Breast Cancer, Explained — with Dr. Lum Wan Wei (Beacon Hospital)

Dr. Lum Wan Wei, a consultant clinical oncologist at Beacon Hospital in Malaysia, discusses breast cancer detection, treatment, and recovery in a conversation aimed particularly at Indonesian patients. He emphasises that most breast lumps are benign but all should be assessed by a qualified doctor, and that around 90% of Indonesian patients he sees arrive with advanced-stage disease due to delays in diagnosis or treatment. He outlines a whole-person approach to cancer care that addresses weight, exercise, diet, menstrual health, and emotional wellbeing alongside medical treatment.

Introduction

Host (Phoebe): Hi everyone, Phoebe here. Today I'm with Dr. Lum Wan Wei, who is a consultant clinical oncologist here at Beacon Hospital in Petaling Jaya, Malaysia. He has years of professional experience in cancer care, holds an MBBS from Manipal University, and is a Fellow of the Royal College of Radiologists in the UK. Today we'll be talking about breast cancer — a topic very relevant to Indonesian patients who travel to Malaysia for treatment. Thank you very much, Doctor, for joining us.

Dr. Lum Wan Wei: Thank you, Phoebe, and thank you to the Indonesian team for coming over.

Training, Philosophy, and Patient-Centred Care

I did my training in Hong Kong, many years ago — mainly at Queen Elizabeth Hospital and also Queen Mary Hospital. Hong Kong is a very advanced oncology setting, both in terms of radiotherapy, chemotherapy, targeted therapy, and whatever newer treatments are available in the world.

The core value I learned in Hong Kong is this: the patient is the centre of your treatment. Never look too much at guidelines alone — you must remember the person, the cancer patient, sitting in front of you. That is what matters most.

"Never look too much on guidelines — you must remember the person, the cancer patient, sitting in front of you. That is what matters most."

Most patients from Indonesia who start coming to Malaysia do so because they find that doctors here give them the care that they need — and more importantly, the care that they want. It is not simply a matter of opening a treatment chart that says you need Drug A, Drug B, Drug C, Drug D — and if you don't have this drug, that's the end of the conversation. I think that is very sad.

Psycho-oncology and the Whole-Patient Approach

Host: You mentioned that you also practise what some might call psycho-oncology. Is that connected to what you learned in Hong Kong?

Dr. Lum Wan Wei: There is no formal training in psycho-oncology in Malaysia or widely in the world. Sometimes you see things labelled as lifestyle oncology. But the important aspect — as I have grown older in my oncology career — is that I tend to treat the patient as a whole, rather than as a segment. You don't simply treat them for the breast issue and nothing else.

"I tend to treat the patient as a whole, rather than as a segment — they have breast cancer, but you treat the whole person."

Most patients in the current setting want to know: Will treatment affect my lifestyle? What do I need to eat to get better? Am I seeing the right doctor? Can I work? Can I exercise? I believe that patients nowadays feel that treatment is 50% medicine and 50% their own effort. That is important.

The Two-to-Three Month Follow-Up Window

Host: You're well known for providing two to three months of counselling and post-care to patients — going where other doctors might fear to tread. Could you walk us through what that looks like?

Dr. Lum Wan Wei: I have patients who come into my clinic and tell me, "Doctor, I know I have breast cancer, but right now I'm not prepared for any active treatment. I want to try Product A, Product B, Product C, and I just want you to follow me and see how I progress." I have heard of other consultants telling such patients, "If you don't do the medicine I prescribe, please get out of my clinic." I don't do that.

So I have patients who try some form of herbal or traditional medicine for about two to three months, and then the tumour grows larger. At that point they come back and say, "Doctor, can I come back for some treatment?" We see those patients every two to three weeks in that setting.

I also have patients who have finished treatment and say, "Doctor, now suddenly with no treatment I feel very abandoned. I'm very scared the cancer will come back" — even though the scans are clean. Who would not be frightened after cancer treatment?

Some of them have young children — five or six years old — and they tell me, "Doctor, you don't know my fear. I am terrified that if anything happens to me, nobody will take care of my children." That fear is very immense.

So for patients who come from Indonesia, we do scans and blood tests, and we offer reassurance. Sometimes we see them once every two weeks. After a while they gain more confidence — they put on weight, their hair grows back, their energy returns. They say, "Doctor, can we push to three weeks?" Then four weeks. And slowly, from there, we build the patient's confidence moving forward.

"For cancer patients it is important to have regular follow-up, regular scans, good family support, and a good doctor who can talk to you."

Patterns in Indonesian Patients Presenting to Beacon Hospital

Host: You see a lot of patients from Indonesia. Is there a pattern in terms of what stage they arrive at and what their stories look like?

Dr. Lum Wan Wei: The feeling I have when patients from Indonesia come to see us for breast cancer is that it is quite advanced when they arrive — and that is a bit sad. A patient may go to a hospital in Indonesia and be told to wait. Then, because she lives far from the hospital, she comes back three or four months later. By then she has already delayed treatment by four months. Family members sometimes also cause delays by advising the patient to try other things first.

So when patients from Indonesia come to us, I normally don't push them into a long list of investigations immediately. When patients arrive with advanced cancer, the objective is to find out why there was a delay, and to work out what can be done to make the patient more comfortable.

I would say about 90% of patients coming from Indonesia to Malaysia arrive with quite advanced cancer. Bear in mind, some of these patients are well-educated and come from major cities like Jakarta — not only from smaller towns. Even educated patients miss out because they don't have access to things like PET scanning, or they thought the tumour was very small, only to find during surgery that there is another tumour in the liver.

The important message for Indonesian patients who find any lump in the breast: please do not ignore it. Find a good doctor to make sure it is not cancer.

Screening: What Every Woman Should Know

Host: In Indonesia there is a lot of confusion about what tests to do — especially for a woman in her 30s, no family history, appearing healthy. What should she do?

Dr. Lum Wan Wei: Indonesia is a very large and beautiful country with many provinces and islands, and not everyone lives in a big city. Malaysia has a similar setting. So our main message for any ladies listening is this:

"All lumps in the breast can happen — but you must see a proper doctor."

If you have a breast lump, don't immediately think it is cancer — but do find a suitable doctor to check it. Maybe nine out of ten lumps are not cancer. But the one that is cancer, if it is picked up early by a good doctor with the necessary tests, can be cured.

Not many ladies like to have a mammogram because they have heard it is very painful. So what we normally tell patients: if you are young and you have a breast lump, you can always do an ultrasound, which is relatively simple. Most centres in Indonesia now should be able to perform ultrasound.

Once you reach the age of 40, a mammogram is something you must consider. At minimum, get one baseline mammogram at age 40, then follow up regularly — perhaps every two years as you get older.

There is also newer technology such as MRI of the breast, which is used in confirmed breast cancer cases, particularly for younger patients, but MRI is not widely available and the cost is high.

At Beacon Hospital, we do what is necessary — we don't subject patients to a long list of unnecessary investigations.

Metastatic (Stage IV) Breast Cancer

Host: What about metastatic breast cancer? A lot of people only talk about breast cancer generally, but there is much more to it.

Dr. Lum Wan Wei: Good question. Breast cancer can be at an early stage — Stage I, Stage II, sometimes with involvement of the lymph nodes at Stage III — and then there is Stage IV, which is what Phoebe referred to as metastatic breast cancer. This means the cancer has spread beyond the breast to other parts of the body.

A large proportion of Indonesian patients who come to us at Beacon Hospital are at Stage IV, because treatment was delayed — due to fear, traditional medications, or because the cancer was not diagnosed early enough. A PET CT scan is very important to identify Stage IV breast cancer. Some patients from Indonesia fly over to Malaysia specifically for a scan. I have one patient who had treatment in Indonesia and flies over every year just to do a PET CT scan with me, because she says, "Doctor, doing only an ultrasound and chest X-ray is not enough."

Treatment is available for Stage IV breast cancer. If you have friends with Stage IV breast cancer, please tell them: treatment is available, control of the cancer is possible, and the treatment is not as bad as people fear.

Can Cancer Come Back?

Host: Is it actually very common for cancer to come back, or is it a very small possibility?

Dr. Lum Wan Wei: Every patient who finishes treatment with me asks, "Doctor, is my cancer going to come back?" If the patient is 75, there is less urgency, because there are only a few years ahead. But if the patient comes to see me at the age of 30, the risk of recurrence is significant.

This is why there is now a growing movement towards the concept of lifestyle oncology — the understanding that after treatment, if you don't change your lifestyle, the cancer risk of returning remains. A simple example: a lung cancer patient who has completed treatment and continues to smoke — that is clearly not a good idea.

For breast cancer patients who have completed treatment, I always sit down with them and focus on what is important for their wellbeing now: managing weight, exercise, and diet. If possible, avoid excessive plastic packaging, fast food, and highly processed items. These are important aspects of care that a good consultant will always educate their patients about.

Life After Treatment: The Five Pillars of Recovery

Host: If someone who has just finished breast cancer treatment walks into your clinic and asks, "What do I do differently starting tomorrow morning?" — what would you say?

Dr. Lum Wan Wei: Oncology is supposed to help you through your entire journey — not just to give you tablets, but to talk to you about your lifestyle. If I have time, I normally ask my patients who have finished treatment to keep a diary.

Journaling is very important. When you go to a café nowadays, you see young people with diaries, doing drawings, writing. I encourage my patients to do the same. The diary covers five areas:

1. Weight — If they are putting on a lot of weight, that is not ideal. If they maintain their weight, that is good. If their weight is too low, we work on increasing it. I monitor them every one to two months.

2. Menstrual cycle — I ask how their menses are, since treatment can affect this.

3. Exercise — This is a big topic on its own. A talk on exercise after breast cancer treatment could take two hours, because in the Asian context "exercise" sometimes means going for a walk or going shopping. That is not sufficient. Exercise needs to raise your heart rate. I teach patients how long to exercise, and what types — yoga, Pilates, weight training, stretching. It is a complex discussion, but it is part of the healing process.

4. Diet — Patients often arrive with long lists of things they believe they cannot eat: no salt, no sugar, no oil, no spices, resulting in bland steamed or boiled meals every day. In the Asian context, we don't simply eat salad. We eat a wide variety of meat, vegetables, and fruits — including durian, lychee, rambutan, mangoes. The dietary subset is far more complex than a Western diet. So we have a dedicated diet advice panel, and sometimes providing proper dietary guidance requires two or three consultations alone — from white rice to brown rice, yellow noodles to other noodles.

5. Mood — After treatment, patients can feel depressed or unhappy. Women are very strong — they give birth, they care for their husbands, they are the pillars of the household. When they are unwell, they often don't tell anyone. They go home, they cry, they can't sleep, they worry the cancer will return. There is nobody to talk to. We are increasingly trying to address this: you need to treat the body, the mind, and the soul together so that the cancer can truly be treated.

"You need to treat the body, the mind, and the soul — so that the cancer gets treated. That's the context."

Does Stress Cause Cancer? Addressing Common Misconceptions

Host: Is it actually a misconception that stress causes cancer, or that cancer patients cannot eat red meat or sugar?

Dr. Lum Wan Wei: If you go to Google or YouTube, there are probably thousands of people telling you different things. From a clinical oncology standpoint, we can only speak to what the literature tells us. There is no single direct study conclusively linking stress to cancer, partly because we cannot measure stress objectively.

That said, after more than 20 years of practice, I do believe that stress causes certain imbalances in the body. When you are stressed, your heart rate goes up, your hands get cold, you cannot sleep, your stomach is unsettled. If you tell me those are not related to your body's state, I think that is not truthful. So I do believe that stress can trigger or affect a person's general wellbeing and may influence recovery during cancer treatment. This is why I emphasise to my patients that during their journey with breast cancer, they must find a balance of joy in their daily life — whether that is going to a favourite restaurant, practising yoga, or whatever brings them genuine happiness.

As for diet, I had a patient who came to me for a second opinion after seeing another oncologist. She had spent days researching what she could and could not eat, and the previous oncologist took her folder, slammed it on the table, and said, "This is all rubbish." She was very sad. I told her that if you have breast cancer, we also need to be understanding.

I sat down with her and we had a dialogue. My general dietary guidance for breast cancer patients is:

• Avoid fast food and processed meats — sometimes these contain fillers that are not real meat.
• Minimise microplastics — reduce reliance on plastic bottles and canned food.
• Reduce high-volume white sugar — perhaps substitute with honey or brown sugar. I understand that Indonesian desserts are fantastic, but the sugar content is very high.
• For protein, a fresh fish is better than processed alternatives. I tell patients: "Imagine a swimming fish is better than a dead fish." Start with fish, then slowly build up to chicken — organic if possible — then some meat.

We always try, in the Asian context, to respect the culture of what people eat. You cannot take a patient's careful notes and dismiss them as rubbish. I always believe that patients today are capable of doing their own research.

Final Advice for Every Woman

Host: If there is one piece of advice you could give every woman watching — to help prevent breast cancer or to keep fighting if they already have it — what would it be?

Dr. Lum Wan Wei: The take-home message is simple: do not ignore a small lump in the breast. Nine out of ten lumps are benign, but the one that is not can be cancerous. Have it checked by a proper doctor. Do an ultrasound if you have a breast lump. If you are over 40 and a mammogram is accessible, please get one.

And do not be afraid of cancer. It is something not to be afraid of. Visit us at our website if you need to, and please don't worry excessively about cancer.

Host: Thank you very much, Dr. Lum Wan Wei, for your time on this podcast. For anyone with more questions, feel free to drop them in the comments below. If you like content like this, we will keep making it with many more doctors. Please keep watching the podcast. Thank you so much, Doctor.

Dr. Lum Wan Wei: And as the younger generation tells me — if you like it, give us a like, do a follow, and subscribe to the channel. Have a good day.

Host: Like, comment, and subscribe. Have a good day, everyone. Thank you!

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