Asians opt for mastectomies

By MARTIN JOHNSTON


New Zealand Asian women with breast cancer are more likely than Europeans to have a mastectomy, an Auckland study has found.

The study of more than 1000 women seen at the St Marks Women's Health clinic shows that 60 per cent of Chinese or Southeast Asian women had mastectomies, compared with 51 per cent of Europeans.

A breast physician at the clinic, Dr Marli Gregory, said yesterday this was for surgical and cultural reasons.

Since Asian women on average had smaller breasts than Europeans, cancerous lumps took up a larger proportion of the breast.

"From the cosmetic way the breast is going to look after you have done the surgery, if the tumour is big enough that you are going to leave them with a markedly smaller breast or with a big dent in the breast, a lot of surgeons now will suggest that they have a mastectomy and consider reconstruction, or just a plain mastectomy.

"For European women, we tend to be larger-breasted, so it tends to be quite a big cancer before we have to think about that.

"If you are only starting with an A- or B-cup breast, it doesn't need to be a very big lump before you can't just take the lump out. That may have more to do with the mastectomy rate than has possibly been appreciated."

She noticed that many Asian patients experienced a sense of shame from illness. They opted for a mastectomy to avoid the extended "adjuvant" therapies such as chemotherapy or radiotherapy which could take weeks following removal of just the lump.

St Marks breast surgeon Dr John Harman said there was a strong element of tradition in his Asian patients' tendency to prefer mastectomy over lump removal - it was what their mothers did.

Breast cancer was a major issue for Asian women, he said. While the incidence of the disease was relatively low in Asian countries, it increased dramatically within a generation when Asians migrated to the West and adopted Western diets characterised by higher fat intake and reduced fibre.

Dr Gregory said international research suggested that new immigrants did not join breast cancer screening programmes. They tended to wait till they detected a lump before seeking medical help.

But the St Marks figures showing similar proportions of Asian and European women - just over 60 per cent - being diagnosed at a stage when the disease was pre-invasive or a tumour up to 2cm across suggested many Asians were taking up screening.

"They are definitely taking up available healthcare."

* October is breast cancer awareness month.