Education about breast cancer still much needed

BREAST Cancer Awareness Month is an annual health campaign in October to increase awareness of breast cancer, educate people about the importance of early screening and treatment, offer information and support to patients and their caregivers as well as raise funds to support breast cancer research and educational activities.

When I was a medical student 25 years ago, I thought breast cancer was a disease of the West and was less important compared to other medical conditions. The medical syllabus taught us what was normal and abnormal and our opinions about diseases were malleable back then.

In clinical practice, the implications of failing to label a condition as a relevant health issue may affect attitudes on its management and treatment. This could result in ineffective treatment, and communication between clinicians and the patients and their families would suffer.

Labelling breast cancer as less important is in the past. Currently, almost 50% of breast cancer cases and 58% of deaths from it occur in less developed countries.

Breast cancer is the most common cancer among Malaysian women, accounting for one-third of all cancers in females. The incidence is increasing and the majority of patients are affected at the younger ages of 40 to 50 years.

The first Malaysian Study on Cancer Survival (MyScan) report revealed that nearly 60% of patients diagnosed with cancer between 2007 and 2011 were women.

The overall five-year relative survival rate for breast cancer was 66.8%, which is lower than in Singapore, South Korea and Japan, and very much lower compared to Australia, the United States and most European countries.

The higher breast cancer mortality rate in our country, categorised as an upper middle-income nation by the World Bank, is attributed largely to diagnosis of the disease in advanced stages and barriers in access to medical care.

A recent study conducted by Universiti Malaya and the UM Specialist Centre found that diagnosis at the late stage appears to be a major contributing factor to poorer survival rate. Demographic differences and treatment disparities between public and private patients in the hospital settings were also responsible but to a much smaller extent.

Prognosis of breast cancer has improved substantially as the result of earlier diagnosis, molecular classification and more efficacious treatments developed over the past decades.

The basic principle of managing cancer is that it is often multi-modality in approach and comprehensive although personalised. But it is always evidence-based.

All conventional treatment methods are tested thoroughly in clinical trials to prove that they work for specific types of cancer.

The aim of treatment is to kill or remove, and hopefully cure, the cancer. If it is not curable, the aim may be to control the cancer for as long as possible.

Continuing to strive for increased access to more advanced technology, a high-quality primary care system without economic or cultural barriers to access, a well-functioning referral system for basic surgical and hormonal treatment, and increased awareness of breast cancer and of the potential for successful treatment would greatly improve survival.

Unfortunately in Malaysia, besides poor awareness, the use of alternative therapies to treat cancer poses a major hindrance. Despite the absence of evidence supporting their use, many people still use alternative therapies, and it is disheartening to see these being widely and openly marketed by their practitioners.

Alternative therapies often fall outside the boundaries of conventional cancer therapy because they have not been scientifically proven to be safe and effective.

Alternative therapies differ from complementary therapies which are used along with conventional therapies to minimise side effects and often do not interfere with standard therapy.

Many studies have shown that avoiding conventional treatment for unproven alternative remedies leads to a higher death rate from cancer.

Unless swift action is taken by the authorities to curb this risky practice, the road to improving breast cancer outcomes will be long and paved with hardship.


Consultant clinical oncologist

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