Cancer Research Malaysia launches first-ever Asian breast cancer risk calculator

Since its founding in 2001, breast cancer has been a major focus for the independent, non-profit organization Cancer Research Malaysia (CRMY) and when its founder, Professor Datin Paduka Teo Soo-Hwang, was awarded the title of Officer of the British Empire (OBE) by Queen Elizabeth II in 2018, she said Choice on a one-of-a-kind risk calculator that would allow Asian women to correctly determine their chances of fighting the disease.

Four years later – during which the CRMY has grown from a national cancer research organization to an organization with international reach – Teo is proud to announce that the risk calculator that she and her team have talked about with so many eagerness is now in place and ready to be deployed.

Created in collaboration with hospitals and universities in Malaysia, Singapore and the UK, ARiCa (Asian Genetic Risk Calculator) is a tool that allows women facing a diagnosis of breast cancer to determine their likelihood of inheriting breast cancer. a defective BRCA1 or BRCA2 gene (these are tumor suppressor genes). genes that help prevent breast, ovarian and other cells from growing and dividing too quickly or out of control). ARiCa was developed based on a 20-year study of more than 8,000 breast cancer patients in Malaysia and Singapore, which allowed CRMY to develop a tool to determine whether Asian women had an individual probability of carrying a defective BRCA.

“Using criteria such as age and the presence of a family history of breast cancer, we estimate that every year nearly 4,000 patients with newly diagnosed breast cancer in Malaysia would require counseling. and genetic testing, but they often do not consider this test as most assume it is unlikely that they have inherited a faulty gene.With ARiCa, we can now give each woman her individual probability to carry a BRCA so that she can be empowered to make informed choices about her health and healthcare professionals can provide more accurate treatment plans to their patients,” says Teo, who led the study.

The study that powers ARiCa was published in the prestigious New England Journal of Medicine last year and a follow-up study was published in the Journal of Clinical Oncology in early February. “It’s a very geeky thing to be proud of, but in the scientific community, being published by top medical journals like NEJM and JCO is a big milestone and a major turning point,” Teo says.

The drive to create the calculator was based on the insufficient number of women getting tested for the defective BRCA gene, which results in a lower level of awareness and action. When it comes to breast cancer, data show that one in 25 patients inherits a defective BRCA gene. But before this research, patients with breast cancer were only offered a test if they were diagnosed at a young age or had close relatives with breast or ovarian cancer. Thus, many gene carriers have not been offered the genetic test, thereby missing out on the opportunity to benefit from life-saving treatments or allow loved ones to consult on prevention strategies.

For example, American actress Angelina Jolie was able to determine her risk based on her family history – doctors estimated she had an 87% chance of developing breast cancer and a 50% chance of developing breast cancer. ovary during her lifetime – and so opted for a preventative double mastectomy which likely saved her from getting breast cancer. Granted, not everyone can afford expensive elective surgery or reconstruction like Jolie, but knowing what her risk factors are can go a long way toward making more informed choices.

As Jolie’s example indicates, mutation prediction tools already exist and are reliable, but the majority of them are designed for European women and less accurate for Asian women. As a result, Asian patients and their family members lose the ability to be aware of their genetic risk status, thereby losing the ability to prevent cancer and choose accurate treatment. Breast cancer has been the subject of much research over the years, while the concept of a risk calculator itself is not new, an Asian one is. Although establishing accuracy rates of 90% for defective genes in European women, existing tools only record a derisory efficiency of 22% for Asian women.

“Western tools have accuracy rates of 90% for the Western population, but only 22% for Asians. Thanks to the New England article, we had data from 16,000 women in Malaysia and Singapore, and data from breast cancer patients was what helped build ARiCa” , explains Teo. “ARiCa remains the best tool available today for the Asian population.

“European tools are not only unsuitable for Asian women, but also for the public health scene in this part of the world,” adds Teo. “These tools take an average of 45 minutes to administer, which is time doctors may not have with patients here. ARiCa is tailor-made to work in local clinical environments, where healthcare professionals may have less time for patients due to current issues.

ARiCa’s database is drawn from a multi-ethnic population of Malay, Chinese and Indian breast cancer patients, ensuring that the developed tool works equally well across Asian ethnic subgroups. Naturally, as clinical trials begin, the more women whose data is entered into the system, the more accurate the calculator becomes. Training is currently underway to equip physicians with the skills to conduct critical conversations with patients that will enable them to make informed decisions for themselves and their families.

“It changes the narrative to just tell them they’re at risk to provide them with a number and context. Genetic testing doesn’t come cheap and you want to have a really good reason to go for it – that’s what that we offer,” she observes.

“We recently won a major international research grant to help us determine whether women who have the necessary information would actually seek genetic testing. If we offer a tool and nobody uses it, it doesn’t change clinical services – you have to prove that developing the tool actually changes the outcome for patients. This is, again, based on precedent in a national study conducted by CRMY – based on information given to patients that faulty BRCA genes are an indication of ovarian cancer, genetic testing rates rose from 2% to 58% for ovarian cancer patients.

ARiCa also puts research into action, which ties in with CRMY’s goal of harnessing the work they do to improve the lives of patients. “We don’t just find out what this means for the population, but we also focus on the translational aspect. This means we take the research, build the tools and incorporate [them] in clinical wards, so eventually it becomes a routine standard of care for all patients – that’s the goal.

Once clinical trials are completed, the calculator can then be scaled up for use by women across Malaysia and Asean. Cancer cannot yet be cured, but if early prevention is the only way, ARiCa is the tool women in Asia need more than ever.

This article was first published on March 14, 2022 in The Edge Malaysia.

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