THE rising number of cancer diagnoses among Malaysians is concerning, said National Cancer Society Malaysia (NCSM) director Dr Muralitharan Munisamy. The most common cancers affecting Malaysians are breast cancer, followed by colorectal cancer, and then lung, trachea, and bronchus cancers.

The Malaysian National Cancer Registry’s (MNCR) summary from 2017 to 2021 shows that the probability of developing cancer for both males and females has increased to 1 in 8. Muralitharan noted that 168,823 cancer cases were reported among Malaysians during this period.

Based on the Global Cancer Observatory report, a World Health Organization (WHO) database, there were 51,650 new cases in 2022, with 24,892 males and 26,758 females.

“In 2017, the MNCR recorded 34,585 cases, slightly decreasing to 33,940 cases in 2018. In 2019, cases increased to 34,278. In 2020, the number rose marginally to 34,332 cases, but in 2021, there was a notable decline to 31,688,” Muralitharan told The Malaysian Insight.

Of the 168,823 cases, 77,692 were males and 91,131 were females. By ethnic group, Malays were the most diagnosed with cancer, followed by Chinese and Indians. Among males, 32,010 Malays were diagnosed, compared to 31,801 Chinese and 4,895 Indians. Among females, 42,763 Malays were diagnosed, followed by 30,301 Chinese and 7,749 Indians.

According to new estimates from the WHO, global cancer diagnoses will reach 35 million by 2050, a 77% increase from the 20 million cases in 2022.

High number of breast cancer cases

Muralitharan highlighted that breast cancer is the most prevalent among Malaysians. Colorectal cancer ranks second, followed by lung, trachea, and bronchus cancers. Lymphoma is the fourth most common, and liver cancer has significantly risen to become the fifth most common cancer.

While breast cancer remains the most prevalent, its percentage dropped from 19% in 2012-2016 to 17.6% in 2017-2021. However, there was an increase in colorectal cases to 14.1% (from 13.5%), lung, trachea, and bronchus cancers to 10.1% (from 9.8%), lymphoma to 5.2% (from 5.1%), and liver cancer from 3.5% to 4.9%.

From 2017 to 2021, male patients mostly suffered from colorectal cancer, followed by lung, trachea, and bronchus; prostate; liver; and lymphoma cancers. Among females, breast cancer was the most common, followed by colorectal; lung, trachea, and bronchus; corpus uteri; and ovarian cancers.

Females aged 25 to 64 had higher cancer rates from 2017 to 2021, similar to 2012-2016, while male incidence was higher than female incidence after age 65.

According to the Department of Statistics Malaysia (DOSM) 2023 report, cancer is the fourth leading cause of death in Malaysia, increasing from 10.5%in 2021 to 12.6% in 2022.

By ethnic group, the 2017-2021 summary report shows that 1 in 11 Malay males, 1 in 9 Indian males, and 1 in 6 Chinese males have the risk of developing cancer before age 75. For females, 1 in 9 Malay females and 1 in 7 Indian and Chinese females are at risk.

Contributing factors and survival

Muralitharan said that according to the Early Detection of Common Cancers and Referral Pathways for Healthcare Providers, about one-third of cancer deaths are attributed to five major behavioural and dietary risk factors: high body mass index, insufficient fruit and vegetable consumption, physical inactivity, tobacco use, and alcohol consumption. Tobacco use is the most common risk factor, responsible for approximately 22% of cancer deaths.

The Malaysian Study on Cancer Survival (MySCan), the first national cancer survival report using population-based data, shows that survival is higher at stage one and deteriorates as the stages progress. This report applies to Malaysian citizens and residents diagnosed from 1 January 2007 to 31 December 2011, with follow-up to 31 December 2016. Survival rates were analysed for 0-10 years after diagnosis for 15 selected cancers, including 72,884 cases (40.2% males and 59.8% females). The majority were Chinese (43.2%), followed by Malays (40.7%), Bumiputera (8.6%), Indians (6.6%), and other ethnic groups (0.8%).

Analysis of cases where the stage was recorded (39,976 out of 69,011 cases) showed that 18% were in stage I, 26% in stage II, and 56% in late stages (stage III and IV). The highest five-year relative survivals were in thyroid (82.3%), prostate (73.0%), corpus uteri (70.6%), female breast (66.8%), and colon (56.8%) cancers. Survival rates were predominantly higher in women and younger age groups.

Preventing smoking

According to the MySCan report, Malaysia has established and accessible cancer screening programmes for breast, cervix, uteri, and colorectal cancers. Despite this, the percentage of cases presenting at late stages (stage III & IV) were 41.3%, 38.5%, and 63.8% respectively. The report highlighted that the most worrying cancer, with the lowest survival, was cancer of the lung, trachea, and bronchus, with a five-year relative survival of 11.0% and a median survival time of 6.8 months.

The focus for this rapidly fatal cancer should be on preventive strategies rather than treatment, with significant policy and programmatic attention directed toward youth smoking prevention. The anti-smoking bill, approved by the Dewan Negara in December and gazetted in February, includes provisions such as prohibiting the sale and purchase of tobacco products, smoking materials, or tobacco substitute products to minors. However, the generational end-game (GEG) element was removed from the revised bill.

Health Minister Dr Dzulkefly Ahmad said that the proposed “generational endgame” law to smoking was discontinued because it would have been unconstitutional due to its discriminatory nature.

Muralitharan advised Malaysians to adopt healthy eating habits to stay cancer-free, following the Quarter-Quarter-Half Plate concept. One-quarter of the plate should consist of carbohydrates, another quarter of protein, and half of fruits and vegetables, with plain water as the preferred beverage. He recommended at least three servings of vegetables and two servings of fruits daily, and to limit the intake of processed foods and sugar-sweetened beverages.

In addition to healthy eating, Muralitharan emphasised the importance of an active lifestyle, suggesting physical activities such as jogging, cycling, or hiking for at least 150 minutes per week. Regular health screenings are crucial for early detection and prevention of health issues. He also advised completely avoiding tobacco, vaping products, and alcohol consumption. Additionally, he highlighted the importance of vaccinations, such as the human papillomavirus vaccine to protect against HPV-related cancers and the Hepatitis B vaccine to prevent liver cancer. – 26 July 2024.