For my final project, I decided to learn more about breast cancer and its impact on Malaysian women. I personally think that the best way to learn more about breast cancer is by looking at it from an epidemiological, anthropological perspective. A study has shown that Malaysian women present at later stages compared to women in Western countries and Singapore. This variation does not only differ among countries but also within different settings in Malaysia. Thus, I believe that epidemiology and anthropology approach have their own role in examining this disease among Malaysian women. According to the article on Medical Anthropology and Epidemiology by Marcia Inhorn, epidemiology is defined as “the study of the distribution and determinants of diseases and injuries in human populations”. Meanwhile, anthropology is more about the study of ‘illness’ which is highly associated with the cultural meaning and social relationships experienced by the patients. Since delayed reporting of breast cancer in Malaysia remains very common, I have decided to look further into the social and cultural factors that lead to this issue.

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. This study combined the hospital-based breast cancer databases in University Malaya Medical Centre (UMMC) and National University Hospital Singapore (NUHS) which consists of data from 5264 patients. They 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. Late stage at presentation of breast cancer had been attributed to a strong belief in traditional medicine, the negative perception of the disease, poverty and poor education, coupled with fear and denial. In Sabah which is one of the states in Malaysia, patients who presented with advanced disease were also poor, non-educated and from rural areas. these social and cultural perceptions are highly associated with the high rate of delayed report of breast cancer in Malaysia. On top of that, anything related to breast is a taboo topic here which makes them feel that their femininity and their role as a wife and mother in Asian culture is somehow threatened by the presence of the disease. Speaking of their role as a wife, there is also a fear that after surgery of removing the infected organ, they will be abandoned by their husband. A study shows that in Kuala Lumpur Hospital, approximately 5% of diagnosed breast cancer cases default further treatment. These women resort to alternative treatment, hence, much time is wasted on ineffective treatment before she presents again with advanced disease. Although this may occur more predominantly in less educated patients, educated patients also seek alternative therapy due to fear and denial. Another social factor that leads to high rate of breast cancer is poverty. As a whole, there are variety of factors that lead to the delay in presentation and further research is needed to fully understand the sociocultural perception of breast cancer geographically and culturally.

I believe that education and breast cancer awareness must be emphasized in Malaysia. Unless women are aware of the dangers of alternative therapy, and understand the nature of the disease, the incidence of advanced breast cancer in Malaysia will remain the same if not increase.