It's the smell that hits you first. Even before I saw the patient, the foul smell of rotting flesh warned me.

'Yet another who may have left it too late," I told myself.

The patient was a woman in her early 30s who worked as a financial consultant. She had fainted at the airport because of severe anemia. As it turned out, she had been bleeding continuously from a large fungating mass for several months.

The tumour, about the size of a large orange, had broken through the surface of her skin and had become infected. She packed it with pressure bandages to slow the blood loss and used lots of perfume to mask the smell.

She received medical attention late, but not, I hope, too late. Six months later, she is now doing better, but is not out of danger yet.

The question is why would someone like her - a highly intelligent person - harbour a large breast cancer and refuse to see a doctor?

I believe the initial reason is one of denial. Wishful thinking that the lump is 'nothing serious" and that it would somehow go away. As the lump gets bigger, some patients do not dare to see a doctor partly because they realise that this is cancer and they fear the treatment process - surgery, chemotherapy and radiotherapy. Others have a fatalistic view that if it is cancer, they are doomed anyway.

In the case of this young woman, I think that by the time it got so big, she was too embarrassed to bring it to the attention of either her family or her doctor.

This is the most crucial message about breast cancer: 'Early detection saves lives".

If you are a woman over the age of 40, call your doctor to set up your annual mammogram today. More breast cancers are being detected at an early stage because of greater awareness of the importance of mammography screening. These very early cancers have no symptoms and often cannot be felt even by an expert.

The earlier breast cancer is detected, the better are the chances of cure.

With surgery alone, the cure rate is 100 per cent for stage 0, 70 to 80 per cent for stage I, 50 per cent for stage II and 10 to 30 per cent for stage III breast cancer. These cure rates can be significantly improved by the addition of hormonal therapy, chemotherapy or some newer targeted therapies.

Of all the many cancers that oncologists see, I think looking after patients with breast cancer is one of the most satisfying. Breast cancer is one of the most treatable and curable of all the cancers. Even at the advanced stage, patients can often continue to live for many years.

It is hard to believe but women actually shy away from mammograms because of the stories that it is painful.

There is some discomfort because we need to compress the breast as flat as possible so that we can get the best images. However, I think it is worth it if this maximum of two minutes of discomfort can give you a better chance of detecting breast cancer early. So I strongly urge all of you who have not gone for your mammograms to stop procrastinating and do it today.

After I tell a woman she has breast cancer, at some point, it is not uncommon for her to say: 'But I have no family history of breast cancer'.

It is a misconception that you're 'safe' because there is no family history of the disease. The other comment that is not uncommonly made is: 'But I breastfed my children'.

It is believed that breastfeeding offers some degree of protection against breast cancer but it does not guarantee against it.

Only 10 per cent of breast cancer patients have a family history of breast cancer. There are several observations and hypotheses on who is at higher risk of breast cancer and why.

The risk of breast cancer is associated with increasing affluence. Affluence often leads to changes in diet. Diets with higher fat content like meats and diary products increase the risk of developing breast cancer.

A higher number of uninterrupted menstrual cycles is also associated with higher incidence of breast cancer. These are women who have early menarche (the first menstrual period), get married late, have few or no children and who do not breast feed.

I hear that girls in Singapore are having earlier menarche (as early as at 10 years) compared to their mothers and grandmothers. With fewer choosing to get married and have children, it is no surprise that the incidence of breast cancer is on the rise in Singapore. This does not mean that the trend cannot be arrested.

Mother's Day is in May. I hope that sons and daughters will remind their mothers and grandmothers to go for a mammogram before then.

This is the second of a three-part series on the three top cancers in Singapore: lung, breast and colorectal cancer.

Dr Ang Peng Tiam, the medical director of Parkway Cancer Centre, has been treating cancer patients for nearly 20 years. In 1996, he was awarded Singapore's National Science Award for his outstanding contributions to medical research.

This story was first published in the Mind Your Body supplement on Mar 26, 2008.