It has been only about a year since Dr Janncy Wong, 42, underwent a double mastectomy after being diagnosed with breast cancer.

She had no symptoms, but because of her family history (her mother, a breast cancer survivor, was diagnosed 18 years ago), she was diligent about having mammograms.

The one she had when she was diagnosed at 41 showed cancer in her left breast. There were also lesions in her right breast which may not have been cancerous, but she made a momentous decision.

Given her family history - and the certainty that she didn't want to repeat the terrible experience she was going through then - she opted for a double mastectomy. Her doctor agreed.

It is still not easy for her to talk about the roller-coaster chain of events that has taken place over the months.

Dr Wong, who is on leave from her position as a senior resident physician at Changi General Hospital until November, still vividly remembers her reaction the day she was told about her diagnosis.

'The world blanked out. It was as simple as that," the petite doctor said, her eyes welling with tears.

As soon as she could, she told her husband, Dr Eng Soh Ping, a consultant Ear, Nose and Throat surgeon at Ascent Ear Nose and Throat Specialist Group. The couple had met in medical school and have been married for over a decade.

He was her pillar of strength throughout her ordeal, unfailingly providing her with emotional support every step of the way.

She said: 'He knew he had to be extra strong for me. I had so much anguish over this happening to me at this time in my life. My husband and I had so many plans, so many things we wanted to do, so many places we wanted to see. And this had to happen and sweep everything away."

They decided on a vacation break before her mastectomy.

'We love to travel and I had always wanted to see the offshore limestone stacks called the Twelve Apostles near Melbourne, Australia, so I decided on that for our last trip before my surgery,' she said.

Dr Eng agreed that the vacation was a good break given the whirlwind of events that had taken place after his wife's diagnosis. It was also an opportunity to spend time with his wife and to listen to her fears and concerns without the distractions of work.

'We didn't talk about the cancer every minute of the holiday,' said Dr Eng. But his wife added that dark thoughts of her upcoming surgery always loomed: 'I'd be taking in the beautiful scenery or admiring the hotel decor and I'd suddenly think about the mastectomy. It was always there. It never went away."

Her mastectomy was performed by Dr Ho Gay Hui, senior consultant breast surgeon at the National Cancer Centre. The months following the surgery were physically and emotionally trying ones for the couple.

The mastectomy made Dr Wong too feeble to perform many simple tasks. Her husband would help her bathe, comb her hair and put on her clothes. He would rush back from work to their home in Bukit Timah to take her for daily walks in the Botanic Gardens.

He tried to provide her with the best care he could by imagining himself in her shoes. He bought her an electric toothbrush because brushing her teeth manually was too strenuous for her. He limited the number of visitors so she would not over-exert herself.

She tired easily and would often be an emotional wreck, venting her frustrations and anger on him.

She said: 'He was my emotional punching bag. He always took my emotional outbursts quietly, letting me scream and shout at him. My emotions were often so volatile.'

She found herself frequently seeking her husband's reassurance that he did not find her less attractive after her mastectomy.

For Dr Eng, the thought that his wife was a lesser woman in any way after her surgery never crossed his mind.

He said: 'She's a strong woman and I was surprised that she would ask that. I love her all the time.'

PAINTING AWAY PAIN

Ting (not her real name), 43, who works in the education field, had a mastectomy at KK Women's and Children's Hospital (KKH) in January this year.

She had spent two weeks agonising over whether to go ahead with the operation and over the pros and cons of having reconstructive surgery after that.

She finally decided against the procedure to restore the appearance of her breast.

After her mastectomy, which left her with a scar as long as her palm where her right breast used to be, Ting joined a 10-week art therapy class organised for breast cancer patients at KKH.

She found that the drawing paper was not unlike a mirror. 'It allowed me to look at myself," she said.

'My breasts had become one breast and one scar. I painted that repeatedly on paper - one breast, one line, one breast, one line. That was my body," she said.

She also painted the way her 'asymmetrical" bosom felt to her: 'One side's soft and tender and the other is flat and hard, like a plank."

The art therapy sessions were led by an art therapist from Lasalle College of the Arts.

It proved to be fruitful and provided the support she needed, and she became friends with a fellow art therapy participant.

They would draw silently, but at the end of each session, they would often share their paintings with each other and talk about the way their feelings metamorphosed on paper.

Ting found one session, when she was assigned to depict cancer cells, profound. She started drawing a black spot, about the same irregular shape as the images of the malignant lumps she had seen in her scan.

'But I made it bigger and bigger and I couldn't stop. I was crying as I poured more and more black paint onto the paper," she recalled.

When the blackness covered almost the entire paper, she decided to add a green shoot at the top to depict hope sprouting from darkness.

'I had cried and painted out all the pain and loss that I felt. I let them all go and that gave me life. It seems like a paradox that life and hope can emerge out of cancer, but that was what I experienced."

Art therapy, which helped Ting cope with the pain and loss, complemented her meditation sessions.

'Meditation equipped me with the skill to manage my emotions in a positive manner and taught me to distance myself from stress and negativity. It has brought me calm."

Looking back, Ting feels fortunate that the year has been one of personal growth and spiritual renewal enriched by the love of friends and family.

'It sounds strange, but I can say that my journey with breast cancer has been an enriching one."

STRENGTH IN SISTERS

Breast cancer is no stranger to the Tham* family. The mother and two aunts of sisters Lynn*, Cindy* and Wendy* had the disease. One cousin had recently died after losing her battle with cancer.

Lynn, the eldest sister, had a cancerous lump removed from her breast in 2000, followed by radiotherapy. Earlier this year, the cancer struck again.

The 43-year-old mother of three, who is taking extended leave from her job in the banking industry, is currently undergoing chemotherapy at the National Cancer Centre. She has five younger siblings, four of whom are sisters.

Wendy, the youngest sister who works in the IT industry, underwent chemotherapy for breast cancer two years ago when she was 34.

Cindy, 42, who works in the construction industry, tested positive for an altered BRCA2 gene in mid-2007. As this meant that she had a high risk of developing breast cancer and also ovarian cancer, Cindy decided to have her ovaries removed.

According to the National Cancer Centre, mutations in two breast cancer susceptibility genes, called BRCA1 and BRCA2, occur in some patients with hereditary breast and ovarian cancer. Women who carry a mutated BRCA1 or BRCA2 gene have a 40 to 80 per cent risk of developing breast cancer by age 70 and a 40 to 60 per cent risk of developing ovarian cancer.

Lynn, who is youthful-looking in a fashionable short wig, was jovial and remarkably upbeat for someone undergoing chemotherapy. The sisters appeared very loving and close-knit.

Lynn attributed her positive attitude to the support and love of her family, especially her sisters. They make sure that she always has company during visits to the hospital and at every chemotherapy session. Her father even stayed at her flat when she had just started chemotherapy so he could help with the housework and look after her children.

It was the same strong family support that gave Cindy the assurance that she too can beat breast cancer should the disease develop in her body. She said: 'I am prepared. I will have my family to get me through it.'

Lynn added: 'We know we can always count on one another. That's enough.'

* None of the names used are real.

This article was first published in Mind Your Body, The Straits Times on Oct 2, 2008.