New report looks at how to raise breast cancer screening rates for Malay women in S’pore

SINGAPORE - Amid low breast cancer screening rates for the Malay community in Singapore, a new report recommends raising awareness of breast cancer and preventive education through schools, to reach younger females early.

It also suggested organising culturally sensitive workshops and deploying more mobile screening services at mosques.

The report was released on July 2 by the Singapore Breast Cancer Foundation (BCF), in collaboration with pharmaceutical company Roche and the Society of Behavioural Health Singapore.

Only about one in five Malay women, or 21.5 per cent, had undergone a mammogram in the last two years, according to the National Population Health Survey released in 2022.

This is almost less than half the proportion of Indian women at 43.9 per cent, and Chinese women at 39.5 per cent.

As part of efforts to raise greater awareness about breast health, the report recommended having more culturally sensitive workshops that cover topics like the importance of breast self-examination, risk factors for breast cancer, and the benefits of regular screening to reach the Malay community.

Although BCF already has initiatives like awareness talks and outreach sessions, the report highlights more opportunities to work with other organisations, like religious groups.

Ms Natalie Lau, head of advocacy and communications at BCF, said: “We do acknowledge that faith plays an important part and religious leaders can be an important advocate for breast health. We want to be able to kick-start dialogue with religious leaders to understand their perspective and what can help them to advocate for breast health.”

These workshops could cater more to the Malay community by having fellow Malay breast cancer survivors share their personal experiences and acknowledge the experiences of Malay-Muslims, such as their faith, she said.

The report highlights that late-stage diagnosis is a concern among Malay women with breast cancer.

The low screening rates for Malay women are due to a lack of awareness about early detection via screenings and cultural taboos which hinder discussions about the topic, it said.

Other factors like limited access to healthcare facilities and financial constraints add to the problem.

The report also cited how misconceptions about cancer, fear of stigma, and reliance on alternative therapies prevent some individuals from seeking medical help.

To address these sensitivities, healthcare professionals could undergo training to improve their understanding of Malay cultural norms, so that they can deliver more personalised care to Malay patients, said the report.

Its findings were gathered from a workshop organised by BCF, Roche and the Society of Behavioural Health Singapore in January 2024. The session, which focused on improving health outcomes for Malay women with breast cancer, involved 22 attendees from different sectors, including Malay-Muslim organisations, patients, healthcare experts and government agencies.

To make breast cancer screenings more accessible, the report recommends deploying mammobuses directly at mosques, for example.

A mammobus is a bus which carries breast cancer screening equipment and brings mobile screening services to communities by making stops at polyclinics and community clubs.

Ms Lau said the report is a stocktake of existing initiatives and is a first step to tackling low breast cancer screening rates in Singapore.

Moving forward, BCF will organise similar workshops to provide feedback on existing efforts and devise plans based on needs.

One breast cancer survivor, Madam Nurhana Abdul Ghani, said it is important to have conversations starting early from home, due to much uncertainty over screenings and breast health.

Breast cancer survivor, Madam Nurhana Abdul Ghani (left), pictured here with her eldest daughter, found out she had breast cancer through a breast self-examination. PHOTO: COURTESY OF NURHANA ABDUL GHANI

Madam Nurhana, now 40, was diagnosed with triple negative breast cancer – one of the most aggressive types – and had a full mastectomy, followed by 16 cycles of chemotherapy in 2017.

Unlike most individuals who discover their diagnosis through screenings, the civil servant found out she had breast cancer through a breast self-examination, something she had been taught to do monthly since she was 16, as she had a benign lump.

She was also only 33 years old then, which was younger than the recommended screening age of 40.

She said women may be hesitant to go for screenings due to uncertainty about the process and what happens after.

Madam Nurhana managed to convince her mother to go for a screening only after her own diagnosis, as her mother was afraid of the pain of undergoing a mammography, knowing that this would involve pressing the breasts between two plates for imaging.

For those who are religious, there may be a mentality of resigning to one’s circumstances, as it is all “God’s will”, hence the reluctance to go for screenings, she said.

She added that women will be more open to screenings if they can be better informed about the process of a mammography, for instance the pain levels and duration.

Madam Nurhana recalled when her daughter, who was nine then, asked her if she would die from cancer.

Since then, there have been more conversations about breast health with her daughter, who is now 16.

She also taught her daughter how to conduct a breast self-examination when she reached puberty, and still reminds her to do it monthly after each menstrual cycle.

Across the board, about 38 per cent of Singaporean women aged 50 to 69 reported going for a mammogram in the last two years, according to the 2022 report.

This was although more than nine in 10, or 96 per cent, knew about mammograms.

Radiation oncologist Choo Bok Ai, who attended the workshop in January, said: “In my practice, I come across many Malay women who present with advanced local breast cancer.

“At these late stages, there are fewer treatment options, and the clinical outcomes can only be improved by palliative radiotherapy. We must drive home the point of early detection: saving breasts, and saving lives.”