KUALA LUMPUR, Oct 22 — For many Malaysian women, the earliest signs of breast cancer are rarely enough to interrupt a busy week. It is tempting to wait, watch, and hope that a small change resolves on its own. That instinct is understandable.
In breast cancer, however, timing does more than shift survival odds on a chart. It can decide whether treatment is a single, contained procedure or a longer, more complex course involving months of systemic therapy.
This Breast Cancer Awareness Month, two specialists at Sunway Medical Centre Damansara (SMCD), Dr Nor Faezan Abdul Rashid, consultant breast and endocrine and general surgeon, and Dr Nur Adila Mokhtar, consultant clinical oncologist, explain how screening, staging, and treatment connect.
Understanding that chain, they say, can help patients make sense of a diagnosis that often feels overwhelming from the very first appointment.
“Stage” refers to how far the cancer has progressed at diagnosis, from Stage 1, when it remains confined to the breast, to Stage IV, when it has spread to other parts of the body. It remains one of the clearest predictors of how straightforward treatment is likely to be.
A 2026 study of 1,739 breast cancer patients in Sarawak found that those diagnosed at Stage 3 had a five-fold higher risk of death from any cause than those diagnosed at Stage 1, while those diagnosed at Stage 4 faced a risk more than 17 times higher.
Nationally, 50.5 per cent of breast cancer cases were diagnosed at Stage 3 or 4 between 2017 and 2021, up from 47.9 per cent in the preceding five years.
Arriving at a stage is a process, according to Dr Nor Faezan. She explains that it usually begins when a woman notices a change, such as a lump, changes in the skin or nipple, or an unusual discharge, or when screening detects an abnormality.
A clinical examination comes first, followed by a mammogram and/or an ultrasound where needed, and a biopsy if anything looks suspicious. Only once cancer is confirmed is it staged, based on the size of the tumour, whether nearby lymph nodes are involved, and whether it has spread.
“While screening can help us detect a cancer earlier, it is the combination of clinical assessment, imaging, biopsy and appropriate staging that gives us the complete picture needed to plan treatment,” said Dr Nor Faezan.
That picture shapes everything that follows. When cancer is still confined to the breast, surgery is often central, with options such as breast-conserving surgery or mastectomy, alongside an assessment of the lymph nodes.
With greater lymph node involvement or spread beyond the breast, treatment may combine surgery with chemotherapy, targeted therapy, hormone therapy and/or radiotherapy.
“This is why we always emphasise early assessment. It is not about assuming that every breast change is cancer, but about finding out what is happening as early as possible.
“The earlier we identify a cancer, the more information we have to plan treatment appropriately and, in many cases, the more treatment options there may be available to the patient,” she added.
Much of the delay in diagnosis comes down to who women assume is at risk. According to the World Health Organization (WHO), approximately 80 per cent of breast cancers occur in women with no specific risk factors other than sex and age, and most women diagnosed have no known family history of the disease.
Even so, many still treat family history as the reason to get screened, and its absence as a reason not to.
Age can be similarly misleading. A regional study found that breast cancer incidence among women aged 15 to 39 rose in every Southeast Asian country between 1990 and 2021.
Malaysia’s rate reached 7.64 per 100,000 in 2021, the third highest in the region after Thailand and Singapore.
“Feeling well does not necessarily mean there is nothing to look for. Breast cancer can occur without noticeable symptoms, and having no family history does not mean your risk is zero,” said Dr Nor Faezan.
She emphasises that it is important to know what is normal for your own breasts and to base screening on age and individual risk factors, not on family history alone.
Once a diagnosis is confirmed and staged, the question moves from the surgeon to the oncologist: what does treatment involve, and how does it change depending on how early the cancer was caught?
Dr Nur Adila explains that at Stage 1, treatment focuses on removing the cancer and reducing the risk of recurrence, typically through surgery followed by radiotherapy, hormone therapy, chemotherapy, or targeted therapy, depending on the tumour’s characteristics.
The treatment at Stage 3 is usually more intensive, combining systemic therapy, surgery and radiotherapy. At Stage 4, the focus shifts to controlling the disease, managing symptoms and maintaining quality of life.
Stage is not the whole story, however. The latest 2026 NCCN guidelines increasingly sequence treatment around each patient’s genetic and molecular markers, including HER2, ESR1, PIK3CA, and BRCA1/2 status.
“Biomarker testing helps us understand the biology of the cancer and identify treatments that are more likely to work for that particular patient.
“This allows treatment to become increasingly personalised rather than relying on a one-size-fits-all approach,” said Dr Nur Adila. It is also why an early diagnosis does not always mean a simple plan, and a late one does not always mean the opposite.
“Stage alone does not determine how simple or complex treatment will be. An early-stage cancer may have biological features that make additional treatments necessary to reduce the risk of recurrence, while some advanced cancers can be effectively controlled for extended periods with targeted or hormone-based therapies,” she noted.
Not every cancer is caught early, but a later-stage diagnosis is not the end of the conversation, nor is it a passive one as treatment for advanced and metastatic breast cancer looks meaningfully different today than it did a decade ago.
“Treatment has become much more personalised. We now have a wider range of targeted, hormone-based and other systemic therapies, allowing us to tailor treatment according to the biology of the cancer and how it responds over time.
“For many patients, the focus is increasingly on controlling the disease while maintaining quality of life,” said Dr Nur Adila.
Patients have an active part to play, and Dr Nur Adila advises staying engaged with the care team and keeping up with treatment, follow-up appointments and recommended testing, so that doctors can monitor response, manage side effects, detect changes early, and adjust the plan when needed.
“Just as importantly, patients should feel comfortable discussing new symptoms or concerns with their doctors,” she said.
A breast cancer diagnosis is rarely one defining moment. It is a series of decisions that begins long before treatment does.
For many Malaysian women, the more useful question is not whether they are “at risk enough” to be screened, but how much a stage caught early, and not late, could change what treatment ends up looking like.
