Finding a lump should not mean getting lost: breast cancer care with the right expertise in one place

Finding a lump in your breast can be alarming. It is natural for your mind to jump to the worst-case scenario, even though not every lump or change in the breast is cancer. Still, any persistent or unusual change should be checked by a doctor.

In Malaysia, breast cancer remains the most common cancer affecting women, with nearly one in two cases diagnosed at stage three or four between 2012 and 2016.¹ The difference that earlier diagnosis can make is significant: the five-year survival rate is 88 per cent for stage one breast cancer, compared with just 23 per cent for stage four.²

Why women still come late

“We do not really have a breast cancer awareness problem in this country. What we have is an early detection pathway problem. There are campaigns after campaigns, yet women are still coming late,” said Dr Harjit Kaur, Consultant Oncoplastic Breast and Endocrine Surgeon at Picaso Breast Centre.

When she asks patients why they waited months after first feeling a lump, the answers are familiar. They hoped it would go away. It did not hurt. They worried about time off work, or how to tell their husband, in-laws and children. Younger women often assume they are too young. “Cancer is painless until it is advanced,” she said.

Sometimes the delay is not the woman’s at all. “She did come forward, but with waiting lists for imaging and then the biopsy, two or three months can pass before she is diagnosed,” Dr Harjit added.

Consultant Breast Radiologist Dr Maninderpal Kaur sees the other side of the same problem. Breast screening in Malaysia is largely opportunistic, so access often depends on women attending healthcare services and screening being discussed or offered during those visits. “The most common misconception is that you need to have a lump before you come in,” she said. “And women are usually the caregivers to everybody around them, so they do not prioritise themselves.”

A decision to put the patient at the centre

The Centre grew from a shared belief among specialists who had seen how disconnected care pathways prolong uncertainty, and who came together to build a centre around the patient’s journey rather than around individual departments.

“I saw how women often had to navigate multiple appointments, with each handover adding to the waiting, uncertainty and anxiety of an already difficult journey. For someone already frightened by what a diagnosis might mean, those gaps can become places where they lose confidence, feel overwhelmed or simply do not return,” said Professor Emeritus Dato’ Dr Yip Cheng Har, Consultant Breast Surgeon, Picaso Breast Centre.

At Picaso, her clinic sits next door to radiology, so a woman who needs a scan or biopsy walks a few steps rather than across a hospital. Prof Yip points to the World Health Organization’s targets of diagnosing 60 per cent of cases early, confirming diagnosis within 60 days and helping 80 per cent of patients complete treatment. “If a woman waits months between appointments, or stops halfway through treatment, we lose what early detection gave her.”

Opened in 2024, the Centre’s multidisciplinary team includes breast surgeons Professor Emeritus Dato’ Dr Yip Cheng Har, Dr Ng Char Hong, Dr Harjit Kaur and Dr Normayah Kitan; breast radiologists Dr Farhana Fadzli and Dr Maninderpal Kaur; anatomical pathologist Dr Lee Bang Rom; and clinical oncologists Dr Mastura Md Yusof, Dr Tan Chih Kiang and Dr Christina Lai Nye Bing.

Every Tuesday at 7.30am, before clinics begin, the surgeons, radiologists, pathologist and oncologists review each patient’s imaging, biopsy findings and medical history together. “Patients want us to give them a plan, not maybe this or maybe that,” said Prof Yip. “So we come to one consensus recommendation. In a way, the patient already has the second opinion built in.”

What happens in the imaging room

For many women, the most frightening moment comes during a scan. “They are watching our facial expressions. When we go quiet and just look at the screen, they fear the worst,” said Dr Maninderpal. “They even ask why I am taking so many measurements. So it is important to talk to them, explain what we are doing, and help ease their anxiety during the examination.”

Imaging has also moved on. Digital breast tomosynthesis, or 3D mammography, produces thin sectional images that reduce the overlap of breast tissue, helping radiologists find small cancers hidden in dense breast tissue, which is common among Asian women. “Looking for a cancer in a dense breast is like looking for a snowball in a snowstorm,” she said. It can also be performed with less compression, which may make the examination more comfortable, although some women still experience discomfort.

Screening is increasingly tailored to a woman’s individual risk. Women with dense breasts usually have an ultrasound alongside their mammogram, with an MRI in selected cases when further assessment is needed. Women with a strong family history may need yearly MRI from around the age of 25 to 30. The mammogram remains essential, however. “Some early cancers show up only as tiny calcifications, and those are best detected and assessed on a mammogram,” Dr Maninderpal said.

Artificial intelligence now supports both ultrasound and mammography at the Centre, flagging areas for a second look. “AI is not going to take over the radiologist’s job, but we should embrace it while maintaining our clinical judgement,” she said. When imaging reveals a suspicious finding, a biopsy can be done the same day as part of the Centre’s one-stop service, with results usually available within two days.

The conversation after the scan

Dr Harjit knows the moment well. “She is looking at me and nodding, but I know her mind is already running. The first thing she thinks about is not the treatment. It is how do I tell my family, what will happen to my children, am I going to lose my breast?” That is why she always makes sure a woman has someone with her when the diagnosis is explained.

“All you need is one wrong person and the whole thing can go in the wrong direction,” she said, describing patients who quietly look to a husband or mother-in-law to decide for them. For younger women, the team raises fertility before treatment begins, so there is still time to consider options such as storing eggs.

Every breast cancer journey is different

“Breast cancer treatment is not a one-size-fits-all process. Even two women of the same age and with the same stage of cancer may require different approaches, depending on the biology of their disease. For some, treatment may be given before surgery to shrink the tumour, while others proceed directly to surgery. By reviewing each case collectively, the team can develop an approach tailored to the individual patient,” said Dr Ng Char Hong, Consultant Breast and Breast Reconstructive Surgeon.

Finding the cancer early widens those choices. “The earlier we find it, the more options you have. It is not like 20 or 30 years ago, when your breast was simply removed,” said Dr Harjit. For suitable early cases, some women receive radiotherapy during the operation itself and go home the same day or the next. For larger tumours, treatment before surgery can shrink the cancer, sometimes until it disappears, so a woman who once faced a mastectomy may be able to keep her breast. Where a mastectomy is needed, the breast can be reconstructed in the same operation. “They wake up and see a breast,” said Prof Yip. “It makes a difference.”

“Oncoplastic breast surgery combines cancer surgery with reconstructive surgical techniques to maintain both function and appearance of the breast. Apart from treating the cancer, we also consider how the treatment affects a woman’s confidence, identity and emotional wellbeing,” said Dr Harjit.

Even stage four is no longer the end of the story. “I have a patient diagnosed at stage four more than ten years ago who swims every morning and travels the world. Sometimes she puts me to shame,” said Dr Harjit.

Life after treatment

“During treatment, they have appointments every week and people fussing over them. When it all finishes, they are suddenly on their own,” said Dr Harjit. With physiotherapy and psychological support often not covered by insurance, many survivors cope in silence.

So she matches new patients with former patients, by age and personality, who have offered to meet them for coffee. “Many of them have become very good friends,” she said. Dr Maninderpal agrees: “The whole journey is emotional, not just for the patient but for everyone around her.”

Advancing care, easing the journey

At “Inside Her Story”, Roche Malaysia highlighted how advances in treatment can give patients back something often overlooked: time.

“Breast cancer care has come a long way. Advanced science now allows us to focus on quality of life and giving back time, reducing treatment times that once took hours to a much lower duration. By streamlining care pathways, we ensure innovation does more than treat the disease: it eases the strain on families and gives women back their time, peace of mind, and a sense of normalcy to live their lives,” said Deepti Saraf, General Manager, Roche Malaysia, and Vice President of the Pharmaceutical Association of Malaysia (PhAMA).

One thing every woman can do

Dr Maninderpal encourages women to be breast-aware from their twenties and to seek prompt assessment of any breast changes, with ultrasound when indicated. She recommends starting mammograms at 40 and repeating them every two years, unless individual risk warrants more frequent screening. Additional ultrasound may be considered for women with dense breasts. Women with a family history of breast or ovarian cancer should seek an earlier risk assessment to determine the appropriate screening schedule.

“Love and invest in yourself,” said Dr Harjit. “Once a year, a mammogram or an ultrasound may well save your life.”

For women with concerns about their breast health, seeking help early can make an important difference. Just as importantly, they do not have to navigate the journey alone. By bringing different areas of expertise closer together, Picaso Breast Centre aims to support patients through each stage of care with greater clarity, continuity and confidence.

Visit https://www.hospitalpicaso.com/en/our-services/centre/breast-centre/ for more information.

Reference

¹ Ministry of Health Malaysia, Malaysia National Cancer Registry Report 2012–2016. 

² National Cancer Registry, National Cancer Institute, Ministry of Health Malaysia, Malaysian Study on Cancer Survival (MySCan), 2018.