Government urged to address gaps in detection, diagnosis and treatment of breast cancer

GOVERNMENT URGED TO ADDRESS GAPS IN DETECTION, DIAGNOSIS AND TREATMENT OF BREAST CANCER

FEBRUARY 10, 2023 @7.30PM

The 'Breast Cancer Care' report highlights that public health efforts to promote breast health screening nationwide have not translated to improved early detection of breast cancer.

The Institute for Democracy and Economic Affairs (IDEAS) Malaysia, supported by Novartis Corp (M) Sdn Bhd, launched a policy report titled “Breast Cancer Care in Malaysia: Access to Early Detection, Diagnosis and Optimal Treatment” today.

“The National Strategic Plan for Cancer Control Program (NSP-CCP) 2021-2025 aimed to downstage breast cancer at the time of diagnosis by 25%,” says Lukanisman Awang Sauni, Deputy Ministry of the Ministry of Health. Through this report, IDEAS calls for priority to be given to improving survival outcomes for breast cancer by increasing resource and budgetary allocation to address talent and facility shortages as well as by promoting public-private partnerships.

Breast cancer is one of the most prevalent cancers in Malaysia. “In line with Sustainable Development Goal 3, to reduce by one-third of premature mortality for non-communicable disease through prevention and treatment by 2030, public health efforts have been focused on improving the early detection of breast cancer as a practice in the NSP-CCP 2021-2025,”

Lukanisman adds. “Despite this, late-stage presentation and relatively poor survival rates of breast cancer remain significant public health issues.”

Malaysia lags behind most developed nations in terms of survival outcomes of breast cancer, recording a 5-year relative survival rate of 67% when compared with other developed nations that range from 80% to 90%. This highlights that there are significant gaps in breast cancer management in the country.

In this report, the authors evaluated the gaps in breast cancer care throughout the patient pathway, from access to early detection, timely diagnosis and optimal treatment. In terms of early detection, this policy report highlights that public health efforts to promote breast health screening nationwide have not translated to improved early detection of breast cancer.

To date, there is low mammogram uptake, particularly in the East Coast Peninsular states such as Terengganu and Kelantan due to the lack of mammogram facilities and infrastructure, which in turn incur higher out-of-pocket expenditure to access screening services. “In addition, there is also a need to address the cultural barriers to mammography screening, to improve monitoring and evaluation of screening programmes as well as to increase breast cancer awareness to effectively promote early detection nationwide,” says Dr Juita Mohamad, Director of Research of IDEAS.

Diagnostic follow-up delays
It is important to highlight that screening does not end at early recognition of mammographic abnormalities, a prompt diagnostic follow-up is crucial. However, diagnostic follow-up is often hindered by disconnected referral processes from private or non-governmental organisation (NGO) facilities to public health facilities, leading to delayed diagnosis.

The lack of awareness of lump and non-lump symptoms among primary healthcare workers and patients may also contribute to diagnostic follow-up delays. This highlights the need to streamline referral processes between public and private healthcare systems as well as to implement comprehensive breast health education for primary healthcare workers.

This report also highlighted that access to best practice options for breast cancer surgery is limited by the lack of specialist surgical expertise and the limited availability of radiotherapy treatment within public health facilities nationwide. Delays in surgical treatment may also be due to patients opting for alternative treatments as a result of cultural influences.

Furthermore, the shortage of oncology specialists within public health facilities also hindered access to radiotherapy and chemotherapy. In addition, this report highlights the potential of Patient Access Schemes to address financial barriers to targeted biological therapy due to its high acquisition costs. Improving survival outcomes of breast cancer as well as non-communicable diseases as a whole should be our public health priority.

The way forward is to adopt a holistic approach to reduce delays throughout the patient pathway, and this can be done through public-private partnerships.

“We need to start by setting up a National Breast Cancer Committee to systematically address these gaps and to foster collaborative efforts among the Ministry of Health, Ministry of Women, Family and Community Development, private sector and NGOs,” says Dr Tricia Yeoh, Chief Executive Officer of IDEAS.

“We also need a collaborative database that maps out existing resources provided by these stakeholders throughout the patient pathway as well as the pathways to accessing these services.” IDEAS Policy Paper No. 76, “Breast Cancer Care in Malaysia: Access to Early Detection, Diagnosis and Optimal Treatment” can be downloaded from https://www.ideas.org.my/publications-item/policy-paper-no-76-breast-cancer-care-inmalaysia-access-to-early-detection-diagnosis-and-optimal-treatment/