Breast cancer screening uptake still low despite awareness

Many women in Malaysia are still hesitant to go for regular breast cancer screening despite being aware of its importance. Thus, breast cancer remains the most common cancer at 31.3 percent of all female cancer diagnoses in 2022, and one of the top causes of cancer deaths, based on the Global Cancer Observatory 2022 report. [https://gco.iarc.who.int/media/globocan/factsheets/populations/458-malaysia-fact-sheet.pdf]

“Younger women are coming in more often, but many are still showing up late. Some hope the lump will go away. Others delay out of fear or because they think cancer is a death sentence. By the time they seek help, the cancer has been there for a long time,” said Dr Aqilah Othman, a consultant clinical oncologist. She noted that women may assume that screening is only required when they have symptoms. However, Aqilah said screening aims to detect cancer early even before symptoms emerge.

Further, early detection due to screening may lead to a better prognosis. “Catch it early, and treatment might only be surgery. If delayed, treatment will involve chemotherapy, radiotherapy, and hormonal therapy. It’s more difficult, costly, and emotionally taxing because once cancer reaches lymph nodes or other distant organs, it needs aggressive, multimodal treatment. At that point, it becomes harder to treat and may spread elsewhere,” explained Aqilah.

Women aged 50 to 74 at average risk of breast cancer should be advised to go for a mammogram every 2 years as per the recommendation by the Clinical Practice Guidelines on Management of Breast Cancer 2019. However, women at moderate to high risk are recommended to go for annual screening from an earlier age (Table 1).

Barriers and myths of screening
Aqilah said screening uptake is likely low due to time, cost, stigma and misinformation. Some women may be too busy to go for screening or they may decide that they do not need screening since they feel healthy. To overcome this barrier, some government initiatives and NGOs offer subsidised mammograms. [https://mamogram.lppkn.gov.my/] By making screening more accessible, it not only encourages timely diagnosis but also helps women feel less anxious, she added.

Some women may also avoid screening due to myths such as mammograms cause cancer and are extremely painful, and biopsies cause cancer to spread, said Aqilah. On the contrary, mammograms do not cause cancer since the radiation dose is relatively low, and they involve just a few seconds of discomfort. Biopsies are important to confirm a diagnosis and determine the best treatment, and not likely to spread cancer.

Pinktober, a more casual name for Breast Cancer Awareness Month, helps to raise awareness of breast cancer among the public. Women aged 50 to 74 should be advised to go for a mammogram if they have not had one in 2 years. In general, women should be advised to look out for symptoms such as nipple discharge, lump, skin changes, or breast pain, and seek medical advice without delay, said Aqilah.