Breast Cancer - Symptoms, Diagnosis and Treatment

How Common is Breast Cancer in Malaysia?

Breast cancer is the number one, most common cancer in Malaysia based on national and international reporting. GLOBOCAN 2022 estimates 8,371 new cases and 3,526 deaths from breast cancer in Malaysia in 2022.

Malaysia's National Cancer Registry summary also highlights a key challenge: 50.5% of female breast cancer cases were diagnosed at late stages (Stage 3 and 4), reinforcing why recognising symptoms and doing appropriate screening matters.

Breast Cancer Symptoms

Breast cancer doesn't always cause pain, and early changes can be subtle. Common symptoms include:

• A new breast lump or thickening
• Changes in breast shape or size
• Skin changes such as dimpling, redness, or a pulled in look
• Nipple changes (new inversion or persistent rash around the nipple area)
• Unusual nipple discharge (especially blood stained)
• Swelling or a lump in the underarm area

Breast Cancer Stages

Staging explains how far the cancer has grown or spread, and it guides treatment planning:

• Stage 1: small, early cancer limited to the breast
• Stage 2: larger tumour and/ or spread to nearby lymph nodes
• Stage 3: more extensive lymph node involvement or local spread
• Stage 4: cancer has spread to distant organs (metastatic breast cancer)

Female Breast Cancer Staging Percentage in Malaysia - The Malaysia National Cancer Registry Report 2017 – 2021

Malaysia registry data (2017 to 2021) reports the following distribution for female breast cancer: Stage 1 (15.1%), Stage 2 (34.4%), Stage 3 (28.3%), Stage 4 (22.2%).

Breast Cancer Screening and Diagnosis

Screening helps detect changes before symptoms appear, while diagnosis confirms whether a suspicious finding is cancer.

Step 2: The Raised Arm Check

Raise your arms and look for the same changes mentioned in Step 1. While your arms are raised, look for any signs of fluid or discharge coming from one or both nipples.

Step 3: The Manual Check (Feel)

While lying down or in the shower (where soapy skin makes it easier to feel the tissue), use your right hand to feel your left breast, and then your left hand to feel your right breast.

• Use a firm, smooth touch with the finger pads of your first three fingers
• Keep your fingers flat and move them in a small, circular motion, about the size of a 20 sen coin
• Cover the entire area, move from your collarbone to the top of your abdomen, and from your armpit to your cleavage

Mammogram

A mammogram screening is a specialised, low-dose X-ray of the breast. It is the gold standard for early detection because it can find tiny changes or calcium deposits (calcifications) that are far too small for you or a doctor to feel during a physical exam.

Breast Ultrasound

A breast ultrasound uses sound waves to create a real-time image of the inside of your breast. It is often used as a partner to your mammogram. While a mammogram is great at finding spots, an ultrasound is excellent at determining if those spots are solid masses or just fluid-filled cysts (which are usually harmless).

Biopsy

If there are any changes detected in the breast tissue, a further examination of the tissue is done to rule out breast cancer. A biopsy is the only sure way to diagnose breast cancer. A cell from the area is removed and studied to determine this.

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Breast Cancer Treatment Options

Once a breast cancer diagnosis is confirmed and the breast cancer stage is identified, our multidisciplinary team, cancer specialists at Sunway Medical Centre Penang, works together to design a personalised medicine plan.

Lumpectomy

This is often recommended if the cancer is caught early via breast cancer screening. Your breast surgeon removes the tumour and a small margin of healthy tissue, allowing you to keep most of your natural breast.

Mastectomy

A mastectomy is the removal of the entire breast. Your breast surgeon will recommend a mastectomy on occasion if the size of the tumour is large or the patient has displayed a high risk of recurrence.

Radiotherapy

Radiotherapy is typically used to ensure no microscopic cancer cells remain. It uses high-energy X-rays to kill cancer cells and shrink tumours.

Intraoperative Radiation Therapy (IORT)

Intraoperative Radiation Therapy (IORT) delivers a concentrated dose of radiation directly to the tumour bed (the area where the tumour has been removed) during surgery. This targeted approach helps destroy any remaining cancer cells while limiting radiation exposure to surrounding healthy tissues and organs.

IORT is delivered as a single session, typically lasting approximately 30 to 40 minutes, while the patient is under anaesthesia. For appropriately selected patients with early stage breast cancer, IORT may eliminate the need for additional radiotherapy after surgery. However, further radiotherapy may still be recommended depending on the patient's individual risk factors.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. These drugs can affect fast-growing cells throughout the body, including cancer cells and some healthy cells, which may cause side effects.

Hormone Therapy

Hormone therapy is an important treatment for hormone receptor positive breast cancer, including cancers that test positive for oestrogen receptors (ER positive) and/or progesterone receptors (PR positive). These hormones can stimulate cancer cell growth. Hormone therapy works by blocking the effects of hormones on cancer cells or reducing the body's hormone production, helping to slow or stop cancer growth and reduce the risk of recurrence.

• HER2-Targeted Therapy - about 20% to 25% of breast cancers have an excess of a protein called human epidermal growth factor receptor 2 (HER2). This protein makes tumour cells grow. There might be higher amounts of HER2 in your breast (HER2+). If this is the case, it is called HER2 positive breast cancer. HER2-targeted therapy uses specific drugs to block HER2 activity or target HER2-positive cancer cells, helping to slow or stop their growth.

Prevention and Early Detection

While breast cancer cannot always be prevented, the American Cancer Society advises that certain lifestyle choices may influence breast cancer risk. Understanding modifiable and non-modifiable factors helps individuals make informed health decisions.

1. Understanding Risk

Some risk factors cannot be altered, including:

• Increasing age
• Female gender
• Family history of breast or ovarian cancer
• Inherited gene mutations such as BRCA1 or BRCA2
• Early onset of menstruation or late menopause

However, several modifiable lifestyle factors have been associated with breast cancer risk.

2. Maintain a Healthy Body Weight

Being overweight or obese, particularly after menopause, is associated with an increased risk of breast cancer. After menopause, most oestrogen is produced in fat tissue. Higher levels of body fat can lead to higher oestrogen levels, which may stimulate the growth of certain types of breast cancer.

Maintaining a healthy weight through balanced nutrition and regular physical activity may help reduce this risk.

3. Stay Physically Active

Regular exercise is consistently linked to a lower risk of breast cancer. Physical activity helps regulate hormone levels, reduce inflammation, and improve immune function. Health authorities generally recommend:

• At least 150 to 300 minutes of moderate intensity activity per week, or
• 75 to 150 minutes of vigorous intensity activity

Even simple lifestyle changes such as brisk walking, cycling, or swimming can contribute to overall health.

4. Limit Alcohol Intake

Alcohol consumption has been shown to increase breast cancer risk. The risk rises with the amount consumed. Alcohol may increase oestrogen levels and cause cellular DNA damage.

Reducing or avoiding alcohol may help lower risk, particularly for individuals with other existing risk factors.

5. Breastfeeding, When Possible

Breastfeeding has been associated with a modest reduction in breast cancer risk, particularly when continued for several months. The protective effect may be linked to hormonal changes during lactation and reduced lifetime exposure to oestrogen.

6. Regular Breast Cancer Screening

Even with risk reduction strategies, early detection remains essential. Regular breast cancer screening and awareness of breast changes can help identify abnormalities at an earlier stage, when treatment outcomes are generally more favourable.

• Women aged 40 to 44 may choose to begin annual breast cancer screening with a mammogram after discussing the benefits and limitations with their doctor
• Women aged 45 to 54 are generally recommended to undergo a mammogram every year
• Women aged 55 and above may transition to screening every two years or continue yearly mammograms depending on personal preference and overall health. Screening is typically advised as long as a woman is in good health and has a life expectancy of at least 10 more years
• All women, regardless of age, should understand what a mammogram can detect, and its limitations, so they can make informed decisions about breast cancer screening

Seek a Second Opinion

Not every breast change means cancer, but it's always worth checking properly. Screening is one of the simplest ways to stay on top of your breast health and catch potential issues early.

Take the next step, book a breast cancer screening at Sunway Medical Centre Penang.

Book a Breast Cancer Screening

Breast Cancer Specialist at Sunway Medical Centre Penang

Dr. Cheah Soon Keat is a resident consultant clinical oncologist at Sunway Medical Centre Penang. Patients can meet Dr. Cheah for assessment and discussion of chemotherapy, radiation therapy, hormone therapy and HER2 targeted therapy options for breast cancer.

Dr. Doris Chow Sze Ying is a resident consultant clinical oncologist at Sunway Medical Centre Penang. Patients can meet Dr. Doris for assessment and discussion of chemotherapy, radiation therapy, hormone therapy and HER2 targeted therapy options for breast cancer.

Dr. Intan Zati Hanani Hamid is a consultant clinical oncologist at Sunway Medical Centre Penang. Patients can meet Dr. Intan for assessment and discussion of chemotherapy, radiation therapy, hormone therapy and HER2 targeted therapy options for breast cancer.

Dr. Cheah Sin Dee is a resident consultant general, breast and endocrine surgeon at Sunway Medical Centre Penang. Patients can meet Dr. Cheah for assessment and discussion of lumpectomy and mastectomy options for breast cancer.

When Should You See a Breast Cancer Specialist?

• You notice a new lump or thickening in your breast
• You notice nipple discharge, particularly clear or bloody discharge
• Your breast has changed in size, shape or skin texture
• A close relative has had breast or ovarian cancer, or you know of a BRCA1 or BRCA2 mutation in your family
• You are 50 or older and have never had a mammogram
• You have been diagnosed with breast cancer and would like to discuss your treatment options or seek a second opinion

Seeing a specialist does not mean you have cancer. It means finding out where you stand and having a plan. Speak with our breast cancer specialists at Sunway Medical Centre Penang to understand your condition and the options available to you.

Learn more about cancer care at our Cancer Centre in Penang

Frequently Asked Questions