Prepared by Claudia Ng
31 October 2024
The Rising Incidence of Breast Cancer Among Malaysian Women
Breast cancer claims the lives of 3,500 Malaysian women each year. Based on this figure, nine Malaysian women will lose their lives to this devastating disease today (1).
As an illness that was once seemingly distant, breast cancer can suddenly become a reality that hits close to home for many. Although breast cancer’s grip in Malaysia is undeniable, it should not be a death sentence for affected women, nor should it stop them from living meaningful lives. Unfortunately, for Malaysian women, nearly 48% of breast cancer was diagnosed in the advanced stage of the disease(2), leaving that demography with only about a 23.3% survival rate. This alarming statistic highlights not only the urgency for proactive female-specific healthcare but also the strong clutch of social and economic impact that breast cancer has on Malaysian women.
Rising Trend Among Young Malaysian Women
Although traditionally associated with ageing women, breast cancer started to become an increasing trend among the Malaysian younger demographic, standing at a whopping figure of 13.6% of women below the age of 40(3). These women, who could be at the prime of their careers, are now at risk of losing their financial support due to job losses as an indirect cost of breast cancer, leaving them with profound psychological and financial distress.
The Great Risks of Early-Onset Cancer
Moreover, women who are diagnosed with early-onset breast cancer between the ages of 18 to 40 carry a higher risk of rapid progression and recurrence of the disease in their later life stages(4). This unfair circumstance can place a huge emotional toll on the well-being of cancer patients, even becoming a huge driving force behind a high divorce rate following women’s breast cancer diagnoses(5). With so many survivors struggling with feelings of inadequacy, often due to the disruption to their professional lives and strains in marriages, the voices of women who experience health-related struggles should not be ignored any further.
Prevalence - Why is Early Detection Important?
Breast cancer is the most common cancer that affects Malaysian women, with about one in 19 women in Malaysia being at risk of developing breast cancer at some point in their life. Although breast cancer is highly treatable through early detection(6), many women in Malaysia still struggle to put their needs above others, often thinking that health screening is a waste of resources and that it is better to turn their back away from it and carry on with their lives(7). On the contrary, early detections can reduce treatment costs before they balloon depending on the complexity of the procedure, eventually allowing it to save more lives.
Healthcare professionals should play a huge role in promoting healthcare-seeking behaviour among women. By truly listening to patients' concerns and responding with empathy, they can empower women to seek help early, when treatment is most effective. Yet, an existing gender bias in healthcare often leads to dismissal of women’s pain, misdiagnosis, and underdiagnosis, leaving many women feeling unheard and unsupported(8). Subsequently, women ended up feeling discouraged from seeking timely care, until it became an impossible task to conceal any discomfort.
According to the World Health Organization (WHO) in 2022, there were 155.507 reported cases of breast cancer in Malaysia within only 5 years, with 31.633 of them resulting in death(9). The high mortality rate of breast cancer in Malaysia is mainly due to late detection. Given that most women diagnosed with breast cancer had no identifiable risk factors other than age and gender, the government should actively look for ways to promote screenings, either through funding or free screening programs.
A Disproportionate Burden on Low-Income Women Leads to Missed Opportunities
While the disease is a formidable foe against many, the financial burden that entails treatment procedures can push the battleground firmly into the realm of social justice, presenting Malaysia with an intersectional challenge. With this, an uncomfortable truth unravels: the disproportionate financial burden that falls on specific socioeconomic groups. In Malaysia, the cost of breast cancer treatment can go as high as RM395,00(10). To make matters worse, a study reveals that non-medical costs for cancer treatments in Malaysia can go as high as MYR 3,600 annually, compared to the total cancer annual cost of MYR 7,955 for each individual. While individuals can rely on public hospitals for the affordability of the treatments, out-of-pocket expenses for essential medical supplies can be substantial, particularly for low-income or B40 communities. Not surprisingly, the direct medical cost was the least contributor to the financial burden of cancer, despite the treatment sought at public hospitals being primarily subsidised by the Malaysian healthcare system(11).
Beyond these direct costs, indirect expenses such as transportation and supplemented food account for the largest portion of the overall financial burden for patients in public hospitals. The distance to treatment facilities can be a daunting obstacle for any individuals seeking healthcare services, particularly for low-income residents situated far away from treatment sites. This particular demography might feel more reluctant to seek immediate help, as the complicated and cost-ineffective journey to the nearest healthcare facilities may deter them from travelling in the first place. Such barriers are translated as missed opportunities for early detection and treatments, further exacerbating the high mortality rate among breast cancer patients nationwide while significantly affecting the well-being of those caught in the battle.
The Invisible Economic and Emotional Tolls of Breast Cancer
Beyond the direct financial costs, breast cancer patients often bear a hidden burden that sticks out like a sore thumb: the indirect costs of lost productivity - associated with job losses- and resources spent on caregiving(11). Extending far beyond the financial hardships, breast cancer can induce immense emotional distress and social isolation among many affected women. If those effects on the female psyche are not enough, many women also grapple with relationship strains, often feeling like their partners fail to give them adequate support during such a life-altering event of their lives(12). The concerning trends above highlight the urgent need for better support systems for patients and their communities. Simultaneously emphasising the importance of fostering resilience through societal support, coupled with proactive governmental interventions to support survivors through socio economic hardships.
Budget 2025 Campaign: A Way Forward
Malaysia’s national 2025 Budget proposal was recently released on the 18th October, 2024. Out of the total budget of RM 421 billion, RM 45.3 billion was allocated to the Ministry of Health (MoH), signifying a 9.8% increment from last year’s RM 41.2 billion(13). The additional funding in the healthcare sector serves as an opportunity to invest in critical areas of women’s healthcare, especially in addressing the socioeconomic burden of breast cancer through alleviating patients’ out-of-pocket expenditures, and necessitating breast examinations to promote early detection.
While the budget did not propose anything specific to breast cancer treatment, the limit of tax relief for medical expenses has been increased to RM10,000, which can help in covering the treatment costs for breast cancer.
Additionally, relief fees for diagnostic tests can potentially alleviate the costs associated with breast cancer screenings like mammograms and genetic testing. Following the release of the national 2025 Budget, it is crucial for stakeholders to take deliberate and concrete steps to achieve its vision of a nearly free healthcare for all citizens.
Dismantling Social Barriers
Although screening is a cornerstone of effective breast cancer care, many Malaysian women reported that poor social support and negative social influences kept them away from seeking help(14). Thus, government interventions aimed at improving breast cancer screening and early detection should be carefully tailored to reflect the unique dynamics of Malaysian families with considerations of sociocultural factors(15). To maximise the funding of 2025 Budget allocation within the ehealth sector, family-oriented messages in breast cancer awareness campaigns would potentially resonate more with Malaysians, as Malaysian families tend to place stronger emphasis on traditional values, and often relying on family consensus from the elderly to make decisions.
Affordability of Breast Cancer Screening
The Malaysian government has also provided subsidised programs organised by the National Population and Family Development Board (NPFDB) in Malaysia(16). Furthermore, The Malaysian Ministry of Health (MoH) clinical guidelines and recommendations have evolved and have been updated periodically with the inclusion of risk assessment and screening recommendations based on risk stratification(17). However, screening uptake in Malaysia remains underutilised and needs to be improved alongside the adherence to the professional guidelines(18).
Although genetic tests are the gold standard for the most accurate breast cancer detection, the estimated cost of MYR1,500(19) far exceeds the median willingness to pay of MYR 200 among Malaysian women(20). This discrepancy underscores the urgent need for government interventions to make these essential screenings more accessible and affordable, especially for women in remote areas. An upgrade of RM 1.35 billion on the 2025 budget for the increase of health facilities nationwide can potentially address the issue of screening accessibility in rural areas. Furthermore, to ensure a more cost-effective way to boost screening uptake, it is crucial to tailor types of screening for women according to their age and background. For instance, mammograms and genetic testing should be targeted to the older population, particularly for women above the age of 50. Many consistent studies suggest that breast cancer is more prevalent among older women due to the bodies losing capability of repairing genetic mutations(21).
Targeted Subsidies for Healthcare: Who Are The T15 Community?
With the announcement of targeted healthcare subsidies on the 2025 budget plan, the T15 community - which refers to the top 15% of income earners - is expected to pay “slightly more” for public health care services.13 However, Prime Minister Anwar Ibrahim, who is also the Malaysian finance minister, has yet to make further specifications on how much more T15 would be required to pay to access public health services under the MOH. Although targeted subsidies might benefit lower income earners, household income alone should not be used as the only benchmark to determine subsidy eligibility. Modifying factors such as electricity consumption, geographical location, and the amount of dependence should be taken into account as additional criterias in determining who can be categorised as a member of the T15 community. In response to the announcement, many economists suggested that the combination of these factors as key variables might be more effective in maximising assistance to those who truly need it and reduce any wastage of resources(22).
Conclusion
The socioeconomic hurdles of breast cancer in Malaysia are an intricate issue that requires multi-pronged approaches. While the government has made bold strides in ensuring affordable and accessible healthcare, addressing the financial challenges faced by patients remains crucial, along with taking proactive measures to dismantle sociocultural barriers behind late breast cancer detections. Ensuring the continuity of one’s life through affordable, effective, and attentive breast cancer care is a fundamental right.
The National Budget 2025 gives promising opportunities to address the pressing needs of breast cancer patients through upgrading healthcare facilities to boost screening uptake, and targeting subsidies to provide financial relief. The success of these initiatives - on the other hand - will rely on the executions of these plans and the stakeholders’ adherence to these frameworks. Through the right implementation, the 2025 Budget can help to bridge healthcare gaps in Malaysia, and ensure that all Malaysians have equal access to essential breast cancer services.
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