There is a saying – paraphrased from American statesman Benjamin Franklin (1706-1790) – that “nothing in life is certain except death and taxes”.
This is something that cervical cancer survivor Teri Choong firmly believes in.
Says the 49-year-old: “So you can’t run away from paying taxes, but when it comes to death, I can choose the way I die.
“We can’t escape death; but we can control the way that we live, whether we live in misery or we live gloriously.”
Saying that she would definitely choose the latter, Choong adds with a laugh: “Even though you know you’re going to die, choose to fight to the end – what do you have to lose anyway?”
Currently based in Singapore as the corporate affairs director of a multinational company, the Selangor native is very enthusiastic about raising awareness of cervical cancer and its prevention.
The most important risk factor for cervical cancer is an infection of the sexually-transmitted human papillomavirus (HPV).
There are two ways of preventing this infection: practising safe sex by using a condom and getting a HPV vaccination.
Women who are sexually active are also encouraged to undergo an annual Pap smear, which is meant to help detect pre-cancerous and cancerous cells on the cervix.
When Choong was diagnosed in November 2005, she was 35 and had already been married for over a decade.
She shares that she had been going for a Pap smear ever since she was sexually active at 20; however, the tests never showed anything abnormal.
This was despite the fact that she had been having abnormal periods starting from her late 20s.
She’d experience spotting, which is light bleeding from the vagina in between periods, and her period would last about 23 days (most regular menstrual cycles last about three to five days).
“Every time I went to the doctor, they would say it’s hormonal, and I guess at my age, they did not look beyond that.
“So, they would give me antibiotics and something to regulate the bleeding,” she shares.
After taking the medications, her period would go back to normal, but after six months or so, the problem would return.
This went on for about five years, until one day when she started bleeding irregularly just before she and her husband were supposed to go for a scuba-diving trip.
This time, she went to see a new doctor in a different hospital.
After hearing her history, the doctor asked to do a biopsy on her cervix.
“So I said, ‘Sure, why not?’, not thinking that he would be looking for cancer cells – he didn’t even tell me, he just said, ‘I want to take samples’,” recalls Choong.
Three days later, she received a call asking her to come in with her husband for the results.
Still not suspecting anything, the couple went to see the doctor and received the news that she had Stage IIb cervical cancer.
“I blinked my eyes a few times. My mind went blank for a while, I’m not sure how long – the doctor was talking, but more to my husband and I didn’t know what was going on.
“After a while, I just snapped out of it and the first question I asked was, ‘What can we do?’” she shares.
The reason why the earlier Pap smears had not detected her cancer was because the tumour was growing behind the area where the cervical cells are usually collected from.
Choong was fortunate in that she had symptoms to alert her new doctor that she might have something sinister going on.
Cervical cancer often does not cause any symptoms until the disease is at an advanced stage.
The treatment recommended in her case – since she had already had four daughters and was not planning to have any more children – was a hysterectomy, a surgery to remove her uterus and cervix.
While Choong was quite sure she wanted to do the surgery, she opted to get a second and third opinion.
This included sending her biopsy samples to John Hopkins University in the United States via a then-pioneer programme by Asia Assistance, which provides local and international medical assistance, among others.
For her third opinion, she was referred to the now-retired consultant obstetrician and gynaecologist Dr Wong Sum Keong.
She also decided to have him perform her surgery, which was set for the following month on Dec 23.
Says Choong: “The most interesting thing was everyone was telling me not to do the surgery.
“And of course, people would ask, why did you pick just before Christmas?
“So my answer to them was, because I want to live long enough to see the next Christmas and many Christmasses after that, so (the date) doesn’t matter.”
At that time, she was already volunteering with Pantai Hospital Kuala Lumpur to help make their breast cancer campaign more appealing.
So, after her diagnosis and treatment, it wasn’t a far stretch to get involved with Assunta Hospital in Petaling Jaya, Selangor, for their breast and cervical cancer education campaign.
In fact, her own experience with cancer and with other cancer patients, inspired her to come up with a module for health professionals on the right bedside manners for cancer patients.
“It’s not about how I had cancer or what I did, but I think people ought to know what they need to know before it even happens.
“It means, don’t take it for granted, don’t take it as if you’re invincible; just because you’re young does not mean you’re not going to be a victim,” she says.
For cervical cancer specifically, she points out that there is an obvious preventative measure, aside from using condoms during sex.
“Back then, there was no such thing as a HPV vaccination.
“But if it’s available now, why aren’t people taking it more seriously?” she asks, adding that all her four daughters have received the vaccination.
Choong notes that HPV doesn’t just affect women, but men as well, who can get genital warts and the rare case of penile or anal cancer from an infection.
There are currently two vaccines available: one that protects against four HPV types and the other, nine types.
These vaccines are approved for both men and women, and are recommended to be taken before having sex for the first time.
Meanwhile, practising safe sex not only helps prevent HPV infection and other sexually-transmitted diseases, but also helps prevent pregnancy for family planning purposes.