Breast cancer: Empowering the public with knowledge
Part two of an eight-part series on raising cancer awareness
IN Sarawak, breast cancer is the most common cancer as statistics from our only public Radiotherapy and Oncology Unit (RTU) at the Sarawak General Hospital (SGH) indicate that it represents around 18 to 20 per cent of all our new cancer cases each year. With 99 per cent of cases occurring in females and only one per cent in males, breast cancer is more of a concern for women and is estimated to develop in one out of 19 women.
But despite its position as the most common cancer in the state, poor understanding and misconceptions about the disease are still rampant in our own backyard, leading to higher mortality rates compared to the rest of the world. In a 2016 study by The Economist Intelligence Unit Ltd titled “Breast cancer in Asia: The challenge and response,” it was found that the mortality rate of breast cancer in Malaysia was 18.9 -- 47 per cent higher compared to the world figure of 12.9.
According to the study, this high mortality rate was mostly due to a lack of awareness, leading to late cancer diagnosis and presentation.
Awareness was even suggested to be lacking in local healthcare professionals as the study also cited an anecdote of a local mid-wife who was diagnosed with an advanced stage of breast cancer, despite supposedly having more knowledge on and exposure to the disease and its symptoms than the public and other healthcare professionals not involved solely in women’s health.
Locally, the RTU statistics suggest a similar scenario as only 55 per cent of all new breast cancer cases in 2014 were presented at Stage I and II where the cancer is still localised in the breast tissue.
In comparison, data from the Public Health of England showed 83 per cent of all new breast cancer cases in the UK being presented at Stage I and II.
Seeking to increase the rates of earlier breast cancer presentation, Dr Voon Pei Jye, an oncologist at SGH and the Sarawak committee chair of the Malaysian Oncological Society (MOS), stresses that first and foremost, women need to understand why it’s so important for breast cancer to be diagnosed and treated in a timely manner. Early presentation
“Cancer is a disease where abnormal cells divide uncontrollably to infiltrate and destroy normal body tissues, and the most dangerous thing about the disease is its ability to spread throughout your body.
“Cancer cells can escape from their primary tumour to other parts of your body through the blood stream, lymphatic system or even locally to adjacent organs,” he explains.
And once the cancer has spread to other parts of the body, it becomes increasingly difficult for oncologists to treat successfully – leading to increased mortality rates.
“So it’s very important to raise awareness of breast cancer in the public, allowing for earlier diagnosis and timelier treatment,” he stresses. Risk factors
But before diving into how women can recognise the symptoms of breast cancer earlier, Dr Voon advises it would be best to first recognise the risk factors involved.
“All women are at risk of developing breast cancer and that risk increases with age as do most cancers.
“But there are also other factors that influence each individual’s risk such as whether or not they have a genetic cancer syndrome like the breast-ovarian cancer syndrome that actress Angelina Jolie famously has.
“For these individuals, their risk is higher and I would recommend they seek advice from professional oncologists on how they manage and reduce this risk.
“Besides genetics, research has also found that an early onset of menstruation, late menopause and late childbirth past the age of 35 all have an association with increased risk of developing breast cancer,” he elaborates. Though most of these are not exactly within our control, Dr Voon notes that the decision to undergo pregnancy and breast feed has been found to help reduce the risk of the breast cancer.
“But the most important decision we can make is to maintain a healthy lifestyle and reduce obesity which has linked to higher risk of cancer in general.
“This means getting as much physical activity as you can along with eating a balanced diet focused on more fresh fruits and vegetables.
“For example if you have the option of taking the stairs just do it. It might seem like a minute thing but it’s actually very important as it adds to your physically activity.
“In total, we encourage around 20 to 30 minutes of exercise daily -- so every little bit of physical activity will help.” Screening processes
While these advices and recommendations will ultimately help us reduce our risk of breast cancer, it’s inevitable some of us may end up developing the disease in the future. And to catch it early, Dr Voon advises young women over the age of 20 to start performing breast and underarm self-exams as a screening process for breast cancer.
He stresses that the exams should be done on a regular monthly basis to allow women to become familiar with their breasts so they may be able to discover any changes early.
The monthly self-exams are recommended for women of all ages but as the incidence of breast cancer increases with age, Dr Voon points out that older women will need to also begin other screening processes as they pass certain age thresholds.
For women over age 40, he recommends that they should begin getting annual clinical breast examinations, performed by either a doctor or trained nurse practitioner.
“Higher risk patients should consider increasing their clinical examination frequency,” he adds.
Annual mammograms, hailed as the best method of detecting breast cancer, should also be started at this age. After 50, women can get mammograms every two year. Treatments
But even if you’ve caught breast cancer early, there is still the matter of treatment, and for some of us, the thought cancer treatment could be scarier than the disease itself – no thanks to widespread fearmongering of its side effects.
Acknowledging these concerns, Dr Voon admits that the common breast cancer treatments of radiotherapy (high-energy rays used to kill cancer cells), chemotherapy (cancer-killing drugs) and hormone therapy all do have some substantial side effects.
However, the exact side effects and their severity will vary for patient to patient.
“We (oncologists) cannot say for certain what range of side effects breast cancer patients might experience because every single case is unique -- so every single treatment will be unique as well.
“Treatment depends largely on the stage and grade of the breast cancer – how large is the tumour, whether or not it has spread, and if so, how far,” he further explains.
For Stage I and II cases where the tumour has not spread, Dr Voon says surgery will be the first line of treatment as it will be the most effective.
“However, we may also prescribe radiotherapy or chemotherapy as adjunct treatments to maybe reduce the size of the tumour before surgery or to help reduce the chances of the cancer relapsing in the future.”
For more advanced cases (Stages III and IV), patients may be given a combination of surgery, radiotherapy and chemotherapy with consideration to the patient’s overall health, age and preferences.
“There’s also hormone therapy treatment but that’s only used for breast cancer cases found to be sensitive to hormones,” he points out.
And while the breast cancer treatments mentioned do tout some scary sounding side effects ranging from hair loss to long-term nerve damage, Dr Voon assures that most of them are manageable if detected early.
“Because of this, I would like to advise all patients to keep asking their doctor’s questions until they fully understand and comprehend what their disease is, what their treatment options are and what potential side effects can manifest.
“Getting this knowledge is not about heightening the anxiety of patients but rather about empowering them with that knowledge so they can understand exactly what treatment they are receiving – allowing them to help reduce the severity of potential side effects as they are able to recognise it much earlier.”
Although cancer can be alarming, Dr Voon emphasises that early detection is by far the best way to increase the chances of a successful treatment and survival rate.
“I’m hopeful that correcting any misconceptions of breast cancer can help alleviate fear and encourage treatment compliance within the general public,” he says.