October has been Breast Cancer Awareness Month since the 1980s.
The first effort to bring public attention to breast cancer was a week-long event in October 1985, organised by the American Cancer Society and the Imperial Chemical Industries Pharmaceuticals, which became part of pharmaceutical multinational AstraZeneca.
Since then, annual campaigns have been held globally to increase awareness of the disease, to educate the public about prevention and early detection, and to raise funds for research.
Breast cancer is the most common cancer in Malaysian women with a lifetime risk of one in 23 for all females, one in 26 for Malays, one in 19 for Chinese, and one in 17 for Indians, according to data from the 2017-2021 National Cancer Registry.
The age-specific incidence rate increases from 62.9 at 40-44 years to 94.3 at 45-49 years, 114.6 at 50-54 years, 132.3 at 55-59 years, 145.8 at 60-64 years, and 149.9 at 65-69 years.
The stage of a cancer refers to the size of the cancer and its spread.
The grade refers to the cellular abnormality on microscopic examination.
Stage 1 means that the cancer is small and only in the breast, or it might be found in lymph nodes near the breast.
Stage 2 means that the cancer is either in the breast or in the nearby lymph nodes, or both.
Stage 3 means that the cancer has spread from the breast to the lymph nodes near the breast, the skin of the breast or to the chest wall.
Stage 4 means that the cancer has spread to other parts of the body like the bones and lungs.
Half (50.5%) of Malaysian women had advanced disease at diagnosis with 28.3% and 22.2% in stages 3 and 4 respectively, compared to 15.1% and 34.4% in stages 1 and 2 respectively.
Risk factors
The risk for breast cancer is due to a combination of factors.
The main factors are being female and increasing age, with most cancers diagnosed after 50 years of age.
Some of the risk factors cannot be changed, while there are others that one can do something about (i.e. “modifiable”).
The factors that cannot be changed include:
Older age is a main risk factor and reflects cumulative cell damage resulting from biological processes or exposure to risk factors over time.
Genetic mutations in the BRCA1 and BRCA2 genes increase the risk.
Periods that start before 12 years and cease (menopause) after 55 years increase the duration of exposure to hormones, thereby increasing the risk of breast cancer.
This refers to a personal history of breast cancer or certain breast conditions.
Women who have had breast cancer are more likely to get the disease a second time.
Women with conditions like atypical ductal hyperplasia have an increased risk.
This refers to a family history of breast or ovarian cancer.
The risk may be increased if a first-degree relative (i.e. mother, sister or daughter) or family members of either parent have had breast cancer, or if a relative had breast cancer at a young age.
A family history of ovarian cancer or breast cancer in a male relative also increases the risk.
Previous radiation to the chest or breast before 30 years of age increases the risk of breast cancer in later life.
DES that was administered before 1971 to prevent miscarriage increases the risk of breast cancer.
Those whose mothers took DES may be at increased risk as well.
Healthier lifestyle choices can prevent about one in four breast cancers.
The important lifestyle choices include regular exercise, maintenance of a healthy weight, breastfeeding, smoking cessation, and avoidance of exposure to tobacco smoke, alcohol, prolonged use of hormones or excessive radiation exposure.
Recent studies have shown that maintaining a balanced diet and body weight can affect breast cancer risks for women 10, 20, or even 30 years later.
Keep a look out
The symptoms of breast cancer include:
- Changes in nipple appearance or alteration in the skin around the nipple (i.e. areola)
- Abnormal or bloody nipple discharge
- A lump or thickening in the breast
- Change in breast colour
- Pitting of the breast skin, or
- Pain in the breast or nipple.
It would be advisable for anyone with the above symptoms to seek medical attention without delay.
Breast awareness refers to the regular look out for any breast changes.
Some women prefer breast self-examinations, which can be helpful.
However, the most important action is routine monitoring of the breast for any abnormality and seeking medical attention if there are any concerns.
The abnormality will not go away if medical attention is not sought.
Breast awareness improves health-seeking behaviour, thereby improving early diagnosis.
Early diagnosis, better outcome
Early diagnosis is less resource-intensive and improves significantly the effectiveness of treatment and survival after treatment.
It also facilitates less aggressive treatment.
These factors improve the quality of life.
Targeted systematic screening of asymptomatic women facilitates early diagnosis.
Such screening, which is primarily a mass public health intervention, requires commitment, organisation and expense, which is practical when there are sufficient resources in the healthcare settings.
There are various breast awareness and early diagnosis initiatives by both governmental and non-governmental organisations and medical professionals globally.
These include:
- Increasing population awareness to educate the public about breast cancer prevention, its common symptoms and the benefits of early diagnosis.
- Teaching women to check their own breasts regularly for any changes.
- Training of frontline healthcare professionals in the recognition of the early symptoms and signs of breast cancer, and appropriate referral of suspected cases without delay.
- Improving the healthcare delivery system’s capacity to evaluate symptomatic women with appropriate diagnostic procedures.
Breast awareness is important because breast cancer is very curable if detected early and treated adequately.
This is especially crucial in Malaysia where more than half the cases are detected late.
Early care is better care.
Treatment can be challenging as it requires surgery, radiotherapy and/or chemotherapy.
The completion of treatment offers the best possibility of cure and survival.
Measures that address issues like mental well-being, sex, nutrition, counselling, etc, facilitate treatment completion and improved outcomes.
As such, it is important that care is provided by a multidisciplinary team of healthcare providers.
Support groups are helpful.
They provide an avenue for sharing by current and previous sufferers.
This facilitates the coping of emotions and working through of the various challenges and feelings during diagnosis, treatment and afterwards.
Some of these support groups can be found at the websites of national organisations like National Cancer Society Malaysia, Breast Cancer Welfare Association Malaysia and Breast Cancer Foundation, among others.
Moving the needle
The World Health Organization’s (WHO) Global Breast Cancer Initiative, which started in 2021, emphasised the need for health promotion for early detection, timely diagnosis and comprehensive breast cancer management.
The goals were to have more than 60% of cases diagnosed at stages 1 or 2; diagnostic evaluation, imaging, tissue sampling and pathology within 60 days; and more than 80% of cases undergo multimodality treatment without abandonment.
Malaysia’s five-year relative survival rate of 67% lags behind the 80-90% in developed countries.
This is not surprising as more than half of our breast cancer patients had advanced disease at diagnosis.
The significant gaps in breast cancer management in Malaysia requires action from the Health Ministry to improve the patient’s journey, from access to early detection, timely diagnosis and optimal treatment.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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