Early detection is key when it comes to surviving breast cancer. Photo: 123rf.com
When it comes to breast cancer, early detection is everything. Breast cancer is the most common cancer among women in Malaysia – 1 in 30 will be diagnosed in their lifetime – and yet a majority of women do not routinely check their breasts for abnormalities, or go for annual screenings after the age of 40.
The lack of access to screening facilities in rural areas may contribute to the problem, but National Cancer Society Malaysia (NCSM) president Dr Saunthari Somasundaram feels that the bigger issue is women’s indifference towards their breast health.
“Early detection in so important, I can’t stress this enough. The earlier you catch it, the better the outcome, not just in the number of years you will live but the quality of life you will enjoy. All the research shows that late-stage breast cancer exponentially increases your mortality rate,” she says.
“The incidence of cancer in Malaysia is not as high as countries like Australia or the US (1 in 8), but our survival rate is much lower (49% compared to 89% in Australia). This means we have fewer women with breast cancer, but we have more deaths. The reason? Most women are diagnosed at a later stage.”
The size of the tumour and how far it has spread are the biggest factors determining the outcome for a patient. The aim is to catch it early.
“When breast cancer is detected early (stage 1), the survival rate is close to 90%. At this stage, the cancer is contained in the breast and hasn’t spread to the lymphatic or vascular system. It’s easier to treat at this stage,” Dr Saunthari explains.
“At stage 2, the survival rate drops to about 70%. At stages 3 and 4, the outcome is even less positive and treatment is more complicated,” she adds. In Malaysia, about 43% of newly diagnosed breast cancer cases are already in stages 3 and 4.
Only 10% of breast cancers are preventable. And unlike other forms of cancer, there isn’t one singular test that can clear a woman of it for the rest of her life. Staying vigilant is the only way to spot the disease. Doing breast self-exams, Dr Saunthari stresses, is about taking responsibility of our bodies.
“We need to be more breast aware; take charge of our own health and our bodies,” says Dr Saunthari, who is also the medical advisor to NCSM.
“Most women would recognise any change on our face because we look at it all the time. Our face and how we look is important to us. Why don’t we do the same with our breasts? If we look at our breasts and feel them regularly, we would most likely detect changes and get checked.”
According to the Health Ministry’s National Health and Morbidity Survey (2015 to 2018), only 6.6% of adults aged 18 and above have an “adequate” level of health literacy. A 2014 study by Universiti Putra Malaysia researchers further revealed that 70.5% of respondents (female undergraduates) did not perform regular breast self examinations (BSE) nor did they know how to. Their knowledge of breast cancer and BSE was also inadequate.
“Accessibility is definitely something the Health Ministry needs to address. We see progress in urban areas where more women are screening earlier, but in rural areas where you don’t have easy accessibility to mammograms and diagnosis, we aren’t seeing a real shift,,” she says.
“But even when there are programmes to improve accessibility in rural areas – NCSM, in partnership with Etiqa insurance and Takaful offers 5,000 free mammograms in rural areas annually, while the National Population and Family Development Board (LPPKN) has its screening programmes too – we’re not seeing enough response from women.
“We need to ask ourselves, why are we not reaching these women? Clearly it’s not enough to just talk about this when Pink October comes around. We need to talk about this all the time,” she adds.
Improved health literacy is key in dispelling stigma around the disease and misconceptions that cause many to rely on traditional medicine instead of seeking treatment. Dr Saunthari says the onus is on the health system. Physicians and public health practitioners need to keep pushing the message of early detection to women, so that they think about breast health as part of their general health.
“The health service has to be proactive. We cannot expect women to be proactive after a once-a-year campaign,” she says.
“If a patient comes in for a common cold or the flu, they have their blood pressure and pulse checked. It’s routine. We should make this routine too. Even if a woman doesn’t go to a physician about her breasts, our physicians should ask them if they’ve done their routine checks, or if they know how to do a self exam.
“If not, we need to urge them to do it. If they are reminded regularly, chances are they will get it done. As for women in rural areas, this may be the best way to make sure they check (themselves) or get checked,” says Dr Saunthari.
