Cover Photo: Pexels

The managing director of National Cancer Society Malaysia sheds light on a screening test that can be a game-changer for people with a family history of breast cancer

Angelina Jolie sparked a global discussion about hereditary breast cancer, caused by the inheritance of mutated BRCA1 and BRCA2 genes, after publishing a powerful essay in The New York Times about her decision to undergo a preventative double mastectomy after learning that her late mother had passed down the BRCA gene mutation. 

Naturally, it has brought attention to BRCA gene testing or screening, which can detect mutations and risk of getting hereditary breast cancer. In this virtual interview with Tatler, Dr Murallitharan M., managing director of National Cancer Society Malaysia, helps us understand the science behind BRCA gene testing and the reality of early breast cancer screening.

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Dr Murallitharan M. has extensive experience in the field of non-communicable diseases. He continues to research public health policy in collaboration with Chulalongkorn University and the London School of Hygiene and Tropical Medicine where he was the ASEAN PhD fellow and Chevening Scholar respectively. He has also held positions as a medical officer and clinician at Hospital Kuala Lumpur, clinical epidemiologist for the Ministry of Health's Clinical Research Centre and medical director of MMPKV Healthcare Sdn Bhd.

What are the BRCA1 and BRCA2 genes?

Put simply, BRCA1 and BRCA2 genes are tumour suppressor genes that protect the body from cancer. They are coded to produce proteins—much like little soldiers—to repair DNA damage from smoking, alcohol, sunlight and external chemicals.

When these genes are mutated, the body’s protective mechanism cannot repair any damage and is unable to keep cells from multiplying rapidly and uncontrollably. This mutation is primarily connected to breast cancer and can also affect the ovaries, prostate and pancreas.

The most important thing about BRCA gene mutation is understanding the risk factor for someone who has a genetic history of cancer. If they have inherited this mutation, it can predispose them to getting breast cancer and unfortunately, the chances are much higher. A normal person has about 10 per cent chance of picking up breast cancer. By contrast, it goes up to 50 to 70 per cent for someone who has inherited the mutated gene from their mother or father.

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Tatler Asia
Photo: Alena Shekovtcova/Pexels
Above Photo: Alena Shekovtcova/Pexels

A lot of the conversations about BRCA centre around the West. What is the prevalence of the BRCA gene mutation in Asian demographic?

In the beginning, nobody really looked at Eastern populations but our colleagues at Cancer Research Malaysia have found that the amount of mutations in Asian populations is just as high, if not higher, than the Western demographic. Their research indicates that 1 in 20 Malaysian breast cancer patients have inherited a genetic alteration in BRCA1 or BRCA2.

What does the BRCA gene mutation testing entail?

In Malaysia, we usually take a blood sample, send it off for genetic testing and receive the results within two weeks.

Would you recommend the test for everybody?

If you have a close relation by blood who has a history of cancer and is BRCA positive, I would strongly recommend that you get tested as early as your 20s. It will help drive diagnosis and figure out treatments with drugs that are targeted towards the gene and more effective. Early diagnosis and treatment are imperative when it comes to any type of cancer. 

But it is important to remember that inheriting the gene mutation doesn't mean that you will automatically get breast cancer.

Instead, a screening can help you better plan your next steps. For example, it can be a signal to change your lifestyle, especially if you are regularly consuming processed meats or exposed to smoke and chemicals. At the other end of the spectrum, you can also opt to remove your breasts in a double mastectomy—a procedure that is often associated with Angelina Jolie. It doesn't have to go straight to this surgical removal but the point is that screening gives you options and choices.

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It is important to remember that inheriting the gene mutation doesn't mean that you will automatically get breast cancer.
Dr Murallitharan

Is there a downside to BRCA gene mutation testing?

This is a practical conundrum. The concern about receiving the news about being BRCA positive is that insurance will not cover your treatment. It is one of the biggest factors preventing people from testing. In the US, there are legal policies in place to ensure that you cannot be denied insurance based on that.   

Another thing with the BRCA screening is what happens after you get the results. It is crucial to go to experienced clinicians and genetic counsellors in places such as University of Malaya Medical Centre who can help you plan out your next steps, instead of sitting at home and worrying.

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Do you think there is still a lack of awareness in Malaysia about breast cancer screening in general, including mammogram, clinical breast exams and breast self-exams?

Yes and no. I appreciate that topic of breast cancer has entered the public consciousness due to the pink ribbon and breast cancer awareness month but it doesn’t necessarily translate into meaningful understanding.

For example, the frequency of mammogram screening changes for people of different ages. Mammograms and self-examinations may come up short, if they have dense breast tissue. And as mentioned, there may be practical repercussions relating to insurance coverage when it comes to BRCA gene mutation testing.

My concern—and I believe a lot of my colleagues would agree—is that the conversation needs to go deeper.

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Are there any resources you can recommend to get a better understanding of breast cancer?

Absolutely! You will find free, reliable and open access information on the Tun Razak Digital Library on the National Cancer Society Malaysia’s official website. There are brochures, booklets and videos in multiple languages, including Tamil, Bahasa Malaysia, English and Mandarin.

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