‘‘I was one of the cancer ‘cases’ of 2020’’
First Lady Prof. Maithree Wickramasinghe talks publicly for the first time of her experience and what SL can do with regard to early detection
The year was 2020. There were 3,975 new cases of breast cancer detected that year and the current First Lady was one of them.
“I was one of these ‘cases’ – detected during March, just as COVID-19 began sweeping the world and our island went into lockdown. The clinical diagnosis was a Stage I HER2 carcinoma of the right breast,” said Prof. Maithree Wickramasinghe on Friday, possibly in the first public declaration about her illness.
“……And I was in the 4.2% of all Stage 1 island-wide breast cancers diagnosed in 2020. This was an aggressive cancer and one reason for my presence here today was the early detection of the disease,” she told the Breast Cancer Symposium 2023 on the theme ‘Empowering Hope, Uniting Hearts & Advancing Minds’ organized by the Indira Cancer Trust (ICT).
The non-profit ICT was launched by former Speaker of Parliament, Karu Jayasuriya after his late daughter, Indira, fought cancer with courage, faith and dignity. It is guided by his other daughter and ICT Chairperson Lanka Dissanayake.
Delivering the keynote address, Prof. Wickramasinghe who is Departmental Chair and Senior Professor of English at the University of Kelaniya relived that time……..“on the seventh day of being confined to the house, my hand brushed against my right breast while doing my yoga exercises – purely by accident”.
Reiterating that it was a “distinctive privilege” to be at the symposium, “though not necessarily to be dressed in pink even though it is the custom for those campaigning for breast cancer awareness”, she said she wished to articulate her views on breast cancer stemming not only from her research on the topic but also from her personal experience of being a cancer patient.
After two surgeries, eight cycles of chemotherapy, 20 days of radiation and another nine rounds of targeted chemo, lasting 17 months in toto, wide was Prof. Wickramasinghe’s coverage of the subject of cancer – from her experience as a patient and how she faced the possibility of death, to cultural and psychological factors and social conditions that could deter early detection to contemplation on ways and means of negotiating these constraints and the need
to introduce health curricula in schools at an early age.
She described how as a young woman, she had visited her general physician and oncologist several times and even undergone a scan due to the presence of benign breast lumps. However, once it was recognised that her breasts were fibrocystic, she “stopped paying attention to my breasts over the next few decades”.
Her generation of women were never encouraged to be self-aware of their bodies, let alone their mammary glands. In fact, as young girls at puberty, they were discouraged from familiarizing themselves with their bodies (“neither by vision, nor touch, nor even speech”) in public. “It is the education system in Sri Lanka, if not at primary level, then at the secondary strata, that needs to be the first entry point – in the prevention or detection of disease,” she said.
She says: “Looking back, my background and lifestyle had several patent risk factors for cancer. At the time of diagnosis: I was postmenopausal; I was in my mid-50s; I had a personal history of fibrocystic breasts; I had not breastfed, nor borne children during my reproductive years; there was cancer and cancer-related deaths in my maternal as well as paternal family (even though it has been established that the HER2 gene cannot be inherited or passed on).
Why? After the diagnosis of the carcinoma, a friend appeased me with why you? But then it occurred to me, why not me? Fairly unappreciated, my life had vacillated: from the humble to the sublime, from the intellectual to the aesthetic, from the global to the spiritual and to the mundane and the ridiculous; amidst the congestion of living. Back then, I never inquired why me?
“Why then, was I not sentient to the possibility or rather, the probability of cancer in my body? Why did I not continue with regular checks? After all, our country still maintains a free healthcare system - for what it's worth; moreover, I am adequately privileged to be able to get private medical care. It is somewhat embarrassing to confess that I had not had a mammogram done until my diagnosis.
“Why? After the diagnosis of the carcinoma, a friend appeased me with why you? But then it occurred to me, why not me? Fairly unappreciated, my life had vacillated: from the humble to the sublime, from the intellectual to the aesthetic, from the global to the spiritual and to the mundane and the ridiculous; amidst the congestion of living. Back then, I never inquired why me?”
Urging an early detection campaign through self-examination as well as compulsory clinical examinations on the part of our free healthcare service for women - from their 30s onwards and particularly after menopause, Prof. Wickramasinghe underscores the need to penetrate the “complacency” in our lives. Our preoccupation or the congestion in our lives, day in day out; deadline by deadline….. even the laziness; and the importance of everything else - other than vigilance of one’s personal health.
With regard to social stigma, she says that it needs to be accounted for in campaigning for early detection. Anecdotal evidence indicates that potential cancer patients are inclined to deny or defer a formal diagnosis due to their reluctance to be identified as ‘diseased’ or ‘victims’ and also its possible impact on employment, marital or financial prospects.
Prof. Wickramasinghe says that there is a need to demystify cancer and its outcomes. To treat it as a routine disease in general - that could have a good prognosis after treatment. Normalizing the growing incidence of breast cancer as well as statistics of remission would serve to negate cultural fears and perceptions. There is also a need to normalize treatment - by creating awareness about the different types of cancers, especially the different categories of breast cancer and the different kinds of treatment options.
“We need to communicate that not only does cancer not equate death; but that it does not always necessitate the ‘dreaded’ chemotherapy; to make it common knowledge that there are different categories and generations of chemotherapy; and that the impact of chemotherapy on the mind and the body of an individual can be markedly dissimilar,” she points out, requesting the highlighting of the more positive, if not balanced narratives of women's and men's experiences of chemotherapy – alongside the negative.
You may be surprised to hear that apart from the discomforts of treatment, this was a very rewarding and soothing time in my life, says Prof. Wickramasinghe giving a glimpse into her life…….“For the first time in our marriage, my husband and I spent extended periods of time together. Family, friends, relatives, students, acquaintances, even adversaries – all got in touch to express their love and friendship. They found ways to send food and gifts – despite the lockdown. After many decades, I was not working – I was emancipated – I had the freedom - to be - to read, write poetry, watch unlimited TV series, listen to compendiums of YouTube music, to lounge around, to sleep late in the mornings….”
While explaining that early detection of cancer is “critical” for a good prognosis, she however, cautions about the risk, that the pressure and enthusiasm for an early diagnosis could lead to misdiagnosis and over-diagnosis of cancer in Sri Lanka.