She said greater public awareness, particularly among women, of the importance of early detection and regular screening is vital to saving lives.

“I urge women in the state to perform monthly breast self-examinations and undergo clinical check-ups at health facilities,” she told reporters after launching the Pahang-level Breast Cancer Awareness Month here today.

She added that women can also undergo mammogram screening offered by the Ministry of Health and the National Population and Family Development Board (LPPKN).

She also stressed that men should be alert to the disease, as they too are not exempt from the risk.

Sabariah further urged families, communities and society to offer encouragement and create a positive environment for cancer patients.

Source: Bernama

Malaysia’s fight against cancer

According to data from Malaysia’s Ministry of Health (MOH), survival rates for breast cancer patients are notably higher in high-income settings, with nine out of ten patients surviving the disease, compared to only 5 out of 10 in low-income settings. Recently, the MOH and Cancer Research Malaysia (CRMY) have published the results of their collaborative efforts aimed at improving survival rates among low-income patients through the Patient Navigation Programme (PnP) implemented at four public hospitals in Klang, Seremban, Kuching, and Kota Kinabalu.

Breast cancer accounts for over 2.3 million cases annually, making it the most prevalent cancer among adults worldwide. In many countries, breast cancer stands as the primary or secondary cause of female cancer-related deaths. However, survival rates for breast cancer vary significantly between and within countries, with nearly 80% of breast and cervical cancer deaths occurring in low- and middle-income countries.

Despite Malaysia’s status as an upper-middle-income country with a robust healthcare system and effective socioeconomic programs, cancer survival rates remain below those of high-income countries. This discrepancy can be attributed to various barriers, including low cancer awareness and screening rates, delays in seeking medical attention, late detection and diagnosis, challenges in accessing quality and affordable care, and a preference for alternative treatments.

While breast cancer is one of the most curable cancers, improvements in survival have made a greater impact among high-income women and less impact on low-income patients, according to Dato’ Dr Imi Sairi, National Head of Service Breast & Endocrine Surgery, MOH Lead for Breast Cancer Patient Navigation and the Head of Breast and Endocrine Surgery at HPRZII (Hospital Raja Perempuan Zainab II), Kota Bahru. “Through our partnership with CRMY, we have addressed this gap through the patient navigation programme with marked improvements in timeliness of diagnosis and treatment, and improvement in adherence to treatment,” Dr Imi Sairi said.

Dr Yatela Zainal Abidin, CEO of Yayasan Sime Darby (YSD) expressed pride in YSD’s collaboration with CRMY and MOH to set up the very first PnP Centre at the Hospital Tengku Ampuan Rahimah in Klang, significantly enhancing access to cancer care for the B40 community.

“Our more than a decade-long partnership with CRMY contributes towards our commitment to improving healthcare particularly for Malaysia’s low-income group. We are delighted that our support for CRMY’s research work to address the unique healthcare challenges faced by Asians has resulted in new services for low-income women through the Breast Cancer PnP. It is our ongoing mission to ensure that equitable access to cancer treatment is made available to all Malaysians,” she said.

Shariah Nelly Francis, CEO of Yayasan Petronas emphasised the importance of having an all-of-society inclusive approach to healthcare, as the basis for the support from Yayasan Petronas for the expansion of the programme beyond these four centres.

“To date, Yayasan Petronas’s contribution comprises the expansion of patient navigation to ensure wider coverage and access to the B40 communities, and research operational costs and expenses,” said Puan Nelly.

CRMY: finding better ways to improve cancer survival

In collaboration with MOH, CRMY established the first demonstration model for the Breast Cancer PnP at Hospital Tengku Ampuan Rahimah, Klang in 2015. The goal was to deliver patient-centered care for breast cancer patients by guiding newly diagnosed individuals to complete recommended lifesaving treatments and overcome barriers that could interrupt their treatment.

Following the successful demonstration of the programme, in 2020, the programme was replicated at three other state referral hospitals that treat breast cancer patients: Hospital Queen Elizabeth II in Kota Kinabalu, Hospital Umum Sarawak in Kuching, and Hospital Tuanku Ja’afar in Seremban.

Over the past nine years, 3,991 newly diagnosed breast cancer patients have been successfully navigated through the four centres. The patient navigation program has yielded significant improvements in the timeliness of diagnosis, the prompt initiation of treatment, and a notable decrease in the default rate. Moreover, the establishment of a one-stop center offering emotional, financial, and transportation support has significantly reduced barriers to care for breast cancer patients, resulting in a higher proportion completing their treatment regimen.

Datuk Dr Muhammad Radzi, Director General of Health highlighted the importance of such initiatives, which are in line with the Global Breast Cancer Initiative Framework from the World Health Organisation (WHO). He said, “The global target is to save 2.5 million lives from breast cancer by 2040, and the WHO Framework recommends countries implement the three pillars of health promotion for early detection, timely diagnosis and comprehensive management of breast cancer. “

The PnP in Malaysia has achieved two key objectives: ensuring timely diagnosis and treatment initiation for patients, as well as a high completion rate for recommended treatment. Moving forward, the MOH is committed to collaborating with CRMY to increase the early-stage diagnosis and treatment of breast cancer to at least 60%. These ambitious initiatives will necessitate dedicated effort and support to be successfully realised.

“Although we have improved timeliness and adherence to treatment, there is still a lot more to do. The focus in the coming years is to expand our partnership to drive early detection of breast cancer. To do this, we have already started programmes to reach out to GPs to ensure rapid referral for women with suspicious symptoms (such as a breast lump) and to reach out to rural and underserved communities to improve health-seeking behaviour,” added Professor Datin Paduka Dr Teo Soo Hwang, Chief Scientific Officer of CRMY and one of the founders of the programme. Through these initiatives, it is hoped that more cancer patients will present with the early-stage disease when the cancer is more likely to be cured.

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Approximately 1 in 500 individuals inherit a mutated BRCA (BReast CAncer) gene. This inheritance significantly increases the risk of cancer, with probabilities ranging from 45% to 87% in European women. Previously, medical professionals in Asia were unable to provide accurate risk estimates for Asian women due to the majority of data being based on European women and the lack of reliable estimates from Asian women. The new study is expected to fill this gap and provide critical information for Asians.

Related: Advocating for Timely Detection and Cancer Screening in Women’s Healthcare

CRMY Chief Scientific Officer, Professor Datin Paduka Dr Teo Soo Hwang and the lead of the study said, “This study builds on our work in the past two decades to develop better ways of detecting breast cancer early and saving lives. Until recently, only 5% of the genomic and genetic studies globally were conducted in Asians and we are delighted that by continuing to focus on Asians, we can ensure that advances in precision medicine can also benefit the Asian population.”

Women with inherited changes in the breast cancer predisposition genes face challenging decisions, contemplating whether to opt for prophylactic surgery to remove healthy breasts or ovaries, thereby reducing the risk of breast or ovarian cancer.

Alternatively, they may consider more frequent or different types of screening to ensure early detection and increase the chances of successful treatment in case cancer does develop.

In making these decisions, it is critical that they have accurate information about their risk of cancer – for example, if a woman has an 87% chance of developing breast cancer, her choices may be different from that if she has a 45% chance of developing the disease.

As actual risk varies based on other genes, lifestyle, and reproductive choices, such as the number of children a woman has, making these decisions is only possible if we have accurate data on cancer risk in Asians. This then is the area of clinical need: to conduct Asian specific studies to provide accurate information to thousands of Asian BRCA carriers so that they can make informed decisions to save their lives.

Researchers from Malaysia and Singapore collaborated on this study, which received funding from Yayasan Sime Darby, Yayasan Petronas, Estee Lauder Group of Companies, and Vistage Group of Companies, to provide a comprehensive analysis of breast and ovarian cancer risk in Asian women. We found a significant shift: for women born from 1920-1940s, Asian BRCA carriers had about half the risk compared to European carriers.

Related: Shanghai Researchers Announce Groundbreaking Treatment for HER2-Positive Breast Cancer Brain Metastases

However, in the GenX generation born from 1960-1970s, the risk aligned with European BRCA carriers. The key takeaway is that lifestyle changes have not only increased cancer risk for the general population but also for BRCA carriers. Doctors should consider the patients’ birth era and lifestyle factors when advising on cancer risk.

“Accurate quantification of disease risk in BRCA carriers demands substantial sample sizes. Our study is a testament to the power of research unity, bringing together brilliant minds from Singapore, University of Cambridge and our home base in Malaysia. Through these expansive collaborative efforts, we’ve achieved a groundbreaking milestone, advancing our understanding of breast and ovarian cancer risks in Asian BRCA carriers and paving the way for more informed decisions in healthcare,” said Associate Professor University of Nottingham Malaysia (UNM) and first author of the study, Dr Ho Weang Kee.

Moving forward, the CRMY-Nottingham team have won the global Basser Grant to identify the lifestyle and genetic factors that are associated with cancer risk in Asian BRCA carriers. This grant aims to create advanced tools tailored for Asian BRCA carriers, offering precise guidance on their risk of breast and other cancers. The upcoming tools developed by Malaysian researchers will integrate additional gene variants and lifestyle factors, enhancing precision in prevention and treatment strategies for Asian women.

“This is a milestone in our efforts in saving Asian lives through precision guidance. Having more accurate risk information for Asian women is crucial when providing genetic counselling to patients and their family members. This development will help us to work with the patients and empower them to make informed, life-saving medical decisions,” said CRMY Consultant Genetic Counsellor, Yoon Sook-Yee.

This study was made possible by the Wellcome Trust Collaborative Science Award to Professors Teo and Doug Easton, led principally by A/Prof Ho. Additionally, the research team has recognized the following hospitals for their participation: Subang Jaya Medical Centre, University Malaya Medical Centre, Beacon Hospital, Gleneagles Penang, Hospital Universiti Sains Malaysia, KPJ Ampang Puteri Specialist Hospital, KPJ Johor Specialist Hospital, KPJ Sabah Specialist Hospital, Loh Guan Lye Specialist Centre, Mount Miriam Cancer Hospital, Pantai Hospital Kuala Lumpur, Penang Adventist Hospital, Universiti Kebangsaan Malaysia Medical Centre, Sunway Medical Centre, National Cancer Centre Singapore, Singapore General Hospital, Changi General Hospital, Tan Tock Seng Hospital, KK Women’s and Children’s Hospital, and National University Hospital Singapore. Their collaboration in recruitment and interviews, according to the researchers, significantly contributed to the success of this study.

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The announcement was made on January 12, following a single-center, phase II clinical study led by Professors Guo Xiaomao, Yu Xiaoli, and Yang Zhaozhi from the Radiation Oncology Center. The research findings, detailed in a paper released on the website of JAMA Oncology on January 4, is expected to benefit breast cancer patients in China.

Breast cancer, a prevalent health concern for Chinese women, is reported to have an annual incidence of approximately 43 cases per 100,000. Among these, HER2-positive cases constitute 20 to 30%, and up to half of HER2-positive patients face the risk of brain metastases.

The standard treatment protocols for intracranial metastases involve surgery and local radiation therapy. However, nearly half of these patients experience primary or new intracranial distant metastases within a year after treatment, posing a serious threat to their long-term survival.

Researchers explored new therapies to control the disease for a longer period after standardized treatment and prevent it from worsening.

In a two-year trial involving 40 participants, the researchers achieved a progression-free survival rate within one year of an impressive 74.9%, surpassing their expectations. The median survival time of the enrolled patients was 17.6 months, significantly extending the survival of such patients by six months compared with the current treatment regime widely used clinically.

This breakthrough study is said to offer a glimmer of hope for those battling HER2-positive breast cancer with brain metastases, and represents a major step forward in the fight against this challenging aspect of the disease.

Sources:
Chinadaily / Jama Oncology

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Roche (Malaysia) Sdn Bhd has unveiled a distinctive initiative designed to ease the financial burden of treatment for breast cancer patients in Sabah. Spearheaded by a pilot co-funding program in partnership with MUIS Malaysia, the project aims to assist financially disadvantaged patients in the public sector.

The fund, named Zakat for HerR, will be managed and governed by the Persatuan Kebajikan Islam Perubatan Sabah (PERKIPS), the state’s Islamic Medical Welfare Association.

YBhg. Datuk Seri Panglima Haji Yahya Haji Hussin, Yang di-Pertua MUIS, clarified the present distribution of healthcare cost burden in Malaysia: “Within our nation, a significant portion of the population, particularly those within the B40 and lower M40 income brackets, heavily relies on the public healthcare sector. Currently, the Ministry of Health shoulders 49.3%1 of public healthcare costs, yet out-of-pocket expenses still constitute 31.5%2. This underscores the pressing need for strategic interventions and partnerships with the private sector to alleviate the burden on both the MOH and the citizens it serves.

With breast cancer being the most prevalent type of cancer in Malaysian women, equitable, timely and sustainable access, especially novel ones, is crucial.

Sabah’s healthcare ecosystem has recently been in the spotlight for its call to increase awareness of early cancer detection. Over 66%3 of cancer patients in the state get diagnosed with late-stage cancer, underscoring the gaps in health-seeking behaviour, particularly in the rural population. The delay is often driven by women seeking alternative or traditional therapies before getting a complete diagnosis.

In a dynamic public-private partnership, Roche and MUIS lead a groundbreaking initiative for timely access to innovative breast cancer treatment. The pilot program supports 14 eligible patients with Her-2 positive breast cancer through neoadjuvant therapy. This Innovative Funding Model unites contributors to share treatment costs for financially challenged B40 and lower M40 patients in the public sector. Designed for expansion, the model aims to provide equitable access to sustainable, innovative treatments, ensuring optimal patient outcomes.

“No woman should be denied her opportunity for remission or extended survival simply due to the prohibitive cost of treatment,” stressed Deepti Saraf, General Manager of Roche (Malaysia) Sdn. Bhd.“ Although this program is in its initial phase, our vision is to amplify this initiative, guaranteeing accessibility to neoadjuvant therapies for women of all socio-demographic backgrounds, “ Saraf added.

Roche, the world’s leading biotech company dedicated to advancing science for the betterment of lives, takes a pioneering role in addressing healthcare disparities in Malaysia. Along with its commitment to strengthen partnerships with stakeholders, it aims build a healthcare system that is equitable and accessible to everyone.

Reference :

1. CodeBlue. (2023, February 24). Report: Malaysia’s Out-Of-Pocket Expense Rises With Higher Spending OnDrugs, Inpatient Services. https://codeblue.galencentre.org/2023/02/24/report-malaysias-out-of-pocket-expense-rises-with-higher-spending-on-drugs-inpatient-services/
2. Ibid.
3. The Star. (2023, October 6). More awareness of early cancer detection needed in Sabah, says oncologist.https://www.thestar.com.my/news/nation/2023/10/06/more-awareness-of-early-cancer-detection-needed-in-sabah-says-oncologist

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Breast cancer in both men and women share many similar attributes. The most common kinds of breast cancer in men are the same kinds that are present in women, namely, invasive ductal carcinoma, invasive lobular carcinoma and ductal carcinoma in situ (DCIS). Additionally, many of the most pressing early warning signs of breast cancer in men are also similar to those found in women, such as lumps in their breast tissue, skin dimpling or puckering, nipple retraction and unusual discharge from the nipple.

So, what exactly sets apart the causes for men in the face of a breast cancer diagnosis?

A question of hormones

First, it is essential to understand that a majority of breast cancers will grow in response to the hormones oestrogen or progesterone. This is because breast cancer cells that are hormone-receptor positive (HR positive) have receptors on the outside of their walls that can latch on to specific hormones that circulate through the body and allow for growth to happen.

According to Kuala Lumpur-based Dr. Nik Muhd Aslan Abdullah, Clinical Oncologist at Sunway Medical Centre, men have a higher possibility of developing breast cancer cells that are HR-positive, when compared to their female counterparts.

“Breast tissue itself grows in response to oestrogen and is prohibited by testosterone. While it is a primarily female hormone, men have them in their bodies too, just at lower levels,” he said.

“Breast cancer cells in men are sensitive to hormonal imbalances, so any factors or conditions that can lead to an excess of oestrogen and a lack of testosterone will increase their risk of developing breast cancer.”

Conditions such as Klinefelter syndrome (a rare genetic condition in which a male has an extra X chromosome and produces lower levels of androgens), injury to the testicles, usage of androgen inhibitors, liver cirrhosis (scarring of the liver), and even obesity can all result in raised oestrogen levels in men.

That being said, since a majority of breast cancers in men are HR-positive, this also makes them more likely to respond to hormone treatments.

“Men who are found to have HR-positive breast cancer can opt for the same route we use to help women in the same situation, which is hormone therapy using treatments such as Tamoxifen,” Dr Nik shares. “Like chemotherapy, this is a form of systemic therapy that can be used to help lower the risk of the cancer cells spreading, or treat cancer that has come back after treatment.”

What’s in a gene?

Another big factor in the causes of male breast cancer, is that about 1 out of 5 patients are found to have had a family history of the disease. This is because men can also inherit a mutation in the BRCA1 or BRCA2 genes or other genes, such as CHEK2 and PALB2, which highly increases their risk for breast cancer.

“Unfortunately, we do not have a say in the types of genes we inherit; however, this is a very strong case of where early prevention is better than cure.” Dr. Nik goes on to say that men with a family history of cancer should consider seeking counsel from their doctors about going for genetic screening tests as soon as they can, especially those over the age of 50.

“These tests are done through blood sampling, where a genetic counsellor is able to guide you on what to look out for and what can be done with the results given. If positive, a genetic counsellor can also provide advice on future treatment for the patient, as well as what it would mean for their families and children, if any.”

Manning up for the doctor

When asked about the outlook for men who are diagnosed with breast cancer compared to women, Dr. Nik emphasised that men who are diagnosed early, can be cured early.

“Through many of the studies that I’ve seen, men who are diagnosed with breast cancer have a 8-9% lower survival rate than women, but this can be boiled down to the fact that men with breast cancer are often being diagnosed late.

“Men will sometimes wait too long to seek out a diagnosis for the symptoms they may be experiencing, or not recognise the warning signs of breast cancer in their bodies. This leads to a delay in diagnosis when the cancer has already metastasised to a much more perilous state.”

As a final word of advice, Dr. Nik encourages men to not be afraid of seeking a doctor’s opinion if they find themselves experiencing any of the mentioned symptoms related to breast cancer.

“Breast cancer can be cured, and it is very treatable if detected early on. The influence of men’s perception and their willingness to go get checked plays an important role in early diagnosis, therefore they must feel empowered to seek help when they need it.”

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Undetectable microscopic pieces of tumour that remain after a mastectomy are a major factor for the recurrence of breast cancer – scientists from Georgetown University Medical Center in Washington, DC, have recently discovered cell types with significant genetic changes that could kick-start recurrence.

The discovery was made possible by an advanced technology developed at Georgetown Lombardi Comprehensive Cancer Center (Georgetown Lombardi) that allows laboratory researchers to expand, or multiply, hard-to-extract breast tissue cells.

Up to 15% of women, those with hormone-receptor positive breast cancer especially, have a high risk of recurrence, sometimes years after surgery and aggressive follow-up.

“When a person is diagnosed with breast cancer, we have several tools, including testing for genes such as BRCA1/2, to decide whether they should get certain kinds of chemotherapy or just receive hormonal therapy. But the tools we have are not as precise as we would like,” admitted Dr. Priscilla Furth, professor of oncology and medicine at Georgetown Lombardi.

With the new technology, Dr. Furth and fellow scientists were able to extract breast epithelial cells, the layer of cells that form the ducts and lobes which make milk during lactation, from suspected non-cancerous breast tissue. The scientists noted dramatic changes in RNA sequences in the epithelial cells which were later recognised as prognostic indicators for cancer.

RNA sequences known as the transcriptome help determine when and where each gene is turned on or off in a cell, preventing uncontrolled division of cellular components and eventual mutation.

Some of the RNA changes discovered were linked to mammary stem cell formation: mammary stem cells are adult stem cells that can differentiate, or change function, into specialised mammary epithelial cells. If these cells get dysregulated, there is an increased potential for cancer. Cells from pregnant women could potentially trigger extra renewing cycles in a cell, thus increasing the risk of cancer.

“About one in eight women are diagnosed with breast cancer in the developed world. […] Many of our cancer survivors say to me, ‘please do work that will benefit my daughter.’ My response is that’s why I’m in the field of cancer prevention.

“Anything we can do to prevent the occurrence or recurrence of cancer is a significant step forward and we think this finding may be an important contribution to reducing misdiagnosis as well as point to ways to develop better therapies to treat the disease,” said Dr. Furth.

Read: New tool for more accurate detection of breast cancer in Asian women

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Cancer Research Malaysia (CRM) havedeveloped a diagnostic tool especially for Asian women that better identifies their likelihood of inheriting BRCA1 or BRCA2 gene faults. BRCA1 and BRCA2 are tumour suppressor genes that help keep breast, ovarian, and other types of cells from growing and dividing too rapidly or in an uncontrolled way.

Cancer Research Malaysia (CRM) have developed a diagnostic tool especially for Asian women that better identifies their likelihood of inheriting BRCA1 or BRCA2 gene faults. BRCA1 and BRCA2 are tumour suppressor genes that help keep breast, ovarian, and other types of cells from growing and dividing too rapidly or in an uncontrolled way.

As most mutation prediction tools are less accurate for women of Asian descent in favour of European women, the Asian Genetic Risk Calculator or ARiCa was developed by CRM – thereby allowing more Asian women patients to be aware of their genetic risk status and pursue life-saving treatments and/or prevention strategies.

In conjunction with International Women’s Day, this year themed “Break The Bias,” CRM’s Chief Scientific Officer, Professor Datin Paduka Dr. Teo Soo Hwang, OBE, explains about ARICa and its relevance to Asian women: “We estimate that each year, nearly 4,000 newly diagnosed breast cancer patients in Malaysia would need genetic counselling and testing, but they often don’t consider a genetic test because most assume that they are unlikely to have inherited a faulty gene.

“With ARiCa, we can now give each woman their individual likelihood of being a BRCA carrier so that they can be empowered to make informed choices about their health and healthcare practitioners can provide more accurate treatment plans for their patients.”

[CRM collaborated with international institutions from the UK, Malaysia, and Singapore to analyse BRCA1 and BRCA2 in more than 8,000 breast cancer patients, including those of Malay, Chinese, and Indian heritage. The results were then used to develop a tool to provide women with an individual likelihood of being a faulty BRCA carrier.]

Breast cancer data (Malaysia) shows that 1 in 25 patients inherit a faulty BRCA gene. Prior to this research, breast cancer patients are only offered a test if they were diagnosed at a young age or have close relatives with breast or ovarian cancer. But because age and family history alone does not accurately predict the likelihood of carrying a faulty gene, many gene carriers are not offered the genetic test.

A patient with a BRCA mutation may alter their surgical management, said Dato’ Dr. Yip Cheng Har, Consultant Breast Surgeon at Subang Jaya Medical Centre, Malaysia. “In addition to changing the available surgical options, medical practitioners can also prescribe the patient with a new class of drugs called PARP inhibitors that targets the BRCA mutation to improve survival in carriers with early and late stages of breast cancer […] ARiCa can help us to identify patients that need to be referred for genetic counselling and testing.”

“Currently, we refer patients for genetic counselling and testing based on age and family history of cancer due to the lower median age of cancer diagnosis among Asian women. These exacerbate the challenges in access to genetic testing even in developed Asian countries like Singapore,” added Associate Professor Mikael Hartman, Senior Consultant at the National University Hospital. “A population-specific tool like ARiCa that enables more accurate identification of mutation carriers can help to meet the increased demand for cancer genetics services.”

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Women are advised to start breast cancer screening by age 50 at the latest to ensure better chances of treatment and survival in case of a positive diagnosis. However, in most Asian countries, many women who could be at risk of breast cancer do not go for screening.

To empower women to proceed with the right screening and prevention choices, a team of scientists from Malaysia, Singapore, and the UK, have together developed a genetic tool to assess breast cancer risk for Asian women. The Asian Polygenic Risk Score (PRS) tool can be used to predict the likelihood a woman will develop breast cancer based on her genetic sequence.

“Individualised screening and prevention of breast cancer is important because the majority of Asian women have a low risk of developing breast cancer, and only a small proportion have inherited genetic factors that are associated with an increased risk to the disease,” said Professor Datin Paduka Dr. Teo Soo Hwang, OBE, Chief Scientific Officer at Cancer Research Malaysia, and co-lead of the project.

The research that went into the PRS project saw participation from over 58,00 women from Malaysia, Singapore, Japan, Korea, China, Hong Kong, Thailand, Taiwan, US, and Canada, and integrated data from 228,951 European women with Asian-specific genetic markers to improve the accuracy of the tool.

Dr. Tai Mei Chee, postdoctoral researcher at Cancer Research Malaysia, further elaborated, “The genetic make-up is not the same for all Asians. For example, the genetic architecture of Malay, Chinese and Indian women are very different from each other. Bringing together patients from University Malaya, Subang Jaya Medical Centre, National University Hospital, Singapore, and six other major treatment centres in Singapore has significantly increased the sample size of Southeast Asians and had enabled us to show that the new Asian tool is predictive of breast cancer risk across the Malay, Chinese and Indian ethnic groups from Malaysia and Singapore.”

Malaysia anticipates a 49% increase in breast cancer cases from 2012 to 2025. It has a much lower five-year survival rate compared to other Asian countries at only 63%, whereas South Korea is at 92% and Singapore is at 80%.

The development of the PRS is hoped to reduce inefficiency, unnecessary cost, and even possible harm caused by over-diagnosis in Asian women, and more importantly reduce the gap in survival of cancer in Asians compared to Europeans.

Read: MALAYSIA: Special survival stories for breast cancer awareness month

Family history has long been linked to a higher risk of breast cancer in younger women, who are generally advised to start getting screening mammograms when they’re ten years younger than the age their relative was at diagnosis.

But family history has been thought to be less of a factor for the elderly, and women often stop routine screenings by their 70s.

“Older women with family history have an approximately two-fold higher risk of breast cancer compared to women with no family history,” said lead study author Dejana Braithwaite of the Lombardi Comprehensive Cancer Center at Georgetown University Medical Center in Washington, D.C.

“As we go from age-based to risk-based screening recommendations, our findings show that older women with family history may benefit from continued mammography screening, even after age 74,” Braithwaite said by email.

While current U.S. guidelines advise women to get a screening mammogram every other year from age 50 to 74, the U.S. Preventive Services Task Force hasn’t found sufficient evidence yet to weigh in on whether women should continue screening after that.

The goal of mammograms is to detect tumors before they can be felt in a physical breast exam, catching cancer sooner when it’s easier to treat. Ideally, this should mean fewer women are diagnosed when tumors are bigger, rapidly growing, and harder to attack.

But widespread screening can also catch small, slow-growing tumors that are unlikely to be fatal. Particularly when women are older or have a limited life expectancy, detection of these less dangerous tumors might result in needless tests and treatment.

But for older women with a family history of breast cancer, the benefits of screening may still outweigh the risks.

Researchers examined data on 403,268 women age 65 or older, including 10,929 who developed breast cancer during an average follow-up period of 6.3 years.

When women ages 65 to 74 had a family history, they were 48 % more likely to develop breast cancer, the study found. For women 75 or older with a family history, the increased risk was 44 %.

Overall, the elevated risk associated with family history didn’t appear to vary based on the relative’s age when diagnosed with breast cancer.

Among women ages 65 to 74, the risk tied to family history was highest for people with fatty breast tissue. After 75, however, the risk linked to family history was greatest for people with dense breasts.

Unfortunately, the study lacked data on second-degree relatives, such as grandmothers, aunts or nieces, researchers note in JAMA Internal Medicine.

Even so, in the absence of clear screening recommendations for women 75 or older, the results should help elderly women decide if they want to get mammograms, said Natalie Engmann, a researcher at the University of California, San Francisco.

“If they have a family history of breast cancer, and particularly if they also have high breast density, they may remain at elevated risk for breast cancer well into their 70s,” Engmann, who wasn’t involved in the study, said by email.

Thinking about family history might mean more elderly women get screened, said Dr. Julie Nangia, director of the Breast Cancer Prevention and High Risk Clinic at the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine in Houston, Texas.

“We shouldn’t ignore family history in older patients,” Nangia, who wasn’t involved in the study, said by email. “Breast cancer is actually more common in women as they age, and some older women who are healthy and have a life expectancy of at least five to seven years perhaps should be screened and followed more closely with annual mammograms.”

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