Breast cancer care is no longer one-size-fits-all

For many women, hearing the words “you have breast cancer” immediately brings thoughts of surgery, chemotherapy and a difficult road ahead. Yet treatment today is becoming far more individual, shaped not only by the size or stage of a tumour, but also by the particular type of breast cancer and the woman herself.

Consultant clinical oncologist Dr Nisha Shariff says understanding the cancer’s subtype can make a major difference to the treatment plan.

“Breast cancer is a group of different subtypes, and each behaves very differently,” she said. Some cancers grow in response to hormones; others produce too much of a protein called HER2, which can encourage cancer cells to grow.

Triple-negative breast cancer has none of these usual markers, which means doctors have to approach treatment differently.

Indeed, knowing which type a woman has helps doctors decide which treatments are most likely to work. Two women can have breast cancers that appear similar in size and stage, yet end up with very different treatment plans.

For example, one woman with a hormone-sensitive, HER2-negative cancer may need surgery, radiotherapy and hormone treatment. Another with HER2-positive cancer of a similar size may also require chemotherapy and a medicine designed specifically to block HER2.

“What may look similar on paper can behave very differently,” Nisha explained. “Understanding what is driving the cancer helps us determine which treatment is most appropriate for each patient.”

Age, general health, whether a woman has gone through menopause and her own preferences can also influence treatment decisions. In other words, doctors are not only treating the cancer: they are also treating the person living with it.

What does ‘aggressive’ really mean?

The word “aggressive” can be frightening, but Nisha says it describes the way a cancer behaves rather than predicting what will eventually happen to a patient.

Some types, including triple-negative and HER2-positive breast cancers, can grow more quickly. But they may also respond very well to treatments developed specifically for them.

“In the past, HER2-positive breast cancer used to carry a poor prognosis,” she said. “With targeted therapy, outcomes have transformed dramatically and improved survival in many women with breast cancer.”

Another part of personalised care is genomic testing, which looks at patterns in the cancer to help doctors judge whether chemotherapy is likely to be useful for a particular patient.

At the same time, advances in surgery, radiotherapy and targeted medicines have widened the range of options available.

“We used to ask which treatment can give the best outcome,” Nisha said. “Now, the question is which treatment is most appropriate for my patient, and our focus has also shifted to survivorship.”

Why screening still matters

Despite these advances, many breast cancers in Malaysia are still found late. Fear plays a role: some women put off mammograms because they worry about discomfort, embarrassment or simply about what the test might reveal.

But delaying screening can mean losing the advantage of finding cancer earlier, when treatment may be simpler and more options are available. A mammogram can offer reassurance when no cancer is found, and when something is detected, finding it earlier is generally linked to better outcomes.

“Don’t let fear make the decision for you. A lot of the fear is in the unknown. Knowledge is power,” Nisha stressed. For women who feel nervous about screening, she suggests bringing a friend or family member along.

Treatment is also about more than controlling the disease itself: women may need help rebuilding strength, managing emotional wellbeing, dealing with changes in body image or intimacy, thinking about fertility, or returning to work.

That is why breast cancer care increasingly involves a wider team rather than a single doctor working in isolation. Support can continue long after active treatment has ended.

“Cancer doesn’t define you,” Nisha concluded. “It is one chapter of your life, not the whole story.”

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