Breast Cancer and Importance of Early Detection

By SeeFoon Chan-Koppen

In a recent Economist Intelligence Study on Breast Cancer across 10 Asia Pacific countries, Malaysia came in 4th with a low 38.7 incidence per 100,000 after China, India and Thailand with Australia topping the list at 86. Surprisingly the tables are reversed when it comes to 5-year survival rates with Malaysia coming in the lowest at 49% while Korea had 92%.

This was revealed by Dr. Kirubakaran Malapan, Sessional Consultant at KPJ Ipoh Specialist Hospital who is also Consultant General and Breast, Endocrine and Bariatric Surgeon at Hospital Raja Permaisuri Bainun, Ipoh. A man wearing many hats, Dr. Kirubakaran is also Chairman, Malaysian Medical Association (Perak Branch) 2017-18 and Chairman, Hospital Raja Permaisuri Bainun Bariatric Support Group.

“So why are the 5-year survival rates for Breast Cancer in Malaysia so low?” I asked. “Especially with Breast Cancer having the highest percentage at 17.1% of all cancers in Perak according to a 2014 study” I added.

“That is because 33% of breast cancer patients in Perak are seen only when their cancers are at Stage 3 and 4”, lamented Dr. Kirubakaran.

“There are many reasons for this, with the primary cause being a lack of awareness on breast cancer screening. Also the taboo around having your breasts examined both for religious and modesty reasons. Plus women here tend to look for alternative treatments whether through herbalists, Traditional Chinese Medicine (TCM) or even their Bomoh and by the time they come to a western medical  doctor, the cancer has progressed past the easily treatable stage 1 or 2. Which makes my job as a surgeon a more difficult one”, he added.

That is why a specialist like Dr. Kirubakaran is so keen to stress on the importance of early breast cancer screening.

The standard recommendation is for women over 50 to have a mammogram followed by one every two to three years till they reach their mid 70s. Also to learn Breast Self Examination (BSE) which women can do often while they shower.

Breast ultrasound and breast Magnetic Resonance Imaging (MRI) are frequently used as adjuncts to mammography in treatment planning and staging and NOT routinely for screening, although some women may opt for these methods.

For women with a family history of Breast Cancer, they may begin to have mammography screening earlier, go for regular clinical breast examinations or if they can afford it, they can opt for a test to detect if they carry the defective BRCA 1&2 gene as made famous by superstar Angelina Jolie, with the choice for voluntary mastectomy an individual one after genetic counselling.

“The earlier the cancer is detected, the higher the chances of a cure. The size of a breast cancer and how far it has spread are important factors in predicting the prognosis (survival outlook).  If the tumour or lesion is a small one, or can only be detected by mammography, then perhaps only surgical removal (lumpectomy) and axillary clearance (removal of axillary lymph nodes) termed as Breast Conserving Surgery will take care of the problem. However if the tumour is large, it may have already metastasized to other organs and involving the lymph nodes. In this case, a more aggressive approach is called for which may involve a mastectomy and axillary clearance followed by either chemotherapy, radiotherapy, hormonal therapy or targeted therapy based on the lab results following surgery. “

There is no sure way to prevent breast cancer, but there are things all women can do that might reduce their risk and help increase the odds if they do get breast cancer. Breast Cancer awareness is the most critical first step.

“My wish is to see a program instituted in schools where teenage girls are taught BSE or breast self-examination which they will keep as a lifetime habit. This will help towards increasing our current 5-year survival rates for breast cancer as we in the medical profession can treat the cancers at the early stages where the success rate is high. According to a study, Malaysia is expected to see a 49% increase of Breast Cancer from now till year 2025. It is high time we be proactive and make Breast Cancer Awareness a top priority for women’s health.” Dr. Kirubakaran emphasised.

KPJ Ipoh Specialist is holding a Breast Cancer Awareness Day on October 28 where Dr. Kirubakaran will be giving a talk entitled: Doctor I have a Breast Lump! What Shall I do? From 10-11am at Dewan Anugerah, 5th Floor.