Barriers to effective treatment of breast cancer

ACCORDING to the 2018 Globocan (a project of the International Agency for Research on Cancer) report, the lifetime risk of cancer among women is one in four. The seriousness of the disease is strongly influenced by the stage at which it is detected; at its very early stage, breast cancer is highly curable. In Malaysia, patients are diagnosed at 10 years or younger than their Western counterparts.

The majority of breast cancer patients continue to be diagnosed at a relatively late stage, and locally advanced cancers constitute over 50% of all patients managed, resulting in higher cause-specific death. This is due to poor awareness, lack of screening programmes, unequal distribution of dedicated facilities, scarcity of resources, and cultural restrictions and limitations.

As the end of Pink October month is just a week away, we wish to highlight two important factors we have observed that could impact on the outcome of breast cancer patients in Malaysia – screening and getting prompt medical attention.

Very early cancers are asymptomatic but many are discovered during breast screening performed for early detection. Three recommended methods are mammography screening, clinical breast examination (CBE), and breast selfexamination (BSE).

While some parties dispute the utility of mammogram screening in improving survival from breast cancer, we wish to emphasise that of these methods, mammography screening in women between 40 and 75 years of age has been proven to reduce cancer mortality and can improve survival in the Asian population.

Considering the limitations of access to rapid diagnosis and multiple treatment with expensive drugs and technology and the social, cultural and ethnic attitudes in our country, we feel that it would make a big difference in terms of survival if women are encouraged to go for screening, diagnosis and treatment at the earlier stage.

Many women may present with a painless breast lump to their primary care providers or surgeon. The high incidence of breast cancer in our country, its relatively easy detection at an early stage, and effective minimal treatment in the form of conservative surgery and hormonal therapy must alert all healthcare professionals to always evaluate any breast mass in detail.

It should begin with a detailed history of the symptoms, taking clinical and family history of cancer, before initiating triple assessment including a clinical (palpa- tion), radiologic (ultrasonography or mammography), and histopathological (tissue biopsy) assessment.

Although most breast masses are benign, a significant concern in women with breast masses is the probability of breast cancer even though they are young.

Cytological diagnosis with fine needle aspiration cytology or pathological diagnosis following core biopsy of breast lumps are procedures that may be performed to determine if the lump is benign or malignant.

Breast cancer is never an easy diagnosis but with concerted efforts to remove barriers to its effective management, the outcome will definitely improve. DR MASTURA MD YUSOF and DR AZLINA FIRZAH ABD AZIZ Kuala Lumpur