Breast surgeons, anthropologists and researchers join hands to improve breast cancer literacy in Asia

The collaboration seeks to examine and change health seeking behaviours of Asian women towards breast cancer

Researchers from the Saw Swee Hock School of Public Health (SSHSPH) and Yong Loo Lin School of Medicine (NUS Medicine) at the National University of Singapore (NUS) have embarked on a series of studies with international area specialists, anthropologists and the medical community to better understand health seeking behaviours of Asian women towards breast cancer. The aim is to develop and implement targeted strategies to encourage uptake of breast cancer screening and early treatment in Asia.

Her Excellency Madam Halimah Yacob, President of the Republic of Singapore and NUS Chancellor was the Guest-of-Honour at the fundraising dinner where the book “Breast Cancer Meanings: Journeys across Asia” was unveiled

Supported by the NUS Asian Breast Cancer Research Fund, this research project saw the completion of a pilot qualitative study aimed at understanding how non-medical and cultural complexities influence women’s decision about breast cancer screening and treatment in Asia.  

Associate Professor Mikael Hartman, Head of the Breast Cancer Prevention Programme at SSHSPH at NUS, who leads the study, said, “The successful implementation of breast cancer screening programmes and public health promotion policies have reduced breast cancer mortality in the West by half over the last decades. However, these strategies seem to gain little traction in Asia, and many Asian women are still dying from breast cancer largely due to later presentation of the disease. 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 is also a faculty member of NUS Medicine as well as Senior Consultant in Division of General Surgery (Breast Cancer) at the National University Hospital (NUH).

Assoc Prof Hartman and Clinical Associate Professor Philip Iau, who is also a breast surgeon at NUH, travelled through multiple Asian countries on motorbikes in a three-month journey from Singapore to Sweden, across 22 countries, in 2014. During their journey, they worked with various cancer centres to raise awareness for breast cancer by conducting lectures, participating in forums and giving surgical demonstrations.

At the same time, Professor Cynthia Chou, C. Maxwell and Elizabeth M. Stanley Family Chair Professor of Asian Studies & Professor of Anthropology at the University of Iowa organised and led a team of anthropologists and area studies specialists to speak with women who have been diagnosed with breast cancer in eight countries to uncover the socio-cultural factors that contribute to the late presentation of breast cancer in Asia, and correspondingly the high mortality rate even for developed Asian countries. Together with Dr Miriam Koktvedgaard Zeitzen from the Department of Modern History and World Cultures at the National Museum of Denmark, an analysis of the narratives collected was done to facilitate a better understanding of breast cancer as lived experiences in all their complexity.

Low breast cancer literacy in Singapore

Four major barriers that attribute to the low uptake of breast cancer screening and early treatment were identified for Singapore:   

• Lack of knowledge of breast cancer occurrence among Singapore women gives rise to low attendance for mammography screening
• Lack of information of breast cancer symptoms results in the disease being treated at an advanced stage
• Misconceptions of breast cancer fatality and its treatments cause women to seek treatments outside of hospitals or give up treatment entirely
• Women fear of becoming an emotional and financial burden to their families

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These barriers also contributed towards low breast cancer literacy among women in other Asian countries.

The detailed findings of this study are presented in the book “Breast Cancer Meanings: Journeys Across Asia”, which also covers the work done in Malaysia, Thailand, Myanmar, China, Mongolia, Iran and Turkey.

The new book was unveiled today at the dinner event to raise funds for the NUS Asian Breast Cancer Research Fund. Her Excellency Madam Halimah Yacob, President of the Republic of Singapore and NUS Chancellor, attended the dinner as the Guest-of-Honour. 

The book is published in Asia by NUS Press and in Europe and North America by NIAS Press, Copenhagen, and is available for sale at major book stores in Singapore at S$26 (before GST). It can also be purchased online via the NUS Press website: https://nuspress.nus.edu.sg

Next step: Focus on Southeast Asia

Following the completion of the pilot study, the work now continues with a focus on Southeast Asia.

In Southeast Asia, higher breast cancer mortality among Malay women is observed despite a higher incidence of the disease among Chinese women. Malay women in Southeast Asia also present the disease at more advanced stages and are significantly associated with poorer survival following breast cancer diagnosis. Moving forward, the study will therefore focus on gaining insights into the socio-cultural factors that may influence the decision of Malay women in seeking breast cancer screening and treatment. The study will be first conducted on the Malay population in Singapore, and findings will facilitate the development of targeted public health programmes to encourage screening and treatment for Malay women.  

“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 socio-cultural barriers towards breast cancer screening and treating, thereby prolong lives,” said Professor Lee Chuen Neng, The Abu Rauff Professor in Surgery at NUS Medicine’s Department of Surgery, who initiated the study.