FOR the past two years she has lived in denial.

The woman in her late 70s lied to herself that the cancerous tumour protruding out of her skull didn't exist.

But ignoring the problem - a cancer related to her thyroid gland - didn't make it go away.

Instead, the tumour grew steadily from the size of a tiny bump on her head to its current mass, about the size of pencil case (12cm) from the front to the back of the woman's head.

Now her tumour has eaten into her skull and is pressing onto her brain.

On top of the growing tumour, the Singaporean also had headaches, dizziness and nausea.

Despite the physical evidence and family pressure, the Singaporean woman continued to denyher condition.

She did see doctors but would not undergo treatment.

Without treatment, she may have only three more months to live.

She isn't the only cancer patient avoiding treatment. Doctors said patients in denial in clude the young and educated.

Although the Singapore Cancer Society (SCS) isn't able to provide numbers, doctors told The New Paper up to 10 per cent of their patients decline or resist treatment.

Fear of facing problem
And the most common reason patients offered is fear. 

But the disease is a problem here and doctors are reporting more cases of patients who get diagnosed with cancer.

The National Registry of Diseases Office shows an increase from 8,144 cases in 2003 to 9,763 cases in 2007. Cancer is also Singapore's number one killer. More than one in four of the deaths here are caused by cancer every year.

Despite medical advancements, the availability of subsidies and cheaper drugs, some patients still resist treatment.

As in the case of the elderly woman.

Dr Wong Seng Weng, 40, medical director of The Cancer Centre, first saw the stage-four cancer patient in early January.

He learnt that she had consulted at least one other doctor earlier but refused further treatment because "her fear of being sick was
so great."

That was two years ago but the patient still has not come to terms with her illness, said Dr Wong.

He's still trying to gradually persuade her to seek further treatment, he told The New Paper.

He said: "She's in denial and says it's not a serious problem."

The woman declined to speak to The New Paper because she's not ready to face up to her illness yet, said her doctor.

Early intervention could help patients like her, said doctors.

Take the case of cancer patient Wu Xiao Fen, 25, from China.

Her tumour is similar to that of the elderly woman but she had it successfully removed here.

But it isn't just the elderly who resist treatment.

Dr Ang Peng Tiam, 51, the medical director of Parkway Cancer Centre related a case involving a woman who worked in private banking.

The woman who was in her 30s, knew she had breast cancer for "at least three years", but didn't do anything.

She allowed her tumour to grow until it became a 15-cm mass which bled until she collapsed in 2006.

She was paralysed by fear of what the growing lump meant, said Dr Ang.

It was only after fainting that she received medical treatment.

By then, it was too late. She died last year.

Dr Ang, who has treated cancer patients for 23 years, pointed out: "She was not an ignorant person. She was in private banking and well-educated.

The thought process ofa patient rationalising why they do not need to be treated, changes as their condition worsens, said Dr Ang.

In the banker's case, the patient had initially thought of the tumour as "nothing", but as it grew bigger, she realised it was "something".

By then she had convinced herself that it was too late to get anything done anyway, he explained.

The biggest reason for delaying or refusing treatment boils down to fear, said Dr Wong.

He said: "There is the fear of diagnosis, the possibility of death, pain and suffering, so patients can choose to ignore the problem in hopes that it will go away."

Misconceptions about cancer
Some patients think they shouldn t treat the cancer or it would spread further believing that they will recover
naturally.

And contrary to perception the youngar patients are not immune from such beliefs, said Dr Wong Seng Weng,
40, medical director of The Cancer Centre.

He said: "They become their own doctor, forming their opinions based on Internet research, which may not
necessarily be always reliable.

"They think that by changing their diet and lifestyle alone, they can fight the cancer, with disastrous consequences."

Mr Gilbert Fan, the head of department of psychosocial oncology at the National Cancer Centre Singapore (NCSS), said some patients decline treatment because of inadequate family and social support.

He said: "They feel that they need additional support for cooking and managing household chores.

"For these patients, we (NCCS) support them with alternatives like getting volunteers to take them for their
treatment appointments or place them in temporary nursing homes while they undergo treatment."

Dr Wong Kutt Sing, a specialist in general surgery at Raffles Hospital, said some patients just aren't aware
they have a serious problem.

He said: "Some patients have intra-abdominal cancers that do not show obvious symptoms - such as
vague abdominal pain as in stomach or pancreatic cancer.

"Due to the invisibility of such cancers, it is easy for patients to be in denial and hence refuse to undergo
treatment."

Then there are the side effects that patients fear.

But Dr Wong said that with medical advances over the last decade, drugs that are carefully administered can
result in less severe side effects.

Dr Ang believes the easiest way of convincing patients to receive treatment is through show and tell.

He shows patients pictures of other patients before and after treatment to demonstrate how well they have
responded.

He said: "They realise then how treatable cancer can be. A picture is worth a thousand words."

There are also patients who have known people who have died from cancer, and those who don't want to
burden their family.

Mr Fan said those who cannot be convinced to get treated usually have other priorities, like saving for their
children's education or forthe family.

Said Dr Wong: "The disappointment is difficult to deal with, but at the end of the day, it is the patient's right to
choose.

"What doctors can do is to ensure that patients make their decisions based on as true and accurate an
understanding of cancer as possible."