Breast cancer is the most common cancer among Malaysian women and the biggest contributor for cancer related mortality, yet, surprisingly a significant number of women remain indifferent on why they should go for regular breast screening.
The regular mammographic screening rate of 3.8 percent in Malaysia pales to 60-70 percent in the United States and remains a serious cause of concern for the medical fraternity and groups advocating the well being of women.
In Malaysia, low levels of participation in mammography screening and 40 per cent of breast cancers detected at advanced stages are a real cause of concern.
Dr Devanand Mangharam, Consultant Breast Surgeon at Pantai Medical Center, noted that women who come to his clinic are well informed on the matter but more needs to be done to convince the vulnerable age group to undergo regular screening.
“Today, with advanced screening equipment like digital mammogram and better access to screening services in the public and private medical care facilities, there is no reason why women should shy away from regular screening.
“Many seem to have a lot of excuses for not undergoing screening, some say they ara too busy, others feel there is no need for it because they don’t have cancer history in the family and a bigger number have an unfounded fear that the mammograms are painful,” said Dr Devanand when met at the recent media event organised by GE Healthcare South East Asia, a leading medical diagnostic equipment company.
THE UNDERLYING PROBLEM
Dr Devanand, who is also an active proponent in raising awareness and funds for breast cancer treatment in Malaysia, including the Pantai Wear-it-Pink annual awareness drives, strongly feels that education, empowerment and encouragement are the key components in improving breast care and cancer screening.
Having said that, financial constrains and the accessibility of the poor, single mothers, housewives and those living in the rural areas are definitely the stumbling block. Also, the low education background often leads to ignorance on the matter.
The denial syndrome or apprehension too cannot be ruled out. This is probably why there were women who waited until the whole breast grew into the size of a football before seeking professional help.
“Many fear they may have to undergo mastectomy thus losing their womanhood, but they must realise that early detection can help save not only their live but much of their breast.
Regardless, regular screening including Breast Self-Examination (BSE), Clinical Breast Examination (CBE), Mammogram and Ultrasound helps in early detection. Screening using modalities like mammogram or ultrasound is highly recommended because a tumour of 4cm could be in the breast for nine years before it becomes a palpable lump that can be felt or visually seen.
THE TARGET GROUP
As for Dr Devanand, women who have reached their fourth decade of life should consider regular screening. But the frequency could vary with the BSE recommended monthly from the age of 20 and CBE every 1-3 years, those in 40-49 age bracket should undergo mammography every 1-2 years and those above 50 years annually.
Dr Devanand emphasised that; “The larger and wider the estrogen window i.e. from the age of menarche to a first pregnancy or menopause, the higher the risk of getting breast cancer. Vigilance is needed and don’t forget a 20-year-old too can get breast cancer”.
Also women who experienced early period, late menopause, no pregnancy or late first pregnancy and those indulging in excess alcohol are vulnerable too. Those who are obese and lead an unhealthy lifestyle also face the same risk.
According to the National Cancer Registry, Malaysian women have a 1 in 19 chance of contracting the disease in their lifetime (Chinese 1:14, Indians 1:15 and Malays 1:25).
The high incidences in the 30-39 and 40-49 age groups, particularly in the Chinese, dictate a current higher concern amongst the younger population in this country.
Only 5 to 8 per cent of all breast cancers can be attributed to inherited genetic mutations and most women diagnosed with breast cancer do not have a family history of this disease.
LATERAL COUNSELLING
Dr Devanand has embarked on lateral counseling to reach the target group. It is basically “I teach you, you teach others” within the family, within neighbourhood and within the society and the results has been encouraging.
The most important issue is that a woman must learn to understand her own breast, evaluate how far she is at risk and what steps she can initiate to help reduce the disease, not withstanding to detect any abnormal lesions at an early stage and get the necessary medical advice and attention.
In a nutshell, regular breast screening helps in early detection, saves the breast where is possible, helps to avoid unwarranted complications and is more cost efficient than treating cancer at a later stage.
