Breast cancer is the number one cancer in Malaysian women with over 7,500 new cases a year in 2018 Over a third of all new cancers in Malaysian are breast cancer. (1) The average cure rate is just over 60%, far below the developed world average of 80%.
(1)Source. Globoscan WHO 2018, Malaysia Factsheet
What are some of the reasons?
One reason is the lack of national breast cancer screening programme in Malaysia and more breast cancers are detected at a later stage when the cure rate is worse. There is also the lack of awareness among the general population regarding breast self-ex amination and importance of getting yearly mammograms. The Malaysian Clinical Guideline on the Management of Breast cancer recommends biennial mammograms from 50 years old, earlier if there are high risk factors like family history of breast cancer. Early detection and treatment at an earlier Stage improves chances of cure.
What are some of the new advances in the treatment of breast cancer?
The mainstay of treatment is still surgical, and the trend is towards doing a smaller operation. Older operations which removed all the lymph nodes, with the entire breast and underlying muscles are replace by smaller operations, removing just the tumor followed by reconstruction and radiotherapy. Consequently, the rate of long-term arm swelling which used to be unacceptably high are now decreasing. There is also a trend toward giving systemic treatment upfront to shrink the tumor such that a smaller operation can be done, and this strategy indicates the tumors response guiding further treatment.
Breast cancer is not a uniform disease, using the cell type information, the oncologists can now tailor the best strategy using combined systemic modality of hormonal, chemotherapy, targeted and immunotherapy. All the while monitoring the individual patient such that side effects are tolerable. Modern chemotherapy is now much more tolerable with the best anti-nausea drugs, given as a day procedure for a few hours. Many patients can continue working, being the wife, mother and daughter in their homes without any need for hospitalisation.
Up to half of a certain subtype of breast cancer with a HER2-rich marker can completely disappear with using targeted therapy called traztuzumab before surgery. A study shows adding traztuzumab to standard chemotherapy improved overall survival by 37%. Another class of drugs called CDK4 inhibitors in trials in recent years shows similar promise when given to breast cancer women with hormonal markers but are HER2-poor. There is much to be hopeful about as there is some promising trial data using immunotherapy for another aggressive subtype called triple negative breast cancers.
After surgery, the newest radiotherapy machines are also getting more precise and accurate and treatments can be delivered in a shorter time, such that the patients can be back to resume their normal activity of daily living, adding more life to the years that they have gained.
In conclusion, breast cancer is eminently treatable now with good results and with acceptable side effects and patients go on living healthy lives.