Introduction
Last year (2001), in conjunction with “October’s International Breast Cancer Awareness Month”, the MMA Foundation Radiology Fund and College of Radiology, Academy of Medicine of Malaysia (formerly the Malaysian Radiological Society) organized a one-month campaign to educate both men and women about breast cancer and to provide them with early detection services. YB Dato’ Chua Jui Meng graciously officiated at the Launch on the 4th October 2001. The primary aim was to drive home the key message that “early detection saves lives“. Proactive, life-saving, breast health messages were disseminated with the help of the media and the College’s electronic arm, www.radiologymalaysia.org. The organizers are grateful to members of the Press, Television & Radio stations (both private and government), Magazines, MSN Malaysia and others for doing such a wonderful job and rallying around for the cause. 2001 was the first time a one-month breast cancer awareness campaign offering subsidized mammograms was organized. The participants had to pay only a fraction of the normal cost (not more than RM30) of the mammogram with additional ultrasound of the breasts where necessary. In some deserving cases, the participants were fully subsidized for their mammograms. The mammography providers (volunteer centres) were located in the Klang Valley and Kota Bharu/Kubang Kerian, Kelantan. Even with such selected locations and a limited reach, 1550 women benefited from the campaign. This was double the number of participants originally expected and was only made possible as a result of a successful appeal for additional funds. Johnson & Johnson (RM100,000) and Meditel Electronics Sdn Bhd (RM30,000) were two of the donors who deserve special mention for their substantial contributions despite the economic climate surrounding the September 11th incident in the United States of America. To cope with the added numbers, several centres had to extend the special mammography services into the month of November 2001! Subsidised Mammogram Programme 2001
A total of 1550 women participated in the 2001 subsidised mammogram programme. Aim of Programme
Early detection of breast cancer involves regular monthly self breast examination, an annual physical examination by the health care provider (in those above 40 years of age) and in high risk groups and symptomatic women – a regular mammogram once a year or once in 2 years. The aim of the programme was to encourage women (especially those who were financially challenged), above 40 years and either of high risk groups (eg Immediate family history of breast cancer, previous breast cancer) or with breast symptoms and signs to come forward for mammography. The programme was also open to men with breast symptoms and signs, especially if of a suspicious nature. The period for the programme was the whole month of October 2001, in conjunction with International Breast Cancer Awareness Month. Mammography Providers
There were 5 providers in the Klang Valley and 2 centres in Kelantan. The number of participants each centre was assigned was dependent on the resources available as well as the nature of practice of each centre. Some had to provide an extended or special time to cope with the “workload”. The 5 centres in the Klang Valley were Hospital Kuala Lumpur, University Malaya Medical Centre, Women’s Cancer Detection Centre & Breast Clinic (National Cancer Society of Malaysia), Pantai Medical Centre and Megah Medical Specialists Group. In Kelantan, the centres were Hospital Universiti Sains Malaysia and Hospital Kota Bharu. In all these centres, where necessary, the adjunct examination of ultrasound was done. Region
Although the 2 main regions involved in this pioneer programme were Klang Valley (Selangor/Federal Territory) and Kelantan, there were 3.5% from other states (Penang, Perak, Negeri Sembilan, Malacca, Johor, Pahang, Terengganu and even 1 lady from Sarawak). 69.1% of the participants were from the Klang Valley region and 27.4% were from Kelantan. The Klang Valley centres accounted for 73.2% of the mammograms done. This is to be expected as Selangor is the most populous state (4.19million) in Malaysia (Population & Housing Census 2000). Besides population density, there were also more mammography centres to cope with the “workload”! Ethnic Composition of Mammogram Subsidy Participants
Overall, Chinese women constituted 63.4% while 25.8% were Malay women, 8.2% were Indian women and 2.6% were from other ethnic groups. Only in 2 centres (Hospital Kuala Lumpur and Hospital Universiti Sains, Kubang Kerian), there were more Malay women (42.2% & 68.2% respectively) undergoing the mammogram compared to the Chinese women (30.4% & 34.7% respectively). Even in Hospital Kota Bharu, there was a slight Chinese majority (52.2%) in the mammogram programme.
Ethnic Group and Region
As would be expected, Malay women formed the majority (56.6%) of those in the subsidy programme in Kelantan. While in Selangor and Federal Territory, Chinese women accounted for 73.8% and 67.8% of those in the subsidy programme respectively.
Age
The majority of the women (68.2%) were less than 50 years old. The ages ranged from 27 to 77 years. The majority (58.5%) of the women were in the 41-50 year age group with 25.2% in the 51-60 year age group. This would be in line with the target age group of the subsidized mammogram programme. Those in the younger age group were referred to the subsidy programme because their doctor had noted some abnormalities on clinical examination or they had risk factors.
First Mammogram?
One mammography provider in the Klang Valley had data showing that 80% of the women in this subsidy programme was going through their mammogram for the FIRST time! Some were doing it for the second time, but the first mammogram was almost a decade ago! Unfortunately this information was not available from all the centres.
Mammogram Reports
Fortunately, 92% of the mammograms were reported to be either normal or benign. Only 2.5% were slightly or highly suspicious.
Age & Mammogram Reported as Slightly or Highly Suspicious
Out of the 39 mammograms which were reported to be either slightly or highly suspicious, 33% were in women in the 41-45 year age group. 7.7% of these reports were in those aged 36-40 years, while 23.4% were in those 46-50 year age group. 15.4% were those in the 51-55 year age group and 7.7% were in those 56-60 years of age. We need to note that not all of these have yet been proven to be cancer on histological examination (biopsy). We have yet to receive all the feedback data from 2 centres.
Detection of 5 Proven Breast Cancers – thus far…
There were 5 proven breast cancers. All have had surgery and are undergoing further treatment.
They were in ladies aged 39, 40, 47, 52 and 59 years (2 Chinese, 2 Malay and 1 Indian). In 3 of them, breast lumps were palpable on physical examination by the doctor at the time of the mammogram.
Comments
In the Mammogram Subsidy Programme, the target age group as well as the numbers expected to participate in this programme were achieved. The majority of the women were aged 41-50 years.
On the surface, it would appear that the level of awareness was higher amongst the Chinese. This is deduced from findings of the Population and Housing Census 2000 where Bumiputera comprised 65.1%, Chinese 26.0% and Indians 7.7% of the Malaysian citizens. Urbanisation level was reported to be very high in the Federal Territory (100%) and Selangor (87.6%). On the other hand, Kelantan had a low urbanization level of 34.2%.
Inferences and conclusions have to be qualified, as not all can be classified as screening mammograms (i.e. those without any breast symptoms or signs), some women came because they had breast symptoms, the number involved in this programme was small and in specific geographic locations within Malaysia, and the follow up of these participants is still in progress.
There is still more data to be traced in the follow up. This is no easy task because of the widely separated geographic distributions as well as the fact that this programme was a volunteer programme with the subsidy only provided for the costs incurred in the provision of this service. We already have participants who have defaulted recommendations for follow up procedures (including biopsy).
Future Plans – Year 2002
Following the successful 2001 Breast Cancer Awareness Campaign, the College of Radiology continues in its community effort to raise awareness for Breast Cancer. We have begun this year by working together with the National Council of Women’s Organisations (NCWO) Breast Cancer Awareness Campaign 2002. The thrust of this campaign organized by the NCWO, which was launched on 8th March 2002 is to educate women and men on the importance of regular monthly self breast examinations as well as to teach them the techniques. The NCWO will be reaching the grassroots in Penang, Selangor/Federal Territory, Kelantan, Pahang and Sabah.
On behalf of the campaign, the College appealed to private centres to hold their own programmes to complement and synergise with the NCWO BCAC 2002. Thus far, several centres have responded. Through these centres, the campaign will reach those in Kedah, Perak and even Sarawak. It is hoped that more will respond and join in this Malaysian effort to “fight” breast cancer.
The Breast Health Info Centre has been expanded in conjunction with this NCWO Breast Cancer Awareness Campaign and more articles have been translated into Bahasa Malaysia. Do not forget to check out the Articles section within this Breast Health Info Centre.
Later in the year, the College together with the MMA Foundation Radiology Fund, plan to consider further activities as a follow up to the 2001 efforts. As such, more funds will be needed to fight breast cancer in Malaysia and tax exempt donations to the MMA Foundation Radiology Fund will be most welcome.
Tax Exempt Donations can be made out to MMA Foundation Radiology Fund and sent to Rooms 1 & 2, 5th Floor, Bangunan MMA, 124, Jalan Pahang, 53000 Kuala Lumpur. Tel/Fax: 03-40427319.
There is a need for concerted and continued efforts to educate the public on breast health in general and breast cancer specifically. This is necessary if women and men are to seek treatment when they are in their initial stages rather than in an advanced state of the disease. Prognosis improves if breast cancer is discovered in the early stage of the disease. In addition, further studies and properly structured research on breast cancer in Malaysia require funds and this is one area which needs to be addressed.
Acknowledgements
We wish to thank once again, all the mammography service providers, the National Cancer Society for acting as the Central Hotline for the Klang Valley during the Mammogram Subsidy Programme, members of the Press, Media, Radio & TV stations, Link Communications, all volunteers, sponsors and donors and the members of the organizing committee of the Breast Cancer Awareness Campaign 2001 for helping to make this campaign a success.
An appeal for feedback on outcome
We would like to urge both the participants who have sought further treatment, investigations and/or their attending doctors (if they are aware their patients had undergone mammography under this subsidy programme) to write, fax, telephone or email us with regards further procedures or follow up plans inclusive of biopsy results. Details needed to be quoted would be the full name, identity card number as well as their mammogram centre.
Contact details:
Dr Evelyn Ho
Tel (O): 03-7806 1384 / Fax: 03-7803 8090
E-mail: webeditor@radiologymalaysia.org
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Breast Cancer Awareness Campaign 2001: The Subsidised Mammogram Programme Highlights
