Understanding Breast Cancer: Insights from Prof. Ava Kwong on Risk Factors, Prevention, and the Future of Treatment

Breast cancer remains one of the most pressing health concerns for women worldwide, and Hong Kong is no exception. As the most common cancer among women in the region, its impact is felt by thousands of families every year. Prof. Ava Kwong, a leading expert in the field, has dedicated her career to understanding and combating this disease. In a candid interview, Prof. Kwong shared her invaluable insights into the risk factors, prevention strategies, and the latest advancements in breast cancer detection and treatment. Understanding the complexities of breast cancer—from its genetic roots to the lifestyle choices that can influence its development—is crucial for every woman. By speaking to Prof. Kwong, we aimed to demystify these aspects, providing you with the knowledge to make informed decisions about your health. Whether you're concerned about your own risk, considering genetic testing, or simply looking for ways to live a healthier life, Prof. Kwong's expertise will guide you through the intricacies of this disease.

Written by: Jeremy Chapnick

Photos by: Raymond Chan

The Prevalence of Breast Cancer in Hong Kong

Breast cancer is not only the most common cancer among women globally, but it also holds this troubling distinction in Hong Kong. According to the latest data, 5,592 new cases of breast cancer were reported in 2021 alone, accounting for nearly one-third of all cancers diagnosed in women that year. This figure is a stark reminder of the disease's prevalence and its significant impact on women's health in the region.

The incidence of breast cancer has been steadily rising, a trend that parallels the increasing affluence and changing lifestyles in Hong Kong. As Prof. Ava Kwong explains, several factors contribute to this upward trend. Women today are having children later in life, having fewer children overall, and are more likely to experience obesity—all of which are linked to increased breast cancer risk due to their effects on hormonal cycles.

This rise in breast cancer cases isn't just a statistical anomaly; it reflects deeper shifts in society. The transition towards more sedentary lifestyles, higher caloric intake, and delayed childbirth is creating an environment where breast cancer is more likely to develop. These trends highlight the importance of early detection and proactive measures to mitigate risk, which are crucial as the disease becomes more prevalent.

Hormonal and Lifestyle Risk Factors

Breast cancer is deeply intertwined with hormonal cycles and lifestyle choices, both of which can significantly influence a woman's risk of developing the disease. Prof. Ava Kwong emphasizes that understanding these factors is crucial for proactive prevention and management.

Hormonal Influence on Breast Cancer Risk

Hormones play a central role in breast cancer development, particularly estrogen. The longer a woman's body is exposed to estrogen, the higher her risk of developing breast cancer. This means that early puberty and late menopause—both of which extend the period of estrogen exposure—are key risk factors.

As Prof. Kwong explains, the modern lifestyle contributes to these hormonal risks. Women today often experience puberty at an earlier age due to improved nutrition, and they tend to have fewer children later in life. This combination of factors leads to more menstrual cycles over a lifetime, increasing overall estrogen exposure and, consequently, the risk of breast cancer.

Impact of Lifestyle Choices

Beyond hormonal factors, lifestyle choices are equally important in determining breast cancer risk. Obesity, in particular, is a significant concern. Fat tissue produces estrogen, and excess body fat can lead to higher levels of this hormone, further increasing the risk. In Hong Kong, where diets are becoming richer and more caloric, this is a growing problem.

Additionally, other lifestyle habits such as alcohol consumption and smoking contribute to breast cancer risk. Alcohol, even in moderate amounts, has been linked to an increased risk of various cancers, including breast cancer. A particularly interesting study highlighted by Prof. Kwong found that binge drinking—a pattern common among some—significantly raises breast cancer risk. Smoking, too, is a well-established risk factor for many cancers, breast cancer included. On the flip side, there are lifestyle changes that can help reduce risk. Regular physical activity, even something as simple as brisk walking, has been shown to lower the risk of breast cancer. Exercise helps maintain a healthy weight, reduces estrogen levels, and boosts overall health—factors that all contribute to cancer prevention.

The Role of Genetics in Breast Cancer

While lifestyle and hormonal factors significantly impact breast cancer risk, genetics also play a crucial role, particularly for those with a family history of the disease. Prof. Ava Kwong sheds light on how genetic factors, especially mutations in specific genes, can dramatically increase a woman's likelihood of developing breast cancer.

Understanding Genetic Risk

Approximately 10-15% of breast cancer cases are hereditary, linked to mutations such as BRCA1 and BRCA2 genes. Women who inherit these mutations face a much higher risk of developing breast cancer compared to the general population. For instance, the average woman has about a 12% lifetime risk of developing breast cancer, but this risk can rise to as high as 65% for those with a BRCA1 mutation and up to around45% for those with a BRCA2 mutation​ by age 70 years.

These genetic mutations not only increase the risk of breast cancer but are also associated with a higher likelihood of developing ovarian cancer and, in some cases, other cancers like prostate cancer in men​. Given the significant impact of these mutations, understanding one's genetic risk is vital for early intervention and prevention.

The Importance of Genetic Testing

Genetic testing offers a way to identify these mutations, enabling women to understand their risk and take preventive measures. However, as Prof. Kwong points out, genetic testing is most beneficial when done selectively. For individuals with a strong family history of cancer—especially if multiple relatives were diagnosed at a young age—genetic testing can provide critical information.

Prof. Kwong cautions against the growing trend of commercial genetic tests, which are often marketed directly to consumers. While these tests might seem convenient, they can lead to unnecessary anxiety due to the misinterpretation of results. Commercial tests might flag variants of uncertain significance—genetic changes for which there isn't enough information to determine their impact on cancer risk. This can create confusion and fear, especially when the results are not accompanied by proper medical guidance.

The Role of Genetic Counseling

This is where genetic counseling becomes invaluable. Genetic counselors are trained professionals who help individuals understand their genetic risks and navigate the complexities of testing. They collect detailed family histories, assess the likelihood of genetic mutations, and provide clear, personalized advice on whether testing is appropriate.

For those who undergo genetic testing, counselors play a crucial role in interpreting the results. They help patients understand what their genetic status means for them and their families, and guide them through possible next steps—whether that's increased surveillance, preventive measures like prophylactic surgery, or simply making informed lifestyle choices.

Moreover, genetic counseling addresses the psychological and familial implications of genetic testing. Discovering a genetic mutation can be overwhelming, not just for the individual but for their entire family. Counselors help manage this emotional burden, offering support as patients make difficult decisions about their health and the potential impact on their loved ones.

Innovations in Breast Cancer Detection and Treatment

The landscape of breast cancer detection and treatment has evolved significantly in recent years, driven by advances in technology and research. Prof. Ava Kwong highlights several promising developments that are changing the way breast cancer is diagnosed and treated, offering new hope to those at risk.

Targeted Therapies: A New Era of Treatment

One of the most significant advancements in breast cancer treatment is the rise of targeted therapies. Unlike traditional chemotherapy, which affects both cancerous and healthy cells, targeted therapies focus on specific genetic mutations or molecular pathways that drive cancer growth. For women with BRCA1 or BRCA2 mutations, these therapies can be particularly effective.

Targeted therapies work by blocking the actions of certain enzymes or proteins that contribute to cancer cell survival. For example, PARP inhibitors are a class of drugs that have shown great promise in treating breast cancers and ovarian cancers associated with BRCA mutations. By interfering with the cancer cells' ability to repair their DNA, these drugs can slow or even stop the progression of the disease.

Prof. Kwong notes that these therapies are a direct result of our growing understanding of the genetic underpinnings of breast cancer. As research continues, more targeted therapies are likely to emerge, offering personalized treatment options that are tailored to the specific genetic profiles of patients.

Advances in Screening Technologies

Early detection remains a cornerstone of successful breast cancer treatment, and innovations in screening technologies are making it easier to catch the disease in its earliest stages. For most women, the standard screening method is the mammogram, but its effectiveness can be limited, particularly in women with dense breast tissue—a characteristic more common among Asian women.

To address this, Prof. Kwong highlights the importance of combining mammograms with other imaging techniques, such as ultrasound or MRI, especially for women at higher risk. MRI scans, while traditionally time-consuming and expensive, are becoming more accessible thanks to the development of abbreviated MRI protocols. These shortened MRI scans can be completed in a fraction of the time and at a lower cost, making them a more feasible option for routine screening.

Moreover, the integration of artificial intelligence (AI) into radiology is poised to revolutionize breast cancer detection. AI-assisted imaging systems are being trained to analyze mammograms and other scans with high precision, potentially identifying abnormalities that human eyes might miss. These technologies are still under development but show great promise in improving the accuracy and efficiency of breast cancer screening.

The Future of Blood Tests in Cancer Detection

Another exciting area of research is the potential for blood tests to detect breast cancer. Known as liquid biopsies, these tests aim to identify cancer-related biomarkers, such as circulating tumor cells or DNA fragments, in the bloodstream. While still in the experimental stage, liquid biopsies could one day offer a non-invasive alternative to traditional screening methods.

However, Prof. Kwong cautions that current blood tests are not yet accurate enough for widespread use in breast cancer screening. While they hold promise for the future, more research is needed to refine these tests and determine their reliability in detecting early-stage cancers. For now, they are primarily used in monitoring cancer recurrence rather than initial diagnosis.

Special Considerations for Asian Women

While breast cancer is a universal concern, its impact and the approach to its detection can vary significantly across different populations. Asian women, including those in Hong Kong, face unique challenges in breast cancer detection and management. Prof. Ava Kwong offers insights into why a tailored approach is crucial for effectively addressing breast cancer in this group.

Dense Breast Tissue and Its Implications

One of the most important factors to consider in breast cancer screening for Asian women is the prevalence of dense breast tissue. Dense breast tissue is composed of more glandular and fibrous tissue than fatty tissue, which can make it more difficult to detect cancer using standard mammograms. On a mammogram, both dense tissue and tumors appear white, making it challenging to distinguish between the two.

Prof. Kwong points out that dense breast tissue is more common in Asian women compared to their Western counterparts. This means that relying solely on mammograms can lead to missed diagnoses or delayed detection. To combat this, Prof. Kwong recommends that Asian women complement their mammograms with additional imaging techniques, such as ultrasound or MRI particularly for women at risk. Ultrasound, in particular, is effective at providing a clearer picture in dense breast tissue, helping to detect tumors that might otherwise go unnoticed.

Cultural Awareness and Breast Cancer

Cultural factors also play a role in how breast cancer is perceived and managed among Asian women. In some cases, there may be a lower awareness of breast cancer risks and the importance of regular screenings, partly due to cultural norms that discourage discussions about health, particularly women's health. This can lead to delayed diagnosis and treatment, with women only seeking help once symptoms become more severe.

Prof. Kwong emphasizes the need for greater public health education tailored to Asian women, focusing on the importance of early detection and the availability of more effective screening methods. By increasing awareness and providing culturally sensitive education, more women can be encouraged to take proactive steps in managing their breast health.

Tailored Treatment Approaches

In addition to tailored screening, treatment approaches also need to be customized for Asian women. Genetic factors may vary across populations, and the efficacy of certain treatments might differ based on these genetic variations. For example, Prof. Kwong notes that some genetic mutations linked to breast cancer may be more or less common in Asian populations, which can influence treatment decisions.

Moreover, the social and psychological support structures available to Asian women can differ from those in Western countries. In many Asian cultures, there is a strong emphasis on family involvement in medical decisions, which can affect how treatment options are discussed and chosen. Prof. Kwong advocates for a holistic approach to breast cancer care that takes these cultural differences into account, ensuring that women receive not only the best medical care but also the support they need to navigate their diagnosis and treatment.

Key takeaways

As we move forward, the key message remains clear: knowledge is power. By staying informed and proactive, women can take control of their breast health, reduce their risk, and ensure that if breast cancer does develop, it is caught and treated as early as possible. Prof. Kwong's expertise and dedication to this cause serve as a reminder that while breast cancer is a formidable opponent, it is one that can be fought with the right tools, support, and knowledge.

Let this be a call to action for every reader: prioritize your health, seek regular screenings, and don't hesitate to explore genetic counseling if you have concerns. Together, we can continue to make strides in the fight against breast cancer, empowering women with the knowledge and resources they need to live their healthiest lives.