I have reached that age when news from friends changes.
The messages that were once about weddings and births now arrive, more often than I would like, with a quiet “do you have some time to chat?”.
In recent years, a few women I care about – friends and loved ones I have known for years – have been diagnosed with breast cancer.
For most of them, it came out of nowhere.
They were busy, they felt well, and breast cancer was something that happened to other people.
That is less unusual than it sounds.
The World Health Organization (WHO) notes that around half of all breast cancers occur in women with no identifiable risk factor other than being a woman over the age of 40.
Their stories came to mind as I thought about “United by Unique”, the World Cancer Day theme for 2025 to 2027, which the Health Ministry adopted at its national launch in February (2026).
The Health Minister described it as recognising that every patient’s story differs in its challenges, emotions and needs, while all share the aim that no one should face the disease alone.
As a doctor, I know that what shapes each of those journeys most is the stage at which it begins.
Where we stand
Breast cancer is the most common cancer among Malaysian women, and it is becoming more common.
The National Cancer Registry recorded 29,534 cases between 2017 and 2021, and a Malaysian woman’s lifetime risk rose from one in 27 to one in 23, compared with the previous five years.
Diagnosis is also getting later.
Of cases with a recorded stage, just over half (50.5%) were found at stage 3 or 4, up from 43% in 2007-2011, while the share caught at stage 1 fell from about 20% to 15%.
Preliminary figures for 2022 and 2023 show more than half were still diagnosed late.
Why screening matters
A mammogram can detect breast cancer before any symptoms appear, and the stage of the disease makes an enormous difference.
In the Health Ministry’s national survival study of more than 17,000 women, five-year survival was 87.5% for those diagnosed at stage 1 and 23.3% at stage 4.
Overall survival was 66.8%, against more than 90% in Japan and South Korea, and 79% in Singapore.
This ranged from 57.9% among Malay women to 76.5% among Chinese women.
National guidelines advise a mammogram every two years for women aged 50 to 74 who are at average risk of breast cancer.
Women at high risk are advised to undergo a mammogram earlier and more often.
In addition, women should have an annual clinical breast examination starting from the age of 40.
Yet, Health Ministry data from 2016 to 2020 show only about a quarter of eligible women had a clinical breast examination in any given year.
Help is closer than many realise:
- The National Population and Family Development Board (better known by its Malay acronym LPPKN) subsidises mammograms through Klinik Nur Sejahtera
- PERKESO has the Health Screening Programme for eligible contributors aged 40 to 59
- Clinical breast examinations are available at all government clinics, and
- Certain non-governmental organisations (NGOs) like the National Cancer Council (better known by its Malay acronym Makna) and the National Cancer Society Malaysia provide free screening.
A new lump, skin dimpling, nipple changes or discharge need prompt attention at any age.
Where family and friends come in
Support starts well before any diagnosis.
A study of rural Malaysian women found that encouragement from husbands and family predicted whether or not they went for clinical breast examination.
In research from Segamat, Johor, women described husbands uneasy about male doctors examining their wives, fears of abandonment after a mastectomy, and childcare leaving no time for a check-up.
Families can remove those obstacles: ask the women in your life when they were last screened, and offer to drive them to the clinic, mind the children or simply go along.
Support matters just as much after a diagnosis.
In a pooled study of more than 9,000 women with breast cancer, including a cohort from Shanghai, China, socially-isolated women were about 60% more likely to die of the disease than those with strong social ties.
Practical help counts: lifts to chemotherapy, meals, chores at home, company in the waiting room, etc.
So does staying present long after the first flurry of messages fades, and making clear that a changed body changes nothing about how she is loved.
What policy should change
Individual effort only goes so far.
Years of awareness campaigns have not reduced the share of women being diagnosed late, and a few structural reforms would make a measurable difference.
Move from opportunistic to organised screening.
Mammography screening has been shown to reduce breast cancer deaths, and organised programmes invite women by name and follow up those who do not attend.
MySejahtera and existing health records could be adapted for this.
Bring the schemes run by the Health Ministry, LPPKN, PERKESO, state governments and NGOs under a common eligibility framework and a shared screening registry linked to the National Cancer Registry, so that we can see who is being missed.
Shorten the road from an abnormal result to treatment by publishing time-to-diagnosis and time-to-treatment standards, expanding one-stop breast clinics and funding patient navigators, particularly in Sabah, Sarawak and rural districts.
Offer subsidised genetic counselling and BRCA testing to women with strong family histories, and to their relatives.
Take prevention seriously, as screening lowers deaths, but not the number of women who develop the disease.
Excess weight after menopause, alcohol consumption and tobacco exposure raise risk, and physical activity and breastfeeding may lower it, so obesity measures and workplace lactation support are breast cancer policies too.
A final word
The women who have faced this disease did not choose their stories, and none would want to be reduced to a statistic.
What we can influence is how many future stories begin early, and how few are lived alone.
The measure of this campaign should be fewer women diagnosed at stage 3 and 4 in the registry figures to come.
Dr Helmy Haja Mydin is a consultant respiratory physician, and chairman of the Social & Economic Research Initiative and PERKESO Rehabilitation Centre respectively. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
