KUALA LUMPUR: Breast cancer is the most commonly diagnosed cancer among female patients and is the leading cause of cancer-related deaths globally.
The disease is characterised by the formation of abnormal cells in the breast that grow uncontrollably, eventually developing into cancer. If not detected early, these cells can spread to other organs and may become life-threatening.
Today, women not only have to be concerned about the typical form of breast cancer; they also need to be aware about triple-negative breast cancer (TNBC), which has emerged as another significant threat.
For Lim Kim Foong, being diagnosed with stage three triple-negative breast cancer at age 39 felt like a nightmare.
The president of the Breast Cancer Welfare Association Malaysia (BCWA) shared that it had been incredibly difficult to face the heartbreaking news when her doctor informed her four years ago, during the height of the pandemic, that she had TNBC.
“I was deeply saddened and in denial about the diagnosis. What made it even harder to accept was that I had no family history of breast cancer, and at 39, I was at the peak of my career. I kept asking myself, ‘Why me?’” she told Bernama.
Lim underwent lumpectomy, chemotherapy and radiotherapy treatments, which took seven months to complete. She has now been in remission for four years.
Fighting cancer, she said, requires strength and determination. Alongside her own struggle, she also faced immense sorrow when her only brother passed away during her second round of chemotherapy.
“Before I was diagnosed with cancer, I lost my job, like many others, during the pandemic. Then, in October 2020, my only sibling passed away at age 43 due to heart failure,” she shared.
“My brother left behind our elderly mother and his 10-year-old son. This ordeal was overwhelming, and I nearly gave up as I was coping with my own illness, caring for my mother, and becoming the guardian of a young boy without any income.
“However, I am grateful and fortunate to have insurance, as well as the support of my family, friends, and encouragement from BCWA,” said the former general manager of a private company in Kuala Lumpur.
Lim also shared words of encouragement for women battling breast cancer, urging them to stay strong and reminding them that they are not alone.
“There are many patient support groups, such as BCWA, that provide emotional support, counselling, rehabilitation activities, and accurate information to help guide you through this journey. Don’t stay in sorrow,” she said.
Lim noted that people generally only know about breast cancer, but many are unaware that there are different subtypes such as TNBC.
“Information and awareness about triple-negative breast cancer need to be increased. This is important because each patient’s journey and treatment are different, even in the case of side effects,” she said.
What is TNBC?
Dr Hafizah Zaharah Ahmad, consultant oncologist at Sunway Medical Centre Velocity, explained that triple-negative breast cancer lacks the three common receptors typically associated with most breast cancers: the oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2).
“Because it lacks these receptors, this type of cancer does not respond to hormone therapies (such as tamoxifen) or HER2-targeted treatments (such as trastuzumab/Herceptin),” she said.
“With regular breast cancer, medications can target these receptors, making it easier to treat. With TNBC, the absence of these receptors makes it more challenging, as drugs targeting hormones or therapies targeting HER2 are ineffective.”
She also highlighted that TNBC is more common among younger women, especially those with BRCA1 (breast cancer gene 1) genetic mutations.
And compared with regular breast cancer, TNBC is more aggressive: it grows rapidly, is more likely to have spread by the time it is detected, and has a higher risk of recurrence after treatment.
Furthermore, it is more prone to metastasise, spreading to other parts of the body, especially to areas like the brain and lungs, Hafizah said.
“Patients with TNBC have limited treatment options. As TNBC does not respond to targeted therapies that are effective for other types of breast cancer, chemotherapy and newer treatments such as immunotherapy are the few options available.”
Nevertheless, “if detected early, treatment can yield positive results”, said Hafizah, who treats between two and four cases of TNBC, including follow-ups, every month.
According to her, around 10-15% of breast cancer cases in Malaysia involve TNBC.
Signs and symptoms
In terms of symptoms, Hafizah advises paying attention to several key indicators, including a hard lump that doesn’t move when touched.
“This may be felt in the breast or under the armpit. In addition, look out for a change in the size or shape of one of the breasts, or abnormal discharge from the nipple or an inverted nipple.
“The skin of the breast may appear dimpled, wrinkled, or take on the texture of an orange peel. It may also become reddish or show signs of inflammation, even without pain.”
While early-stage breast cancer is usually painless, some women with TNBC may experience discomfort or pain in the breast or armpit area. In advanced stages, symptoms such as fatigue, weight loss, or pain in other parts of the body may indicate that the cancer has spread to other organs, she added.
Hafizah emphasises the importance of early detection. “Women must understand the risk factors because being young is no guarantee against breast cancer. TNBC is often diagnosed in women under 40.
“Additionally, changes during pregnancy may be misinterpreted as pregnancy side effects, but any abnormal or suspicious changes in the breast should still be evaluated by a doctor.”
She thus advises all women, regardless of age, to perform self-breast exams every month, especially in the week following menstruation. “Never ignore symptoms, as many young women often assume breast cancer only affects older people,” she concluded.
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