. “My husband Winston was with me when we received the diagnosis,” she says. “It was all quite overwhelming—we had such a huge amount of information to digest and then we needed to make decisions about the treatment.”
Josephine’s breast surgeon gave her three surgery options. “The first was a lumpectomy, which is simply removing the cancerous lump. The second was a mastectomy, which was to remove one breast. And the third option was a double mastectomy, which means both breasts are removed,” she listed. “My breast surgeon also asked if I wanted to go for genetic testing.”
The genetic test revealed that Josephine had the BRCA gene, which was baffling, since there was zero family history of cancer.
“In my family and extended family, there was no one with breast cancer or any cancer-related disease due to defective genes—nothing that could have indicated that my cancer could be hereditary at all. It was my surgeon who suggest the genetic test as I was below 40 years old,” she explains. The optional BRCA test is conducted mostly for younger breast cancer patients or those with family history, to determine if there are mutations in the DNA that increase the risk of breast cancer.
Josephine was faced with formidable weight of the shocking news and the urgency with which she needed to make decisions. “I had no idea how to decide on my treatment plan,” she admits. “I didn’t know what a good option would be. All I knew to do was to pray for guidance on how to decide on my surgery plan.”
It was also deeply painful to be facing this after a long period of trying for a baby. “I prayed to God for answers to why this was happening, after years of infertility, IVF treatments and miscarriages,” she shares. “The challenges just seemed so overwhelming.”
WALKING THROUGH THE “VALLEY OF DEATH”
The onslaught of information and decisions to be made left Josephine in a daze. “My mind was a whirlpool of emotions, options and uncertainty,” she remembers.
She went for a second opinion. “God sent a friend who brought me to meet her oncologist and seek a second opinion. This person is from my fertility support group—we were acquaintances, we had not really connected with each other. The appointment was at Mount Elizabeth Hospital, and she said it would be free, just a casual chat with the doctor,” recounts Josephine.
“Little did I know, she had paid for the consultation! It was only after much prompting that she admitted it and told me that the doctor had charged 50 percent of his consultation rate. They were like angels that God sent to let me know He is with me. The visit to the second doctor helped me to understand my condition better and I found out that there were more treatment plans available in private clinics. My friend also told me that it is quite rare to have hereditary cancer, especially since I do not have any known family history.”
Having explored her options, Josephine decided to continue her surgery and treatment at KKH as it would be more affordable in the long run. “As I was a subsidised patient, I didn’t get to choose my breast surgeon or plastic surgeon or oncologist, but I am very thankful for the ones I was assigned to,” she says. “Since I had no idea what treatment plan to decide on, I went for genetic testing first to see whether it would make the decision-making easier. We also had a consultation with the plastic surgeon to see what choices I will have to decide for reconstruction if mastectomy was necessary.”
The results of the genetic test came back after three weeks, confirming that Josephine fell into the small percentage (5 to 10 percent) of breast cancer patients who have the BRCA2 gene. “With this result it was easier for me to decide on my surgery plan,” she says. “Since I have the defective gene, my rate of recurrence could be as high as 49 percent. So Winston and I decided I would have a double mastectomy to reduce the chance of recurrence.” She opted for reconstruction of both breasts.
Josephine’s surgery was a success. The surgeon removed some lymph nodes to test, and no cancer was found, which indicate that there was no spread. “My breast surgeon assured me that all cancerous cells were removed, which means I am in remission. There were some physiotherapy exercises that I needed to do to regain mobility in my arm.”
One week following the surgery, Josephine and Winston went to see the oncologist. “He shared my treatment plan with me which included four sessions of AC chemotherapy (every three weeks), followed by 12 weeks of Taxol chemo (weekly), together with Herceptin (targeted therapy every three weeks for one year) and hormonal therapy would start after chemo,” Josephine lists.
“All these treatments are maintenance to reduce my recurrence rates. Before chemotherapy began, the nurses would tell me about all the side effects that may happen, and the medical team would also provide medication before every chemo session to minimise side effects,” she describes.
She adds, “I thank God that I did not really experience much of the common side effects like vomiting or nausea. I had general fatigue a few days after each chemo sessions, and I would just sleep in more during those days. I did experience peripheral neuropathy (numbness and tingling, weakness in the limbs, loss of balance) from chemo, but I am glad that I could still do things that I used to be able to do.”
Today, Josephine has completed all her treatments and is on the road to full recovery. Through the whole of the past year, her husband has walked with her each step of the way.
“He was super supportive of any decisions I had to make, he was there for me whenever I needed,” she says. “He always tried to be there with me at all the doctors’ appointments, when treatment plans were discussed. He tried to keep his composure and would ask the doctors what the side effects would be, how to alleviate them and what the after-care procedures would be like. Knowing that I might be overwhelmed by emotions, he went through each option with me as objectively as possible.
“After my surgery, due to limited mobility, he arranged for me to go back to my parents’ place rather than be at home without care. He came to visit me every day, and helped me in activities that I couldn’t do on my own. When I moved back to our own home, he ensured that I was taken care of by making sure the kitchen was well-stocked with clean food. And he would rush back daily to take care of me.
“He is just the most amazing person I could ever ask for.”
FAITH TO FAITH
Apart from Winston, Josephine also turned to her church family from the start. “When I first discovered the lump in my breast, my husband shared it with Pastor Veron (Veronica Tang) and we also told our cell group about it. I am super thankful for their support, care and concern throughout my cancer journey,” she says.
“Just before my surgery, some of the ladies in the cell group sent me a song to encourage me,” she recalls. “That song helped me to rest during my first night in the recovery ward, where everything felt so uncomfortable and unfamiliar.”
Josephine woke up after her surgery feeling stiff and immobile, and it seemed she could not get comfortable in any position. “Emotionally, I was all over the place,” she shares. “I was even regretting my decision to do a double mastectomy.”
She would be woken up various times throughout the night as the hospital staff had to monitor her condition. “I felt I couldn’t rest at all, but the song that was sent to me by the cell group ladies comforted me and reminded me that I was not alone,” she recalls. As the week progressed, Josephine felt her low mood lift. “Throughout my week-long hospital stay, I was blessed to receive wonderful care from the nurses of the wards and even my fertility doctor came to visit.”
The word of God strengthened her. “One of the first verses I was reminded of during my hospital stay was ‘Let the weak say. ‘I am strong.’’ (Joel 3:10). I was reminded that His strength is there to help me through my situations. I may not know the reason why cancer happened to me, but I am always reminded that He is always with me, by my side, throughout all my circumstances, and He has everything under His control,” she says.
“There are days when I question ‘Why me?’ after 10 years of infertility, six IVF cycles and four miscarriages. There are times I felt I don’t deserve unfair treatment with regards to workplace arrangements from my office, after all I have gone through,” she admits. “But I am always thankful for His strength to allow me to see beyond my circumstances and find my comfort and assurance in Him.”
Josephine’s relationship with God has only grown through this ordeal. “This cancer journey really taught me to depend on Him and trust Him more,” she says. “There are good days, there are bad days, but every day is better with Him. When we think back to how smoothly things went for me this past year, we just feel that indeed He was in control, sending the right people at the right time.”
Last year, CHC launched a new initiative, Cancer Care Group, where volunteers would reach out to cancer patients in the church to offer support, prayer and a listening ear. Josephine was among the first group of beneficiaries. “I’m thankful to have my support group who would pray for me,” she says. “As there were Covid restrictions, we did not meet physically but we had a WhatsApp group to stay in contact.”
Now, Josephine has decided to join Cancer Care Group as a volunteer herself. “Being fresh out of cancer treatment, with minimal side effects, I felt that I can encourage others who are going through their treatment to believe that is possible to experience minimum side effects,” she explains. The group she is in now regularly visits their beneficiaries or keeps in touch with them through calls and messages.
Josephine and Winston, 39, hope to resume trying for a child in time. “Currently, we still have some embryos stored in the KKH bank. The plan is for me to undergo hormone therapy for three years, after which I will continue IVF treatment,” she explains.
It has been a long journey for them both, but the couple have seen the goodness of God through it all. “This journey may not be the smoothest or the easiest, but having gone through it, we learn to trust and believe in God even through our lowest points in life,” Josephine says. “We choose to believe that everything is in His plans, and His plans for us are the best. We are constantly reminded of His goodness in our lives when we see His hand in things that are beyond our control.”
According to the Singapore Cancer Society, women aged 40 to 49 are advised to go for a yearly mammogram, while women 50 and above should go every two years. Find out how to get a free breast cancer screening in October if it’s your first time, or pay only $10 if it’s a second screening. Check here if you are eligible for a subsidised screening any other time of the year.