Cancer studies should focus on Asian women, says Malaysian scientist awarded RM11.5mil grant

Ho says that breast cancer research that is specific to the Asian context is necessary as it will be more relevant for Malaysian women. Photo: Dr Ho Weang Kee

Everyone knows that people are all genetically different, but did you know that our genes affect our health risks?

Because of this, it is important that there be rigorous breast cancer research that is specific to the Asian context (rather than European contexts), for it to be relevant for Malaysian women, says University of Nottingham Malaysia Faculty of Science and Engineering associate professor Dr Ho Weang Kee.

“According to the National Cancer Society Malaysia, breast cancer is the most common cancer in Malaysia.

“Breast cancer is a complex disease. Certain genes such as BRCA1 and BRCA2 are known to increase the risk in affected women by up to 80%, but only a small percentage of patients are in this category.

“For the majority, it is believed that breast cancer is caused by a combination of smaller, more common genetic variants which go-hand-in-hand with environmental factors such as lifestyle,” she says.

There is a surge in breast cancer cases among Malaysian women – especially those under the age of 40 – due to lifestyle factors, she highlights.

“Factors such as an imbalanced diet, lack of physical activity, alcohol use, not giving birth, and even longterm intake of contraceptive pills, all play a crucial role in increasing the chances of developing breast cancer,” says Ho, who is the winner of the Wellcome Trust (UK-based charitable foundation that funds research advancing scientific discoveries) Career Development Award – the first of its kind in Malaysia.

Differences in lifestyle factors between populations can also influence risk levels, she adds.

Historically, Asia has had a low rate of breast cancer compared to the West, but with a shift towards a more Westernised lifestyle and diet, the disease is now increasing at an alarming rate, she says.

Ho preparing for her presentation. Photo: Dr Ho Weang Kee

“For example, our recent Singapore-Malaysia collaborative study provided a comprehensive analysis of breast and ovarian cancer risk in Asian women with BRCA1 and BRCA2 mutations.

“We found that Asian BRCA carriers born in the 1920-1940s (Silent Generation) had about half the risk compared to European carriers.

“However, for Asian BRCA carriers born in the 1960-1970s (Gen X), the risks aligned with European BRCA carriers,” she explains.

“By studying how these factors vary in Asian populations such as Malaysia, we can understand breast cancer better.

“This helps doctors give better advice to Malaysian women, making sure they get the right care,” she says.

Ho adds that prior to their study, doctors had to give advice to Asian BRCA carriers based on European carriers’ analysis, without any evidence on whether it was accurate and relevant for them.

Ho presenting her data during a lecture. Photo: Dr Ho Weang Kee

“Existing studies predominantly focus on European populations, resulting in less accurate risk assessment for non-European contexts such as Malaysia.”

“This is because breast cancer research has traditionally been biased towards Western contexts with Asian populations being underrepresented in areas from risk assessment to datasets and research insights.

“We hope this research project will help to address the traditional lack of representation and patient data from Asian countries and strengthen research capacities and capabilities in Malaysia,” says Ho.

“Most women are often advised to attend breast cancer screening at a later age, but here’s the thing: every woman is different. Some might have a higher risk of breast cancer due to genetics, which means they could get cancer earlier before they’re 50, and it might not be detected in time. Others might have a very low risk and end up getting unnecessary tests.

“Hence, we are working on more accurate ways to provide an individual with a personalised risk assessment of breast cancer to so they can choose the screening and prevention that is right for them.

“That means fewer unnecessary tests for low-risk women and better chances of catching cancer early for those at higher risk.”

Ho with two members of the Cancer Research Malaysia team. Photo: Dr Ho Weang Kee

Securing the eight-year Wellcome Trust Career Development Award with its £1.92mil (RM11.5mil) grant will enable us to bridge the gap in cancer studies, she says.

The research project – co-hosted by the University of Nottingham Malaysia and Cancer Research Malaysia – is a collaborative effort that aims to reshape breast cancer risk prediction for Malaysians, focusing on creating a disease risk prediction model for underrepresented populations and improving risk communication, with the ultimate goal of making health more inclusive for all Malaysians, she adds.

“Our research project – spanning over eight years – aims to address critical gaps in breast cancer risk assessment, particularly within Asian ethnic subgroups where large-scale research data is often lacking.

“It will empower Asian, including Malaysian, women with valuable information to make informed decisions regarding their health.”

Although their primary focus is on breast cancer, Ho says their vision will extend to cover other non-communicable diseases in the future.

“These methods have broader applications beyond breast cancer and can be adapted to develop prediction models for other non-communicable diseases such as diabetes, cardiovascular diseases, and other types of cancer,” she concludes.