Breast cancer is the most common cancer among women in Malaysia.
In fact, it is the most common cancer in Malaysia, irrespective of gender.
The incidence of breast cancer has been on the rise for the past 20 to 30 years. Multiple factors have contributed to this rise, including sedentary lifestyles, obesity, having smaller families, less breastfeeding, hormone consumption and so on.
According to Sunway Medical Centre’s (SunMed) consultant breast and endocrine surgeon Dr Normayah Kitan, each year, about 5,000 new cases of breast cancer are diagnosed.
If you break down the Malaysian numbers according to ethnicity, breast cancer affects approximately one in 14 Chinese women, one in 16 to 18 Indian women, and one in 20 Malay women.
“Generally, we still have a lot of breast cancers that are detected at the late stage. This is a phenomenon seen in poor and developing countries.
“In Malaysia, this occurs probably due to differences in healthcare equity and lack of awareness about breast cancer.
“In remote areas of various states such as Sabah and Kelantan, the incidence of late stage presentation is quite high – almost 50% of women.
“In contrast, in the urban areas of the country, such as the Klang Valley, late presentation is about 25%,” notes Dr Normayah.
“We’re seeing more ‘urban’ cases earlier, probably because of increased awareness of the disease, but the numbers who present late are still substantial,” she adds.
Types Of Breast Cancer
There are different types of breast cancer. The type is often classified according to the specific cells in the breast that are affected.
Most breast cancers start in the epithelial cells that line organs and tissues throughout the body.
According to Dr Normayah, the most common types arise from the ducts – infiltrating ductal cancer (about 80% of invasive breast cancer are of this type).
Other types may arise in cells that make up the breast glands, fat or connective tissue.
In recent years, researchers have further classified breast cancers according to their biomolecular characteristics, such as Luminal A, Luminal B, triple negative/basal-like or HER2 type.
So, even if it’s a cancer arising from the ducts of the breast, its biomolecular charteristics may differ. These markers can help doctors tailor treatment that is specific to the patient.
For example, according to Dr Normayah, if the cancer is triple negative, it will be quite aggressive, compared to a Luminal A type, which is less aggressive, and hence, has a better prognosis.
What Causes Breast Cancer?
There is no definitive cause of breast cancer. However, certain factors do increase risk – lifestyle, genetics and environment.
According to Dr Normayah, breast cancer is related to excess oestrogen and progesterone. If a woman is exposed to long-term oestrogen and progesterone excess, the risk of breast cancer increases.
“Hence, lifestyle factors that reflect this exposure increases relative breast cancer risk. For example, if a woman has her first baby later in life; small number of children; early menarche (first period); late menopause; using hormone replacement therapy (HRT); all these increase breast exposure to oestrogen and progestrone, hence increasing the risk for breast cancer,” she explains.
“Other lifestyle factors include smoking, regular alcohol consumption and obesity (which increases the risk for many other types of cancer).
“Even long-term stress can increase breast cancer risk,” she notes.
According to Dr Normayah, genetic factors in breast cancer contribute to less than 10% of all breast cancer cases.
For example, BRCA1 and BRCA2 are genes that produce tumour suppressor proteins, which play a role in repairing DNA damage. If these genes are mutated, they may not function properly, leading to alterations that can lead to cancer.
Other genetic factors that may affect breast cancer include breast density. The higher the breast density, the more the risk.
In terms of environmental factors, radiation is the main culprit.
Screening For Breast Cancer
Dr Normayah advises that women with higher risk should be screened more vigilantly.
For example, women with a strong family history of breast cancer, i.e. family members who develop breast cancer at a young age, male family members who develop breast cancer, or women taking HRT.
“Usually for such women, they have to be screened at least five to 10 years earlier than when the family member was first diagnosed with breast cancer.
“Let’s say the family member was first diagnosed at age 40, then the woman should be screened regularly from age 30. If diagnosed at 35, then screening should start from age 25.
“For the population with no risk factors, generally, you start the screening at 40 years old, though this recommendation differs from country to country,” says Dr Normayah.
Surgery, chemotherapy, radiotherapy, hormonal therapy and targeted therapy are the mainstays of breast cancer treatment.
“It depends on the stage of the cancer,” says Dr Normayah. “Some patients might just need surgery alone, while others may require all the options available.”
In general, if a patient follows through on all the treatments and follow-ups required, stage 1 patients have a five-year survival rate of about 98%.
For stage 4, this goes down to about 25%.
These days, the side effects or complications of breast cancer treatment have been reduced quite dramatically.
“Even with radical surgery, patients now have the option of breast reconstruction surgery. As for chemotherapy, most of the side effects are reversible.
“For radiotherapy, with the current technology and equipment that we have, side effects are usually not such a big issue.
For example, a linear accelerator (LINAC) focuses high energy x-rays right at a tumour, destroying cancer cells while sparing surrounding normal tissue. It has several built-in safety measures to ensure that it will not deliver a higher dose than prescribed.
“With targeted therapy, the complications are not as big an issue compared to chemotherapy, though such treatment can be rather expensive,” she adds.
Dr Normayah stresses the importance of diagnosing breast cancer early. If it’s caught early enough, you may just need surgery for treatment and not all the other adjuvant treatment.
And she stresses the importance of seeking help and treatment with the right experts.
“Get treatment as soon as possible. Do not delay. Alternative treatments do not work. We have seen a lot of patients who, after seeking alternative treatment, come back to us worse. Often, it’s turned from treatable breast cancer to one that’s untreatable,” she emphasises.
Tender Loving Care
Dr Normayah also stresses the importance of family and support when a woman undergoes treatment. “If a patient is married, you need to involve the husband when it comes to treatment matters. We have to make sure that the husband understands what the wife is going through.
“A breast cancer patient usually looks normal. She doesn’t look sick.
“Family members sometimes don’t understand her journey while she goes through treatment because of outward appearances.
“But these patients need support. The treatment takes quite a long time, at least seven to eight months.
“During that period, the patient needs to be highly motivated for treatment. There will be ups and downs during this period.
“Support helps the patient cope with the downs, encouraging them to persist until treatment is finished,” advises Dr Normayah.