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Dr. Ava Kwong Talks About Breast Cancer

ExpertsPost Category - ExpertsExperts

Cancer. It’s an ugly word for an ugly disease. As health-conscious women, we should be aware of the dangers of breast cancer. We normally associate cancer with a nameless stranger, but how common is breast cancer in Hong Kong?

1 in 21 women in Hong Kong suffer from breast cancer. 1 in 21 women. This means that there is a very high chance that someone close to you will suffer from breast cancer; that a woman in the same office as you will suffer from breast cancer.

While it is true that there is an increased chance of getting breast cancer as a woman gets older, breast cancer can, and does, hit women of all ages. It is important to maintain a healthy lifestyle to decrease your chances of getting breast cancer.

Unfortunately, being young and healthy doesn’t automatically mean that you’re not at risk. Breast cancer can be due to the inheritance of a ‘bad’ gene. This means that no matter your age, you can be at risk for breast cancer.

To help us understand more about breast cancer, Dr. Ava Kwong – Chairman of The Hong Kong Hereditary Breast Cancer Family Registry – answered some commonly asked questions for us.

What causes breast cancer?
The cause is not due to one reason but a combination of risk factors and environment factors interacting with each other.  These include familial and genetic risks – ie: a history of breast cancer in your family as well as the inherited ‘bad’ gene that causes the disease.

Hormonal and reproductive risks involving the increased exposure to oestrogen is also a factor. Women who have babies later in life – after 30 – or not at all tend to be at a great risk for developing breast cancer, as do those who didn’t breastfeed.  Going through menopause at a later age also increases the risk of breast cancer. For example, studies show that women who go through menopause after age 55 are at a higher risk of breast cancer than women who do so before age 45.  Another risk factor comes from the prolonged exposure to oestrogen from oral contraceptives or hormone replacement therapy.

And then there are of course the lifestyle risk factors such as smoking, the use of alcohol, having a high fat diet, a lack of exercise and obesity.

Are there any other ways of knowing my own risk of breast cancer?
About 10% of all breast cancers are due to the inheritance of a bad gene from your parents. According to statistics, mutations of BRCA 1 and BRCA 2 genes account for over 80% of the hereditary breast cancers and also increase the lifetime risk of developing breast and ovarian cancer significantly.

BRCA 1 and BRCA 2 are the mutated genes that can cause breast and ovarian cancer. If either of the mother or father’s BRCA genes is damaged, it can be passed onto the next generation.

When a woman inherits the mutated genes, the lifetime risk of developing breast cancer is 85% – over 10 times higher than those who do not carry the mutation. The risk of ovarian cancer also rises to 50 times that of other female counterparts.

The good news is, while we are all at risk for breast cancer, it is possible to diagnose cancer early and change the outcome! It is shown that breast screening have been proven to reduce mortality by 25%. Get screened today and beat breast cancer!

And though women come to mind when talking about breast cancer, don’t forget that men are at risk too! Men can also carry the gene and pass this gene on. For men with the mutated gene, the lifetime risk of being diagnosed with breast cancer is 60 times higher than the average male population. Men also have an increased risk of prostate cancer (around 4.5 times more) than non-carriers of the mutated gene.

How do I know if I have BRCA gene mutation and an increased risk of breast cancer?
The BRCA gene mutation can easily be tested through a blood test. However not everyone should get tested.

Since a family history of breast cancer is one of the major causes leading to breast cancer, BRCA mutation genetic testing is recommended if there is a family history of breast cancer and in particular if the cancer occurred at a young age.

Individuals who should get genetic testing include those with a family history of:

  • Breast cancer in the family at a young age (45 and below)
  • Families with breast and ovarian and or prostate cancer
  • Triple negative type of breast cancer
  • Bilateral breast cancer
  • Men with breast cancer
  • Families with breast cancer and other cancers including stomach, colorectal, pancreatic cancer

The test is usually performed in the most high-risk person in the family, and when a BRCA mutation is found in these individuals, the rest of the family can be tested as well.

So why do BRCA mutation testing?
Once a high-risk individual is identified, strategies can be taken to achieve early diagnosis and prevention of cancer so that an individual can have a better outcome and better survival. Research studies have shown that preventative strategies can improve survival of individuals with breast cancer and ovarian cancer. These include more intensive breast screening aside from the standard mammography and ultrasound screening to include an annual MRI breast screening as well as ovarian screening and prostate screening and checking of tumor markers from a simple blood test.  Preventative surgery for ovarian and breast cancer can be offered for high-risk individuals and these have been proven to improve survival. Prevention can also be performed by prescription of medications.

To see if you’re at risk of hereditary breast, ovarian and prostate cancer, go to The Hong Kong Hereditary Breast Cancer Family Registry or email

Finally, tips to prevent breast cancer:

  • Be aware of the disease!
  • If there is familial history consider genetic testing for the BRCA mutation gene to assess your risk.
  • Practice regular breast screening. For those who have been identified to have an increased risk based on an inheritance cause, this may need to be started as early as age 20s. Otherwise breast examination should start at age 30s and mammography and ultrasonography breast screening should start at age 40s
  • Make adjustments to your lifestyle to reduce some of your risk factors.  Have babies (and breastfeed them!); avoid a fatty diet, smoking, and too much alcohol; and exercise regularly.

Dr. Ava Kwong is the Chairman of The Hong Kong Hereditary Breast Cancer Family Registry, Chief of Breast Surgery Division, eUniversity of Hong Kong Medical Centre and as well as Visiting Associate Professor at the Stanford University, USA.

About The Hong Kong Hereditary Breast Cancer Family Registry

Established in December 2007, HK Hereditary Breast Cancer Family Registry is a charity for the Asian population of women (and even men!) as well as their families who are at high risk of being diagnosed with hereditary breast and ovarian cancer. Working together with our counterpart, HK Hereditary and High-Risk Breast Cancer Programme (HRBCP), information, counselling and proactive intervention is being offered in an effort to boost rates of early detection and save lives. The Registry offers free genetic screening to the underprivileged, in addition to collecting data, conducting research and promoting awareness of hereditary breast and ovarian cancer.

The Hong Kong Hereditary Breast Cancer Family Registry supports research in breast cancer in multiple areas including clinical, epidemiological, population based research, basic science, genetic and psychological related research to better understand breast cancer locally to make are difference to our population.

This is achieved by working with local academic institutions including Hong Kong University, Public Hospitals and Hong Kong Cancer Registry. Moreover to better understand the genetic basis, cause and treatment of breast cancer, we are working, with renowned international institutions such as Stanford University School of Medicine, CIMBA genetics group, and countries including Europe, Canada, Iceland, and is a member of the Asian Hereditary Breast Cancer Consortium.

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