Malaysian scientists discover 3 things we never knew about Asian breast cancers

We now have more data on Asian breast cancers than ever before.

Breast cancer is the most common cancer in women worldwide, and although Asians make up more than half of the world’s population, previously less than 5% of the genetic information used in breast cancer research were from Asian women. The majority of this information called characterised genomes (we’ll explain that in a bit), came from Caucasian women – which means we may miss important genetic information that may be rare in Caucasians, but common in Asians.

The good news is, there’s a group of scientists working hard to close that gap. Together with the University of Cambridge and Subang Jaya Medical Centre, Cancer Research Malaysia has built the LARGEST genetic and genomic database of Asian breast cancers to date.

(But wait, what is a genome?)

Let’s say you want to bake a cake. You would probably first look in a cook book, copy a recipe, then bake a cake. Our genes are like a cook book – the DNA we inherit from our parents hold the instructions of life. DNA can be made into “recipe” copies for daily use, and these are called RNA. Genomes encode these RNA molecules, which are used to make proteins i.e. the stuff that makes our liver different from our kidney, or why some of us have brown eyes or blue eyes. If there is a mistake in the genome, this will make a mistake in the “recipe”, for example 40 eggs instead of 4 eggs, and as a result the “cake” will be ruined.

In our research study, we analysed the genomic sequences of 560 breast cancer tumour samples to understand molecular differences in breast cancer specific to the Asian population. This leads to more precise cancer diagnosis, and helps us choose the right treatment for the right patient i.e. precision medicine.

In fact, our scientists discovered 3 things about Asian breast cancers we never knew before!

“Through our study, we discovered that Asians are at higher risk of an aggressive type of breast cancer, are more likely to have a mutated TP53 gene, and have an enriched immune tumour profile.” – Professor Datin Paduka Dr Teo Soo Hwang, OBE, Chief Scientific Officer at Cancer Research Malaysia, who led the study

Team Malaysia! Seated, from L-R: Professor Pathmanathan Rajadurai, Subang Jaya Medical Centre (Lead Pathologist), Professor Datin Paduka Dr Teo Soo Hwang, OBE, Cancer Research Malaysia (Lead of the Genomics Study), Professor Emeritus Dato’ Dr Yip Cheng Har, Subang Jaya Medical Centre (Clinical lead), along with the Cancer Research Malaysia team involved in the Genomics study.

The study published in the prestigious Nature Communications science journal, was a collaboration between Cancer Research Malaysia, Professor Carlos Caldas and Dr Suet-Feung Chin from the Cancer Research UK Cambridge Institute, University of Cambridge, Professor Pathmanathan Rajadurai and Professor Emeritus Dato’ Dr Yip Cheng Har from Subang Jaya Medical Centre. We’ll let them tell you more about these key discoveries.

#1. An aggressive breast cancer subtype that expresses the HER2 protein is more common in Asian women compared to Caucasians.

“The HER2 subtype of breast cancer is one of the most aggressive, and it is becoming clear that the risk factors may be different from other types of breast cancer. Our study highlights that Asians have a higher risk of this type of aggressive disease and underscores the need to do more research in Asians so that we can save more lives.” – Professor Emeritus Dato’ Dr Yip Cheng Har, Consultant Breast Surgeon at Subang Jaya Medical Centre

Patients with HER2 positive breast cancers experience 18% lower overall survival compared to others, and we know very little about this disease, its risk factors, and why Asians are more likely to get this aggressive subtype of breast cancer. The more research we do, the more we know, the more lives we can save through targeted therapy!

#2. The TP53 gene – often called the ‘guardian of the genome’ because it protects normal cells from becoming cancer cells – is more commonly altered in Asian breast cancers compared to that of Caucasians.

“TP53 is frequently mutated in the more aggressive hormone negative breast cancers in Caucasian women. In Asian breast cancer patients, we observe an increase in TP53 mutations in hormone receptor positive cases and is associated with poorer survival.” – Dr Suet-Feung Chin, Senior Research Associate at the University of Cambridge, who co-led the study.

Our research showed that 1 in 3 Asian breast cancer patients have this gene alteration, and TP53 mutated cancers are more likely to result in poor survival. There is currently no treatment that is targeted at these cancers, and so we need to continue exploring possibilities.

#3. Asian breast cancers have an enriched immune tumour profile.

“We’ve also observed that Asian breast cancers are more likely to have immune cells present, and this suggests that if we can find some way to lift the invisibility cloak that cancers have to evade detection by the immune system, we may be able to improve survival for Asian breast cancer patients.” – Dr Pan Jia Wern, the study’s first author and the Deputy Head of Bioinformatics at Cancer Research Malaysia

Ultimately, a milestone study like this is a stepping stone to identifying targeted treatments that will save more lives.

One of the discoveries (#3) from this study has already led to a new clinical trial to test immunotherapy in Asian breast cancer patients, called AUROR. The trial started in July 2020, and is led by Cancer Research Malaysia, in partnership with oncologists at the Clinical Investigation Centre (CIC) of University Malaya Medical Centre (UMMC) and National University Hospital Singapore.

But more can and should be done for cancers that affect Asians.

This year we are launching two other clinical trials for more effective treatment options for Asian cancer patients, continuing our research in cancer prevention, developing an AI-powered app to aid telemedicine, and creating a tool to improve breast cancer risk prediction for Asian women.

You may be surprised that a non-profit organisation in Malaysia is leading cancer research in Asians. But we can’t do it alone! We depend on your donations to ensure the fight against cancer doesn’t miss Asians – especially Malaysians. If you’re an individual, it only takes RM10/month to help save lives, and if you’re a company, RM100/month can make a difference for Asian cancer patients.

Have questions? Want to know more? Sign up for our webinar on 3 February 2021, in conjunction with World Cancer Day to ask Professor Teo yourself!

Read the study published in Nature Communications. A big thank you to the UK Medical Research Council via the Newton-Ungku Omar Fund, Scientex Foundation, Yayasan Sime Darby, Yayasan PETRONAS , Cancer Research UK and Estee Lauder Group of Companies, for your support and contributions that made this study possible.

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