By DR MASTURA MD YUSOF

Of late, there have been many news articles pertaining to cancer – the big C is no longer a taboo subject. This is a war we need to fight together to win.

The most common cancer affecting women worldwide and in Malaysia is breast cancer.

Data from the GLOBOCAN 2012 (the World Health Organization/International Agency for Research on Cancer’s project to provide estimates of the incidence, mortality and prevalence from major types of cancer for 184 countries) shows that the incidence of breast cancer among Malaysian women was 28%, while the death rate was close to 25% – the highest in the ASEAN region!

Not to mention, these figures were also higher than the world average of about 25% and 15% respectively.

Numbers aside, it is important to note that survival rates are highest when breast cancer is detected in its early stages, hence the saying, “early detection saves lives”.

That being said, it is when the cancer cells metastasize – spreads beyond the breast – to other parts of the body that it poses a huge threat to one’s life.

Although there has been fierce advocacy for annual breast check-ups and monthly self-breast examination within our region, a recent study conducted in Southeast Asia called the ACTION (ASEAN CosTs In ONcology) Study found that most cancer patients (including breast cancer patients) were at late stages of the disease at first diagnosis.

While we continue to strive to promote early detection, it is imperative that we also explore the available treatment options for patients with late or metastatic breast cancer.

HER2-positive breast cancer

Every 20 seconds, one woman is diagnosed with breast cancer somewhere in the world.

In every five women diagnosed, at least one will present with HER2-positive breast cancer – an aggressive form of the disease whereby cancer cells grow more rapidly and spread more quickly than other types of breast cancers.

As a matter of fact, about 15-20% of patients diagnosed with metastatic breast cancer are found to have unusually high levels of HER2.

Under normal circumstances, the HER2 gene controls growth, division and repair processes of healthy breast cells. However, when the HER2 gene over-replicates itself with a corresponding excessive growth of HER2 receptors on the surface of cells, breast cells begin to divide and grow uncontrollably.

Although HER2-positive breast cancer patients are expected to have lower survival rates compared to those with HER2-negative disease, in this day and age, receiving a diagnosis of metastatic HER2-positive breast cancer is no longer a death sentence.

Significant progress has been made over the past two decades involving treatment with HER2-targeted therapy in these patients, showing improved outcomes.

Treating HER2-positive metastatic breast cancer

Most people would have heard about chemotherapy – a type of treatment used to stop or slow down the growth of cancer cells.

Chemotherapy is used to treat women with metastatic breast cancer via its cell-killing effect on fast multiplying cells throughout the body, but it does not specifically target cancer cells that have HER2 receptors.

Researchers worked tirelessly to better address this cancer, identified as a very invasive subtype of breast cancer. Treatments that surfaced over the years have been specifically targeted to attack cancer cells found to harbour HER2 receptors on their surfaces.

This targeted therapy treatment is commonly known as anti-HER2 therapy. Some targeted therapies are used in combination with chemotherapy, while others can be given as standalone treatments.

Trastuzumab, Trastuzumab Emtansine, and Pertuzumab are three examples of such treatments which are able to prevent further uncontrolled breast cell growth.

The emergence of anti-HER2 targeted therapies has brought positive changes to the HER2-positive metastatic breast cancer treatment landscape and has shown remarkable outcomes in patients.

Patients with advanced stages of cancer are given hope for better survival rates without their quality of life being compromised. Some treatments have also seen quality of life improved.

It is important that HER2-positive metastatic breast cancer patients in Malaysia are given access to these treatments to ensure they are not deprived of the potential benefits, including an increased chance for improved overall survival.


Dr Mastura Md Yusof is a clinical oncologist. For further information, e-mail starhealth@thestar.com.my. 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.