There are many influential factors that can affect a population’s health and its outcomes and one of them is social determinants. Social factors are the conditions in which people are born, live, and work (World Health Organization, 2010). In today’s world, social determinants are vital in assessing the health status of a population. In Malaysia, breast cancer is associated with social determinants such as poverty and social injustice. These social factors contribute to a higher mortality rates among impoverished and minority women especially in rural and less developed areas. According to a study on breast cancer in Malaysia, the stage at presentation of breast cancer cases are highly influenced by ethnicity, education level, socio-economic status and access to treatment centers in urban areas. (Yip, Mohd Taib & Mohamed, 2014).
A study among 5264 patients that combined the hospital-based breast cancer databases in University Malaya Medical Centre (UMMC) and National University Hospital Singapore found that the Malay ethnicity was significantly associated with larger tumors at presentation and later stages at presentation, compared to the Chinese and to a certain extent, the Indians. On top of that, it is likely that the negative sociocultural perception of breast cancer and strong belief in traditional medicine in Malaysia is the main reason for the delay in presentation. (Rajaram & Rashidi, 2008). This is because topics related to breast health is considered as taboo. This somehow makes these women feel that their femininity and their role as a wife and mother in Asian culture is threatened by the presence of the disease. They will then develop a strong sense of denial as a protective mechanism against the disease. Speaking of their role as a wife, there is also a fear that after surgery of removing the infected breast, they will be abandoned by their husband. Due to strong traditional influence in Malaysia, especially in the rural areas, many women heavily depend on traditional or alternative treatment such as ‘bomoh’ (a Malay shaman and traditional medicine practitioner) or by believing that the disease will eventually heals by itself before they present to hospital when the initial treatment has failed. A study shows that in Kuala Lumpur Hospital, approximately 5% of diagnosed breast cancer cases default further treatment. (Hisham & Yip, 2004) This is because these women resort to alternative treatment which causes much time to be wasted on ineffective treatment before she presents again with advanced disease. Even though this usually occurs among patients with less education background, educated patients also seek alternative therapy due to fear and denial. The practice of alternative and traditional medicine should be regulated and monitored strictly by the authorities in Malaysia.
I personally think that one of the ways to reduce the disparity in breast cancer incidence and deaths is to remove social barriers to preventive screening. Also, there should be an increased access to health centers, community education and also increased awareness about breast cancer. The public should also be made aware that alternative and traditional therapy should not be the options in the management of breast cancer. Besides, the discrepancy of doctor-patient ratio with the rest of Malaysia should be addressed in order to reduce breast cancer rates among women in Malaysia.
References
Hisham, A. N. & Yip, C. H. (2004). Overview of breast cancer in Malaysian women: a problem with late diagnosis. Asian Journal of Surgery, 27(2), 130-3. https://www.ncbi.nlm.nih.gov/pubmed/15140665
Rajaram, S. S. & Rashidi, A. (2008). Asian-Islamic women and breast cancer screening: a socio-cultural analysis. Women and Health, 28(3), 45–8. https://www.tandfonline.com/doi/abs/10.1300/J013v28n03_04
Yip, C. H., Mohd Taib, N. A. & Mohamed, I. (2014). Epidemiology of breast cancer in Malaysia. Asian Pacific Journal of Cancer Prevention, 7(3), 369-74. https://www.researchgate.net/publication/6737412_Epidemiology_of_breast_cancer_in_Malaysia