By: Assoc. Prof. Dr. Ganesh Ramachandran & Dr Khine Pwint Phyu

Cancer is a significant cause of death and disability in Malaysia, and statistics from 2020 indicate about 48,639 new cases and 29,530 deaths. This number is expected to double by 2040. According to the Malaysia National Cancer Registry Report 2012-2016, among women in Malaysia, the six most common cancers were breast cancer, colorectal (large intestine) cancer, cervical (neck of the womb) cancer, ovarian cancer, lung cancer, and uterine (womb) cancer.

The risk of developing cancer before the age of 75, also called the lifetime risk among women in Malaysia, is about 1 in 9. The risk among the Malays is lowest at 1 in 10 and highest among the Chinese community at 1 in 8. These are significant when you consider the age ranges when women are susceptible to cancer development, between 25 to 64 years of age. This is a period of productivity and the impact on family, community, and the country are considerable in terms of physical, emotional, and financial well-being.

There are many risk factors for cancer, four of which have been identified in a recent study as modifiable: tobacco usage, obesity, sedentary (inactive) lifestyle, and alcohol consumption. A Malaysian study also pointed out that obesity was a major risk factor for cancer in women, and up to 1,652 cases of cancer in women could have been avoided with weight reduction.

The relationship of obesity to cancer is a complex one but the potential seriousness of this risk factor is clear when we consider these two facts: Malaysia ranks first in terms of obesity in Southeast Asia and that one in two Malaysians are overweight. On the brighter side, the fact that these are modifiable factors and that addressing them would potentially prevent 25 per cent of cancers, makes it a target worth pursuing.

Diagnosed late

Preventing cancers should always be the aim of any cancer mitigation programme and in women it is a paradox that two of the cancers that contribute most to deaths among women, breast and cervical cancer, also have very established screening programmes.

Statistics from the Ministry of Health (MOH) indicate that a significant proportion of all cancers in Malaysia, whether in men or women are diagnosed late. This is a problem as treatment options are limited at this stage, often expensive and do not result in cure.

Respectively, 48, 76, and 56 per cent of breast, cervical, and ovarian cancer cases are diagnosed at a late stage. While the conundrum of ovarian cancer is not easily addressed as there are still no clear and effective screening strategies, the same cannot be said for breast and cervical cancers.

Malaysia has had a National Screening Programme for cervical cancer, which has been in place since the 1960s and cervical smears have been made available for free since 1995. However, despite health promotion campaigns, we have not met a coverage rate of 70 to 80 per cent that is required to lower death and disability from the cancer.

Vaccinating against HPV

In such situations the WHO has strongly recommended the need for vaccinating against Human Papilloma Virus (HPV), which is the causative agent for more than 95 per cent of cervical cancer cases. This has been nationally implemented in Malaysia and MOH reported a complete coverage of three doses of vaccine in 87 per cent of 13-year-olds in 2011.

If both these strategies can be ramped up, we could overcome the scourge of cervical cancer, however the difficulty in reaching the 70 per cent screening mark required to make a difference makes the use of the HPV vaccine an indispensable strategy in Malaysia.

Regarding breast cancer screening, while there are established protocols for screening and the recognition that it improves outcomes, cost and difficulty in accessing facilities as well as awareness remain hurdles that need to be overcome. One of the efforts is a mammogram subsidy programme introduced by the government to assist women in early detection at registered private mammogram centres at a lower price rate.

Meanwhile, patients who develop ovarian cancer need to receive treatment, which is often expensive. To some extent there is a policy that allows all Malaysians to obtain healthcare at a government facility, however universal healthcare is still sometimes not available, especially when the treatment needed is expensive and complex.

Overall, 65 per cent of Malaysians obtain their health care from a public facility, resulting in long waits and sometimes lack of access to more specific targeted therapy for cancer management. These are available in the private healthcare centres but come at a significant cost albeit with much shorter wait times. Unfortunately, they are not accessible to a large proportion of the population as they are financed out-of-pocket or through healthcare insurance.

National Cancer Control Plan

Clearly there is a cognitive, physical, emotional, and financial burden caused by cancer. With this in mind, the National Cancer Control Plan was implemented in 2003 which aimed to provide screening and awareness to reduce cancer risk among Malaysians.

These have helped somewhat but the gap remains and is being addressed by the government by increasing the availability of oncologists who share their expertise to improve access to cancer treatment. Medications are also being made more accessible and research on effective and affordable care has also been implemented to provide solutions.

The burden of gynaecological cancers or any other disease for that matter can only be reduced by awareness, education, leading a healthy lifestyle, implementing and adopting appropriate screening tests and preventive measures. We need to overcome the stigma of a cancer diagnosis which is often looked upon as a death sentence and is often the reason why treatment is not sought early enough.

Reducing the burden will need participation of the public sector, the private sector and NGOs who can together craft strategies to solve this problem. Efforts are being made and there are glimmers of hope on the horizon, but work needs to continue so that we can finally reach a stage where we can control this disease and its enormous impact on our lives, communities, and country.

-- BERNAMA

Assoc. Prof. Dr. Ganesh Ramachandran is Head of School, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University.

Dr. Khine Pwint Phyu is Senior Lecturer in Obstetrics and Gynaecology, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University.