By SeeFoon Chan-Koppen
Dr Zamzida Yusoff is an Obstetrics & Gynaecology specialist with a special niche and clinical focus in Gynae-Oncology and Palliative Care. Dr Zamzida is no stranger to Ipoh having worked as an O&G Specialist in Hospital Ipoh between 2003 to 2006 and subsequently from 2009 to 2012, she was head of Gynae-Oncology Unit for Perak, based in HRPB Ipoh and Perak state. She is also one of the founding members of Malaysian Gynae Cancer Society (MGCS). In addition to being a Sessional Consultant at KPJ Ipoh since early 2013, she was also a Senior O&G Lecturer at UniKL RCMP. Today she has a full practice at KPJ Ipoh Specialist Hospital.
Ipoh Echo spoke to Dr Zamzida to learn more about cancer affecting females.
1. What are the predominant cancers afflicting females in Malaysia?
Based on the national data for the year 2006 (the latest as of now), the top 10 cancers for Malaysian females are: Breast; Colo-rectal (large bowel); Cervix of the uterus; Ovary; Thyroid; Lung; Uterus; Stomach; Brain and Blood (Lymphoma).
2. What are their remission rates for the different stages?
Cancer can be staged as Stages 1, 2, 3 and 4 with the lowest number denoting the minimum invasion of cancer cells inside a person. In general, for Stage 1, around 90% of patients might achieve a total cure and become cancer free. At stage 2, the numbers reduce to 60-70%. For those at Stage 3 and 4, cancer is already advanced that an actual cure might not be possible. Doctors talk of five years survival rate which is the percentage of patients who will still be alive (not necessarily cancer-free) five years from the time of diagnosis. For Stage 3 the number is around 40% and by Stage 4 it falls to 20-25%.
3. What is this BRCA1 and BRCA2 gene that predisposes females to having breast cancer?
Genes are the parts of the body that pass hereditary traits down through families. They contain information to build and maintain cells in the body. Genes are made up of a material called DNA. DNA determines certain characteristics (genetic traits) that are passed from parents to children, such as blood type, hair colour, eye colour, and risks of developing certain diseases.
The names BRCA1 and BRCA2 stand for BReast CAncer susceptibility gene 1 and BReast CAncer susceptibility gene 2. BRCA1 and BRCA2 belong to a class of genes known as tumour suppressors. When they are normal, these genes ensure breast, ovarian, and other types of cells grow and divide in a controlled manner. Things function as they should.
When certain changes or “mutations” in the BRCA genes occur, the body is unable to control certain cells and prevent these cells from undergoing cancer changes.
4. What did you think about Angela Jolie’s much publicised mastectomy and would you recommend that?
The news about her undergoing surgery to remove both breasts in 2013 and subsequently undergoing operation to remove her ovaries in 2015 were much publicised. Ms Jollie made those decisions after undergoing genetics testing and full counselling from her doctors. It was not an impulsive decision and much thought went into it. She had a very strong history of cancer in her family (grandmother, mother, aunts- who died due to the cancers) both for ovarian and breast cancers. And upon testing, she did have a BRCA1 mutation identified.
Unlike the normal population whose risk of having breast cancer is at 12%, Jollie’s risks based on her doctors’ calculation were 87% for breast cancer and 50% for ovarian cancer. She wrote that she chose to undergo operation so that she has a chance of watching her children grow up and be with them in the process. Taking out her breasts did not make her less of a woman; she did not feel inadequate or less beautiful or feminine.
Would I recommend it? Looking at her risks in numbers: Yes. However the final decision is by the patient. The points that need to be remembered are:
The risks have to be fully evaluated. That means looking at the family members and the medical problems. Then, undergoing genetic testing as recommended.
Proper counselling by trained personnel regarding the test results and implication on the patient’s future cancer risks.
Making an ‘informed decision’ based on the facts.
5. Can this gene be tested for in Malaysia?
Yes, a lot of laboratories, organisations and research institutes are doing it. However, one should not do the test unless genetic counselling has been done. Firstly, because it is costly and it is only necessary if the risk of inherited cancer is high. The genetic counsellors will identify if there is a risk and how high the risk is. Secondly, because of the implication after getting the test results. A positive or negative result needs different actions.
6. Please discuss the risk factors for cancer
There are a lot of risk factors, both general (seen in most cancers) and specific only for certain cancers. The general ones will be obesity, lack of exercise, having other medical problems such as high blood pressure, diabetes, etc. and also a “Western-style diet” (high in meat, processed food). Age can be considered risk factors as well as a lot of cancers are found when a person is above 60 years. As obesity is related to cancer, a sedentary lifestyle and being a couch potato most of the time is a risk factor as well. The genetic component is a risk factor in ‘inherited’ types of cancers such as: ovarian, breast, womb, colon, thyroid, liver, pancreas and others.
7. Does diet play a role?
The answer is yes as above. High sugar and salt in the diet also predisposes to problems such as high blood pressure and diabetes which again increases the risk of having cancer.
8. What about environmental factors…for women…in cosmetics, toiletries, perfumes, etc.?
There are a lot of websites that will scare off any woman from using cosmetics, etc. It is true that a lot of things used in household products or cosmetics, etc., have been identified to cause cancers in animal studies. One can find things like aluminium, lead, parabens, Polycyclic aromatic hydrocarbons (PAHs), 1,3-butadiene, Ethylene oxide being accused of causing cancer. According to American Cancer Society and Cancer Research UK however, these findings cannot be blindly postulated to humans. The doses used are really high (not the amount that any human will use in her/his lifetime), and the test subjects are mice. Mice bodies are not similar to humans. There are strict rules and regulations regarding what goes into any cosmetics/toiletries preparations for humans.
10. Is gynaecological oncology a new sub specialty?
It had been around since the late 60s. Both in Malaysia and abroad.
11. Does it mean you specialise in breast and uterine/cervical/ovarian cancers?
Only for cancers of gynae organs (below the belly button) – all those mentioned above except breast. The breasts cancers are under the domain of surgeons. However, since breast cancers are usually related to the hormone estrogen, and certain gynae cancers are also related to it, we learn a lot about the breast cancers as well. To know your field well, one has to read up on everything connected with it.
12. How are these diagnosed?
By biopsy and laboratory tests. Doctors must take tissue samples. CT scan or blood tests/ Pap smears alone do not diagnose cancers.
13. Anything else women should know?
Thank you again for allowing me to share my knowledge with your readers. Women should take good care of their health as they are important persons in the family. Please, please do your annual checks, ensure you are eating well, and lead a healthy life style. Love and take care of yourself first before you nurture others.
Kudos to Ipoh ECHO for helping to spread health info and keeping Ipohites and Perakians on their toes. Love u guys!
Dr. Zamzida can be contacted for appointment at 05 240 8777 ext. 244/8518. Address: Suites 1-05 at KPJ Ipoh Specialist Hospital.
By SeeFoon Chan-Koppen