Pink Ribbon Wellness (L) Foundation

Breast Cancer Updates In Malaysia

Breast cancer is the most common cancer to affect women, often occurring in the prime of their lives. And the incidence of breast cancer has substantially increased over the past 50 years. This is now more acute than ever because over the next 10 years there will be a dramatic increase in the number of women developing breast cancers. Globally 15 million new cancer cases will be diagnosed and it is expected that by 2020 there will be 1.7 million new breast cancers detected and 4.4 million Survivors. In Malaysia, the incidence continues to rise with the WHO [Globocan 2018] predicting more than 7500 new cancers diagnosed each year and an annual mortality of more than 50% of women diagnosed with breast cancer. It will form our women’s most feared disease.

This increase is only partly because women are living longer, allowing more time for cancers to develop, or because more women are getting mammograms, resulting in more cancers being detected. Many people think breast cancer is all about family history and inherited genes. While it is true some women inherit one or more abnormal genes that make their breasts more prone to cancer, these abnormal genes only increase the RISK of developing breast cancer. They don’t CAUSE cancer by themselves. For breast cancer to develop, other genetic changes still have to occur.

In fact, there is growing evidence that many other factors are contributing significantly to the rise in breast cancer cases. Today, we know we have a major public health problem that is rooted in a number of new realities. Pink Ribbon Wellness [L] Foundation visions that the way to fight breast cancer will be through Education and a strong commitment to fulfill our mission to educate and empower women in the country on breast health care and support cancer survivors, while advocating preventive measures.

We’ve made huge advances in awareness, knowledge and treatment of breast cancer, but we haven’t managed to reduce mortality significantly due largely to late diagnosis of almost 42% of women presenting with Advanced Breast Cancers. More than half of the women in this country who are diagnosed with stage II and stage III breast cancers will develop metastatic disease within five years of their diagnosis.

For every woman who’s ever been diagnosed with breast cancer, the fear of recurrence will always be there.

Breast cancer incidence has increased because modern life has changed the
environments both outside and inside our bodies. Here we highlight the new
realities of modern life and its influence on breast cancer.

1. More women are living longer:
Today’s women are living longer than ever before. On average, women are living nearly 30 years longer than a century ago but it’s not such good news for our breasts. Aging is the biggest risk factor for breast cancer. Our genes are more likely to develop new harmful mutations and less able to repair the genetic damage. BUT breast cancer is now seen to occur in much younger women in the Asian population. Almost 52.3 % of breast cancers occur in women younger than 49 years in Malaysia versus 70% in the developed nations in women who develop breast cancer after the age of 50 years.

2. Puberty and breast development are starting earlier than ever:
The earlier a girl gets her first period, the higher her risk for breast cancer later in life. Girls who get their periods at age 16 and above have a 50% lower risk of breast cancer as adults than do girls who get their periods before the age of 12. Today, due to better nutrition and increasing childhood obesity, some girls start puberty as early as 9 years old. The production of estrogen and other hormones brings on the onset of puberty and breast development is usually the next step. The earlier the breasts are formed and the longer they are exposed to stimulating or altering substances, the higher the risk of breast cancer later in life.

3. More women are delaying full-term pregnancies:
Pregnancy rates have declined steadily in the last century. Economic issues, late marriages, independence of self, personal choices and many other social issues have changed the way a woman equate the necessity of marriage and parenting. This may explain the increasing rates of breast cancer in developed nations and developing countries are following suite in the new reason for increasing incidences of breast cancer! A woman’s first full-term pregnancy protects against breast cancer by making the breast cells mature. Mature breast cells are more likely to grow normally and are less likely to become abnormal and give rise to cancer.

4. Fewer women breastfeed, and more breastfeed for less time:
Breastfeeding further lowers the risk of getting breast cancer by forcing breast cells to become even more mature. As with pregnancy, breastfeeding also causes genetic changes that protect the breast against breast cancer. Today, relatively few women are still breastfeeding 6 months later and even fewer breastfeed exclusively.

5. More adolescents and women take prescription hormones:
Hormone replacement therapy to reduce postmenopausal symptoms produces a moderate increase in risk of breast cancer. Similarly prolonged birth control pills are linked to a small increase in risk and many adolescents and young women start using oral contraceptives much earlier and stay on them longer, often for reasons other than preventing pregnancy. Taking these extra hormones can cause extra breast cell growth and promote the growth of breast cancer. 

6. More women and girls are overweight or obese:
 Obesity is an epidemic of modern life and Malaysian women and girls are not excluded in the new epidemiology. Over the last 30 years, obesity rates amongst Malaysian children, adolescents and women have tripled [refer Star June 16, 2014 publication]. Over a third of American women are obese. Extra weight and obesity can increase the risk of breast cancer in multiple ways.

Overeating increases body fat and fat cells make estrogen, and the extra fat makes extra estrogen. Fat can also collect and store many environmental pollutants that can act like estrogen. The extra hormonal activity can turn on too much breast cell growth, possibly increasing the risk of breast cancer.

In addition, overweight children and adolescents are more likely to become overweight mothers, with tendencies to have overweight babies. Being heavy at birth is a risk for breast cancer later.

7. More women and girls are physically inactive:
More women today go to work, some with long working hours. Modern life demands, increasing stress, long hours surfing the web and in front of the TV, all these have limited the amount of time for physical activity. Many of us don’t get the exercise we need. Regular exercise can help lower the risk of breast cancer in a number of ways. It helps us manage our weight by burning more calories, limiting food cravings, and improving selfimage. Exercise helps to regulate our hormone, and this helps to postpone the onset of puberty in some girls.

8. More modern women consume alcohol:
Alcohol use by women has increased. Longer and greater alcohol use in women produces more harmful effects, leading to a higher risk of breast cancer. Greater amounts of alcohol i.e. more than 1 unit / day, can both interfere with the breakdown of estrogen and increase the production of estrogen. It can also make the estrogen receptors inside breast cells more sensitive to estrogen. In girls, alcohol use is associated with a higher rate of benign breast changes and some of these non-cancer changes are linked to a higher risk of breast cancer later in life.

9. More women smoke than ever in the last half-century:
Beyond the strong link between smoking and lung cancer, smoking produces but a small increase in breast cancer risk.

10. Many women are stressed and sleep deprived:
More than 50% women are in the work force today and modern life is surely exhausting and stressful. The extra stress leads to high blood levels of the stress hormone ‘cortisol’, which consequently can have a negative effect on our immune system’s ability to function properly and protect our cells from injury. Researchers in UK, including lead author of a study – Dr. Osten Helgesson, concluded that the risk of breast cancer was doubled among the stressed women.

11. Many women are exposed to more environmental pollutants:
Women and girls today are exposed to more environmental pollutants. But the impact of these chemicals on breast health has only been partly studied. Some pollutants can directly damage our genes. Others can mimic estrogen or disrupt the normal hormonal balance and lead to abnormal breast cell growth. According to the Annual Report of the President’s Cancer Panel on Reducing Environmental Cancer Risk of 2008-2009, there is ‘a growing body of research documents that suspect environmental factors are linked to genetic, immune and endocrine dysfunction that can lead to cancer and other diseases’.

Many pollutants in the environment have biological effects, so even in the absence of specific information linking these chemicals to diseases it is not safe to assume that they are benign. Avoidance whenever possible would seem to be a prudent policy.” – Larry Norton, M.D., Deputy Physician-in-Chief for Breast Cancer Programs, Memorial Sloan-Kettering Cancer Center.

Lifestyle changes that we make today could lower our risk tomorrow.

How can we make change that will benefit women and society in significant ways that will change incidences of breast cancer over time? 3 fundamentals must be instituted in our life style – the 3 E Principle:

First Principle: Understand breast health through EDUCATION
Second Principle: EAT right and healthy