In 2020, 2.3 million women were diagnosed with breast cancer and 685,000 women died of the disease globally. Sadly, more Asian women died of breast cancer compared to the rest of the world combined, and the incidence of breast cancer is rising rapidly in Asians.

Because it is the most common cancer in women in almost every country, Malaysia included, we are doing everything we can to find better ways to prevent and treat the cancer more effectively, focusing specifically on the features of Asians that are different from other populations.

Prevention

Today, the only effective ways to prevent breast cancer are to have a prophylactic mastectomy or to take prophylactic chemotherapy – because these are such drastic measures, doctors and patients will consider these only if the risk of cancer is very high (like for Angelina Jolie and other BRCA carriers).

Interestingly, we now know that Asian women who consume high quantities of soy have a lower risk of getting breast cancer, but little is known about whether women should be consuming soy early in life, or when they are undergoing menopause. We led the only Asian study to test if consuming soy later in adulthood can reduce some of the breast cancer risks [more on the MiSo Study], and are studying whether anti-oxidants (such as those from palm oil) can also reduce the risk of developing breast cancers.

Risks and Screening

Screening can help to detect cancers at an earlier stage, so that we have a higher chance of curing cancer. Today, mammograms are the most effective way to screen for breast cancer and doctors recommend women get mammograms every 2 years if they are above the age of 50. But women have different risks of developing breast cancer and with higher risk factors may need to start screening at a younger age or take a different approach entirely – the challenge is that it was previously not possible to accurately tell who was at high risk, and who was at lower risk.

We led the largest study in Asians to develop more accurate genetic and imaging tools to determine a woman’s risk of developing breast cancer [published BRIDGES Study in New England Journal of Medicine and the Polygenic Risk Score (PRS) article in Nature Communications]. We developed an Asian-specific genetic risk calculator [Asian Genetic Risk Calculator, ARiCa] and are now making this tool available in hospitals in Malaysia. Together, we aim to help women understand what their own risk to breast cancer is, and to make decisions about what type of screening is appropriate for them.

Unfortunately, not many people are aware of genetics and there is fear and stigma about whether genetics is beneficial or harmful. Genetic counselling is playing a big part in catching cancer early on, and we are working to make genetic counselling accessible for low-income individuals who have family members affected by breast, ovarian, prostate, pancreatic cancer or other cancers [MaGiC study]. We have developed decision aids that can help family make decisions about genetic testing, and patients and family members can reach out to us for more help.

Treatment

Today, there have been major advances in cancer treatment because of our understanding of what genetic changes cause cancers to happen (and which treatments can target these genetic changes and kill cancer cells). Such an understanding of genomics has played an important part in creating more effective therapies for breast cancer, but unfortunately, there is little done in genomics of Asian cancers. Our study on genomics of breast cancer in Asian women, the largest study of its kind, is being used as the basis to develop more effective treatment options.

We found that a genetic variant that is found in 60% of Asians (and only 15% of Caucasians and <5% of Africans) is associated with breast cancers that have activated immune systems and recently completed a clinical trial testing whether Asian patients with this genetic variant may be treated with methods that harnesses the patient’s own immune system to target cancer cells.

We have also developed a new method to identify breast cancer patients whose tumours are BRCA-like, even though the patients do not have BRCA gene mutations, and are conducting a clinical trial testing whether Asian patients with aggressive breast cancer may be treated with newer therapies targeting BRCA-like features.

Survival

In high-income countries and in some private hospitals in Malaysia, 9 out of 10 breast cancer patients survive 10 years. But some areas in Malaysia, the same stats is 5 out of 10. The reason for this poor outcome lies in late detection and poor or delayed access to treatment, things that are potentially preventable. In partnership with the Ministry of Health, we have developed a patient navigation programme to ensure all women have access to treatment to improve instances of survival.

What’s next?

• Developing more accurate ways of determining each Asian woman’s risk of developing breast cancer, and testing new ways to reduce the risk of breast cancer.
• Developing new ways of making genetic testing for hereditary breast cancer affordable and accessible.
• Improving the treatment options for Asian breast cancer patients, through discovery of new ways of treating cancers using genomics maps of Asian breast cancers and translating these into clinical trials for Asian patients.
• Improving survival through a Patient Navigation Programme to remove barriers to early detection and treatment for low-income women.