The total population in Malaysia was estimated at 32.1 million people in 2017, with 15,665,370 of them being female, making up 49.3% of total population.
According to the latest WHO data published in 2018 life expectancy is 75.3 which gives Malaysia a World Life Expectancy ranking 71.
Not only are women live longer, but they also can anticipate the possibility of enjoying a better quality of life throughout their span of years. In order to accomplish this, it is essential comprehend how they can maximize their personal health and fitness.
Common Health Issues Affecting Women
| Cancer | Two of the most common cancers affecting women are breast and cervical cancers. The latest global figures show that around half a million women die from cervical cancer ad half a million from breast cancer each year. The vast majority of these deaths occur in low and middle income countries where screening, prevention and treatment are almost non-existent, and where vaccination against human papilloma virus needs to take hold. |
| Reproductive health | Sexual and reproduction health problems are responsible for one third of health issues for women between the ages of 15 and 44 years. Reproductive issues like uterine fibroid, endometriosis and ovarian cysts are commonly seen in women of child bearing age group. |
| Sexually Transmitted Infections | The importance of protecting against HPV ( Human Papilloma Virus) by using vaccination. |
| Non-Communicable | In 2012, some 4.7 million women died from non-communicable diseases before they reached the age of 70. They died as a result of road traffic accidents, harmful use of tobacco, abuse of alcohol, heart diseases, diabetes, stroke, etc. |
| Osteoporosis | if you’re a woman, you’re automatically at greater risk for osteoporosis than men especially after menopause when estrogen is low. The International Osteoporosis Foundation estimates that osteoporosis affects about 200 million women worldwide. |
Breast Cancer
Breast cancer is the leading cancer affecting women in Malaysia and studies show one in 19 women will develop this dreaded disease in their lifetime.
Men can also develop breast cancer, although incidences are rare. It is possible to diagnose breast cancer at an early stage. The early detection of cancer greatly increase the chances of successful treatment.
Risk Factors for Breast Cancer
| Age | Women who are over the age of 50 are at greater risk.
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| Personal History of Breast Cancer |
Patients who have previously been diagnosed with breast cancer in one breast are more likely to develop the cancer in the other breast.
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| Personal History of Ovarian Cancer |
Ovarian cancer is associated with hormone use, a history of ovarian cancer can increases the risk of breast cancer.
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| Family History of Breast Cancer | The risk of developing breast cancer is higher if there is a family history of breast cancer.
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| BRCA1 or BRCA2 Mutation | Mutations of these genes are associated with an increased risk of developing brest cancer. |
| Exposure to the Hormone Estrogen | The female sex hormone estrogen induces female characteristics. Extended exposure to estrogen can increase the risk of breast cancer. |
| Lifestyle | Lifestyle Factors, such as obesity, lack of exercise, drinking alcohol, exposure to high radiation |
Symptoms of Breast Cancer
Women with breast cancer may have no symptoms. However, it is important to seek medical attention when the following symptoms appear:
- Lump or thickening in the breast or armpit
- Nipple becoming dimpled, discharge from the nipple, or an ulcer on the nipple
- Red rash on the breast, with the appearance of orange peel
- Breast pain
Early Detection of Breast Cancer
| Breast self-examination (BSE) | Women should regularly check their breasts for any changes in the appearance of the skin or abnormal lumps. It is important to check under the armpits for any lumps as this may indicate the spread of cancer to the lymph nodes. BSE is ideally done once a month just after menstruation. |
| Mammogram | This is the best screening tool to detect early breast cancer. It is an X-ray of the breast which can detect small cancerous lumps which may be missed in a physical clinical examination. A mammogram screening, also called mammography is recommended if you are over 40 years old. However, if you have a family history of breast cancer or are prone to having suspicious lumps, a mammography is recommended even earlier. A mammogram is advised every 1 to 2 years but for younger women (below 35 years old), the ultrasound scan of the breast is preferred as breasts at this age contain less dense tissue which makes a mammography less accurate. |
| Fine needle aspiration cytology (FNAC) | This can be done on suspicious lumps. This is a minor procedure that involves the removal of a small amount of tissue from the lump, which is then sent to the lab for further investigation. |
| Magnetic resonance imaging (MRI) | This is the most sensitive investigation to detect the presence of cancer cells as it gives a good picture of the soft tissue. However, not all cases require an MRI be conducted unless recommended by the doctor. |
Treatment of Breast Cancer
Treatment of breast cancer requires a multidisciplinary team of physicians such as surgeons, radiologists and cancer specialists, who together will make the most suitable treatment plan for each individual patient. The doctors will make their decision based on the following factors:- Size, location and characteristics of the cancer cells
- Stage and spread of the disease
- Age and health of patient
- Hormone receptors
- Pre- or post-menopause
- Factors indicating disease severity, such as the HER2 gene
Treatment Options for Breast Cancer
- Surgery
- Radiotherapy
- Chemotherapy
- Hormonal Therapy
- Targeted Therapy
Ovarian Cancer
Ovarian Cancer is the 4th most common cancer in Malaysia. Every year, over 500 Malaysian women are affected by ovarian cancer and about 70% of women are diagnosed at stage three or four of the disease, when the cancer has well spread. Compared to other gynaecological cancer like cervical cancer, ovarian cancer has the highest number of deaths.
Risk Factors of Ovarian Cancer
The exact causes of ovarian cancer is still unknown, but existing research has identified a number of risk factors:
- A family history of ovarian cancer, especially among a mother, siblings, or daughters
- ≥ 50 years of age
- Early menstruation; if the patient had her first period before the age of 12
- If the patient has never been pregnant or has never given birth
- If the patient had given birth to her first child after age 30
- If the patient reached menopause age 55
- If the patient has a history of breast cancer or bowel cancer
Symptoms of Ovarian Cancer
Ovarian cancer may cause several signs and symptoms. Women are more likely to have symptoms if the disease has spread, but even early-stage ovarian cancer can cause them. The most common symptoms include:
- Abdominal pain or pelvic pain
- Difficulty eating, indigestion or stomach pain
- Early satiety
- Abnormal vaginal bleeding
- Unexplained weight loss or weight gain
- Diarrhea/ constipation
- Frequent urination
- Fatigue
Diagnosis
Tests and procedures used to diagnose ovarian cancer include:
| Pelvic exam | During a pelvic exam, your doctor inserts gloved fingers into your vagina and simultaneously presses a hand on your abdomen in order to feel (palpate) your pelvic organs. The doctor also visually examines your external genitalia, vagina and cervix. |
| Imaging tests | Tests, such as ultrasound or CT scans of your abdomen and pelvis, may help determine the size, shape and structure of your ovaries. |
| Blood tests | Blood tests might include organ function tests that can help determine your overall health. Your doctor might also test your blood for tumor markers that indicate ovarian cancer. For example, a cancer antigen (CA) 125 test can detect a protein that’s often found on the surface of ovarian cancer cells. These tests can’t tell your doctor whether you have cancer, but may give clues about your diagnosis and prognosis. |
| Surgery | Sometimes your doctor can’t be certain of your diagnosis until you undergo surgery to remove an ovary and have it tested for signs of cancer. |
Treatment
- Surgery
- Chemotherapy
- Radiotherapy
Cervical Cancer and Human Papilloma Virus
Malaysia has a population of 11.55 millions women ages 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 2145 women are diagnosed with cervical cancer and 621 die from the disease. Cervical cancer ranks as the 2nd most frequent cancer among women in Malaysia and the 2nd most frequent cancer among women between 15 and 44 years of age.
Important Facts About Human Papilloma Virus (HPV)
- Sexually active women will likely be infected with the Human Papilloma Virus (HPV) at some point in their lives.
- Even those with only one sexual partner still have a chance of being infected. Therefore, regular screening for HPV is important.
- HPV can be spread through oral, vaginal, or anal sex.
- It can result in genital warts and some types of cancer.
- Sometimes, HPV can be transmitted during birth to an infant causing genital or respiratory system infections.
- There is no cure for HPV but safe and effective vaccinations are recommended at the age of 11 to 12 years.
Cause of Cervical Cancer
The Human Papilloma Virus (HPV) is the main cause of cervical cancer, especially the “high-risk” HPV such as HPV type 16 and 18.
| Immune system deficiency | Women with lowered immune systems have a higher risk of developing cervical cancer. A lowered immune system can be caused by immune suppression from corticosteroid medications, organ transplantation, treatments for other types of cancer, or from the human immunodeficiency virus (HIV), which is the virus that causes acquired immune deficiency syndrome (AIDS). When a woman has HIV, her immune system is less able to fight off early cancer. |
| Herpes | Women who have genital herpes have a higher risk of developing cervical cancer. |
| Smoking | Women who smoke are about twice as likely to develop cervical cancer as women who do not smoke. |
| Age | Girls younger than 15 years old rarely develop cervical cancer. The risk goes up between the late teens and mid-30s. Women over 40 years of age remain at risk and need to continue having regular cervical cancer screenings, which include both a Pap smear and HPV test. |
| Socioeconomic factors | Cervical cancer is more common among groups of women who are less likely to have access to screening for cervical cancer. |
Symptoms of Cervical Cancer
- Patient may remain asymptomatic in early stages. Regular Pap Smear and HPV testing is advisable.
- Blood spots or light bleeding between or following periods
- Menstrual bleeding that is longer and heavier than usual
- Bleeding after intercourse, douching, or a pelvic examination
- Increased vaginal discharge
- Pain during sexual intercourse
- Bleeding after menopause
- Unexplained, persistent lower abdominal and/or back pain
Screening
Cervical cancer that is detected early is more likely to be treated successfully. Most guidelines suggest that women begin screening for cervical cancer and precancerous changes at age 21.
Pap Smear
During a Pap smear, your doctor scrapes and brushes cells from your cervix, which are then examined in a lab for abnormalities. A Pap test can detect abnormal cells in the cervix, including cancer cells and cells that show changes that increase the risk of cervical cancer.
HPV DNA
The HPV DNA test involves testing cells collected from the cervix for infection with any of the types of HPV that are most likely to lead to cervical cancer. This test may be an option for women age 30 and older, or for younger women with an abnormal Pap Smear.
Diagnosis
- Cone biopsy
- Punch biopsy
Prevention
HPV vaccines are vaccines that protect against infection with human papillomaviruses (HPV).
The Food and Drug Administration (FDA) has approved three vaccines that prevent infection with disease-causing HPV types: Gardasil®, Gardasil® 9, and Cervarix®. All three vaccines prevent infection with HPV types 16 and 18, two high-risk HPVs that cause about 70% of cervical cancers and an even higher percentage of some of the other HPV-caused cancers (1, 2). Gardasil also prevents infection with HPV types 6 and 11, which cause 90% of genital warts (3). Gardasil 9 prevents infection with the same four HPV types plus five additional cancer-causing types (31, 33, 45, 52, and 58).
Who should get HPV vaccination?
- All children aged 11 or 12 years should get two HPV vaccine shots 6 to 12 months apart
- HPV vaccine is recommended for young women through age 26, and young men through age 21.
- Adolescents who get their first dose at age 15 or older need three doses of vaccine given over 6 months.
Treatment
There are several options for treatment of early-stage cervical cancer. Decisions about treatment depend on the stage of the cancer, your age and health, and your and your doctor’s preferences.
- Chemotherapy
- Radiotherapy
- Targeted therapy
- Surgery
Osteoporosis
Osteoporosis is a type of bone disease that involves bone denigration due to a loss of calcium in the bones. This condition is generally not painful, unless bones are fractured or broken. It is most commonly found in the spine, hips, and wrists, but can also occur in other parts of the body. In addition, osteoporosis is a major cause of spinal fractures or spinal deformities in older women.
Causes of Osteoporosis
- Menopause
- Family history of osteoporosis
- European or Asian lineage
- Lack of vitamin D or calcium
- Regular consumption of alcohol or caffeine
- Smoking
- Rapid weight loss
- Overuse of steroids
- Conditions such as hormonal imbalances or thyroid disease
- Chronic diseases such as liver disease or gastrointestinal disorders
Ways to Protect Yourself
- Eat healthy, especially foods rich in calcium and Vitamin D, which are important minerals for building strong bones.
- Exercise regularly.
- Do not smoke.
- Avoid drinking beverages that contain alcohol or caffeine.
- Have regular bone health screenings (bone densitometry test) , especially when over the age of 50, in order to prevent bone loss at an early stage.
Treatment of Osteoporosis
Once someone is diagnosed with osteoporosis, a doctor may recommend medication. The type of treatment varies based on what the doctor considers to be the most appropriate for the patient.