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L’Oréal-Unesco Fellowship for Women in Science winner Shivaani Mariapun tells us about wanting to give women across Asia a fighting chance against breast cancer before it’s too late

Before we get to the nitty gritty details about the most prevalent cancer among Malaysian women, let’s start with some real talk: how many of us actually look into the mirror and take a good, long stare at our breasts? Do we know what to look for that indicates our bosoms are free of pesky, unwanted growths? And if we don’t, why aren’t we getting ourselves checked despite the underlying knowledge of how devastating breast cancer can be in its later stages?

“While there have been various efforts to raise awareness for breast cancer among women in Malaysia, the fact remains that we have a very high percentage of breast cancer patients who are only diagnosed at late stages,” Shivaani Mariapun reveals. “As it is, we also have a much lower five-year survival rate compared to other Asian countries." What this grim reality tells us, the scientist explains, is that there are existing barriers that prevent women from adopting good health screening behaviours.

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According to a 2019 article in The Star newspaper, "one in 30 (women) will be diagnosed in their lifetime” as a majority of them either do not perform routine breast self-exams or do annual screenings after the age of 40. And according to the president of the National Cancer Society Malaysia, Dr Saunthari Somasundaram, one of the many barriers may be a general lack of urgency when it comes to the early detection of breast cancer. “Most women would recognise any change in our face because we look at it all the time,” she states in the article. “Our face and how we look is important to us. Why don’t we do the same with our breasts? If we look at our breasts and feel them regularly, we would most likely detect changes and get checked.”

Another potential barrier that stops Malaysian women from truly understanding the magnitude of this disease is the limited access to affordable health services. This is mentioned in Shivaani’s paper on Ethnic Differences in Mammographic Densities: An Asian Cross-Sectional Study (2015), where she writes that despite mammographic density (the percentage of dense tissue in the breast) being a strong risk factor for breast cancer in Asian women, the amount of studies done on the issue was startlingly little, “particularly those in low- and middle-income Asian countries where genetic and lifestyle determinants may be significantly different."

Put it simply, according to a 2017 study by the Global Journal of Health Science on the estimated number of avoidable deaths should healthcare be provided equally regardless of one’s economic status, it was found that the high mortality rates for breast cancer were largely attributed to the “differential access to cancer care between affluent and deprived groups”.

“A huge reason why population-based screening mammography isn’t available in most low- and middle-income Asian countries is due to the lack of resources as well as the generally lower breast cancer cases in these countries,” said Shivaani, who was a winner of the L'Oreal-Unesco For Women In Science 2019 Award. “Which in turn limits our study of the mammographic density in Asian women because there’s so little data on them. So in my case, 100 per cent accuracy is incredibly challenging as my work involves data from human study participants, which can be rather erratic as there are so many uncontrollable factors like environmental exposure as well as recall bias (the instance where participants in a study don’t remember previous events and experiences or omit details).”

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By creating an accurate risk prediction model that helps with more effective screening strategies for early detection, we stand a chance at really helping women across Asia.

Knowing how different our bodies are from one another, it’s not too far of a stretch to assume that the risk of developing breast cancer isn’t equal in all women. “Providing the same screening recommendation to all women is an inefficient way to use our already limited resources,” she states. “So by tailoring the screening process according to risk profiles, we may detect cancers earlier and avoid unnecessary distress in women who may not benefit from regular screening.”

Shivaani remains optimistic and she is encouraged by both the support provided by her colleagues at Cancer Research Malaysia and the grant money from the L’Oréal-Unesco For Women in Science award. “I feel validated. Like the work I do with my mentors and colleagues is worth doing,” she shares. “Because by creating an accurate risk prediction model that helps with more effective screening strategies for early detection, we stand a chance at really helping women across Asia.”

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