The College of Radiology & MMA Foundation Radiology Fund Subsidised Mammogram Programme (SMP) 2002 Highlights

• Organised by the College of Radiology (COR), Academy of Medicine of Malaysia and MMA Foundation Radiology Fund (MMARF)

• Made possible by volunteer mammogram providers

• This programme is partly aimed to provide the impetus and model upon which all medical centres can provide specially priced mammograms with breast health counseling.
   

Category of Mammograms (reports)

In both 2001 and 2002, the figures for normal or benign reports were 92% and 91.2% respectively. Only 2.5% were slightly or highly suspicious in 2001 but this was higher at 3.8% in 2002 with 5.0% in the indeterminate category.

Age & Mammogram Reported as Slightly or Highly Suspicious
2002: Out of 1870 patients whose report was known, 71 mammograms (3.8%) proved to be slightly or highly suspicious. The majority (83.1%) of these were in the 41-60 years age group. Of these mammograms, 31.0% were in those 46-50 years of age, and 15.5% in the 41-45 years age group. 23.9% were in the 51-55 years age group while another 12.7% were in the 56-60 years age group.
 

Number of histopathologically proven breast cancer

In 2002, there were 16 proven breast cancers. However, a few of the patients with suspicious mammograms defaulted follow up and biopsy. Of the 16, all were Chinese except for 2 who were Malays. Their ages ranged from 33 years to 74 years. 69% were below 50 years of age.

Out of the 16 patients, one of them was a recurrent breast cancer. Six of the ladies were clinically found to have breast lumps. The rest were “true” screening mammograms (62.5%). Out of the 6 with breast lumps, one of them was a 33-year old Malay with proven breast cancer on core biopsy. However, this lady has refused conventional proven treatment and opted for traditional treatment at last follow up (June 2003).

The patients were reviewed for risk factors. Only 1 patient had a positive family history of breast cancer and also had past breast cancer. Two other patients had not had any children before. Another patient had early menarche at 10 years of age. Therefore, in the majority of the patients, there were no significant known risk factors for breast cancer.
 

Follow up of SMP 2001 breast cancer survivors (June 2003 update)
 

Three of the 5 proven breast cancer patients picked up in the SMP2001 were traced in June 2003. They are all well and still undergoing follow up at their respective centres/doctors.

One of them (Indian lady, 59 years at time of diagnosis in SMP2001) was surprised the mammogram could pick up cancer so early, before she had symptoms and her breast surgeon also could not feel anything wrong with her breasts. Before this, she never thought of having another mammogram since her mammogram 4 years ago at a government hospital was normal. This lady only had removal of the area of cancer and therefore avoided mastectomy. She also did not require chemotherapy.

The other lady from Kelantan, 52 years old at time of diagnosis in SMP2001 has this message for the ladies – to go for their regular checkup and mammogram before they feel anything is wrong with their breasts. “Especially for the kampong folk, it is important not to be afraid of the mammogram. In fact, if one finds anything wrong with the breasts, do not wait but go and see your doctor. Do not be like me, don’t wait until there is a lump. Early detection is best,” said Puan K. Puan K is currently on follow up at Hospital Universiti Sains Malaysia.

The third lady is Chinese and was 47 years at age of diagnosis in SMP2001. She was glad that her cancer was picked up by the mammogram. Her message is this, “The mammogram is “painful” only for a very short period of the compression and it is tolerable. Do not be afraid to go for one.” This lady had chemotherapy as well as surgery and is currently on follow up in the Clinical Oncology Unit in Hospital Universiti Kebangsaan Malaysia in Kuala Lumpur.
 

Comments and Observations

The NCR 2002 report supports the need for increased breast cancer awareness
The National Cancer Registry 2002 Report Launched on 4 July 2003 for the first time gives us more accurate statistics with respect the burden of breast cancer in Malaysia. It appears that it is definitely the most common cancer in women (30.4% of all newly diagnosed female cancers), far exceeding the next most common cancer, that of cancer of the cervix (12% of all newly diagnosed female cancers).

These facts support the need for programmes such as the Subsidised Mammogram Programme spearheaded by the College of Radiology and MMA Foundation Radiology Fund. Our target groups were achieved in both SMP 2001 and SMP 2002.  More breast cancers were picked up in the SMP 2002. The majority of these came from Sabah and the Klang Valley.

Breast cancer is more common amongst the Chinese
It still appears that the level of awareness was higher amongst the Chinese as in both years 2001 and 2002, the Chinese made up the majority of those who accessed the service. They may also live closer to where mammogram services are available. Since more Chinese accessed the SMP, it also probably explains the “higher” incidence of breast cancer amongst the Chinese. This need not be reflective of the race predominance.  However, the from the NCR 2002 report, Chinese women are indeed far more at risk for breast cancer compared to the other main races. The cumulative life time risk for developing breast cancer is 1 in 14 Chinese women, 1 in 15 Indian women and 1 in 24 Malay women.

Data collection improved but still can be better with regards follow up information
Although there was improvement in the data collection from 2001 to 2002, there were still losses from incomplete forms, incongruent entries or participants who were lost to follow up or defaulted recommended treatment and investigation.

Cultural background influence means more emphasis on education is required
The cultural background is probably a very strong influence and the need to educate Malaysians rather than just extend the mammogram service is of paramount importance. Hence our programme’s emphasis on the value added mammogram with counseling. This is also the reason why we collaborate with other bodies such as the National Council of Women’s Organisations, Breast Cancer Welfare Association, the clinical oncologists, breast surgeons and others to provide a complete overview of breast health.
 

Acknowledgements

Johnson & Johnson (RM100,000) and Meditel Electronics Sdn Bhd (RM30,000) are 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 in 2001 for the first ever SMP. To cope with the added numbers, several centres had to extend the special mammography services into the month of November 2001!

Avon Cosmetics joined this caring group of corporates with a donation of RM30,000 in 2002 to enable the SMP to carry on and expand to 7 states. We also thank all the other donors, some of whom where individuals who responded to the appeal for funds for the SMP.

Tax Exempt Donations for the Subsidised Mammogram Programme can be made out to MMA Foundation Radiology Fund.

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 for 2 years now. Meditel Electronics also sponsored advertisements in 2002 to promote breast health and the early detection message. Thank you too to Link Communications, Micronet Solutions, all volunteer subsidized mammogram centres and supporters for helping to make our past 2 years’ campaigns successful.

For more information, please contact:
Dr Evelyn Ho
Webeditor, Radiology Malaysia Homepage
Breast Cancer/Health Programme Coordinator
Councillor, College of Radiology, Academy of Medicine of Malaysia

E-mail: bcac@radiologymalaysia.org

Discussions: http://forum.radiologymalaysia.org

Tel (O): 03-7806 1384 / Fax: 03-7803 8090

 

Check out the National Cancer Registry's 2002 Report

This report will give you some insight as to the cancer statistics in Malaysia will shape the government's future health policies. Please click here!