Giving meaning to breast cancer

Researchers from the Saw Swee Hock School of Public Health (SSHSPH) at NUS and the NUS Yong Loo Lin School of Medicine (NUS Medicine), as well as area studies specialists, anthropologists and the medical community have completed their first pilot qualitative study as part of a collaborative project. The study investigated the non-medical and cultural complexities that may influence breast cancer literacy in Asia — specifically women’s attitudes and decisions regarding breast cancer screening and treatment.

Supported by the NUS Asian Breast Cancer Research Fund, the study — the first in a series — identified four major barriers associated with low uptake of breast cancer screening and early treatment. The barriers identified were lack of knowledge of breast cancer occurrence, lack of information of breast cancer symptoms, misconceptions of breast cancer fatality and treatments, and the fear of being an emotional and financial burden to their families. Barriers of a similar nature were also observed among women in other Asian countries.

Associate Professor Mikael Hartman, Head of the Breast Cancer Prevention Programme at SSHSPH, who leads the research project, said that breast cancer mortality has decreased by half in the West, due to the successful implementation of breast cancer screening programmes and public health policies, but the same strategies do not seem to have similar effects in Asia.

“It is imperative to examine the health seeking attitudes of women in Asia in order to come up with programmes and policies that are tailored to their needs and concerns,” Assoc Prof Hartman, who is also a faculty member of NUS Medicine and Senior Consultant in the Division of General Surgery (Breast Cancer) at the National University Hospital (NUH), added.

The findings, peppered with anecdotes and narratives from breast cancer patients, caregivers and medical personnel in the Asian countries, were compiled into a book, titled Breast Cancer Meanings: Journeys Across Asia. This book was launched on 16 March by State President and NUS Chancellor Madam Halimah Yacob at a dinner to raise funds for the NUS Asian Breast Cancer Research Fund.

It is imperative to examine the health seeking attitudes of women in Asia in order to come up with programmes and policies that are tailored to their needs and concerns.

The inspiration for this research project began with Assoc Prof Hartman and NUH Clinical Associate Professor Philip Iau’s motorcycle trip in 2014 across multiple Asian countries when travelling from Singapore to Sweden over the span of three months. The trip began with a few main aims — to understand the multiple factors that affected the way women gave meaning to breast cancer, to raise funds for Asian breast cancer research and to build collaborations with breast cancer resource centres across Asia. During their journey, the two surgeons worked with various cancer centres, raising breast cancer awareness by conducting lectures, participating in forums and giving surgical demonstrations.

One stop in their journey was Denmark, where they met the anthropological team led by Professor Cynthia Chou, C. Maxwell and Elizabeth M. Stanley Family Chair Professor of Asian Studies & Professor of Anthropology at the University of Iowa. While Assoc Prof Hartman and Assoc Prof Iau were on their journey, the anthropologists and area studies specialists in Prof Chou's team spoke to some 1,000 women, of all ages and backgrounds, diagnosed with breast cancer in nine Asian countries to look into the sociocultural factors that lead to late presentation of breast cancer patients and the corresponding high mortality rate. This eventually became the pilot qualitative study of the project.

“The pilot study has seen the coming together of academic collaborators, donors, fund raisers, event organisers, transcontinental explorers, clinicians, cancer survivors and their relatives to gain cultural understanding of breast cancer behaviours. The continued partnership between cancer surgeons and cultural experts will form the vanguard of new and important discoveries that will address sociocultural barriers towards breast cancer screening and treating, and thereby prolong lives,” said Professor Lee Chuen Neng, The Abu Rauff Professor in Surgery at NUS Medicine, who initiated the project.


Assoc Prof Hartman (far right) and Prof Lee (far left) with Madam Halimah at the fundraising dinner

Moving forward, the team will now focus closer on Southeast Asia. Malay women in Southeast Asia were found to experience higher breast cancer mortality despite higher incidence among Chinese women. They also present their disease at more advanced stages, and have poorer survival after diagnosis. The team hopes to investigate the sociocultural factors that impact Malay women in their decision to seek breast cancer screening and treatment.

The research team aims to eventually use their findings to develop and implement a host of targeted and culturally diverse strategies to encourage Asian women to go for breast cancer screening and early treatment.

See press release.