BREATHE ing New Life to Cancer Research

While most research focuses on finding a cure for the big C, Dr. Jingmei Li, a Group Leader at A*STAR’s Genome Institute of Singaore, takes the off-beaten path of investigating how precision medicine and early screening can interact. Her work strongly advocates amplifying the importance of preventative measures in breast cancer screening.

The prevalence of breast cancer is at a record high with more than 2.26 million cases reported worldwide in 2020. In Singapore alone, women who suffered from breast cancer accounted for [11,805 cases](https://www.nccs.com.sg/patient-care/cancer-types/cancer-statistics#:~:text=Cancer%20Incidence%20in%20Singapore&text=Females%3A%20breast%20(11%2C805%20cases%2F,(3%2C074%20cases%2F7.7%25).) during the period 2015-2019, and is the most predominant cancer type reported, followed by colorectal and lung cancers. Unlike other cancer types where specific risk factors can be identified, breast cancer is known to be a complex disease. The [National Human Genome Research Institute](https://www.genome.gov/genetics-glossary/Complex-Disease#:~:text=%E2%80%8BComplex%20Disease&text=A%20complex%20disease%20(or%20condition,the%20physical%20and%20social%20environment.) describes complex diseases as a disorder that results from the contributions of multiple genomic variants and genes in conjunction with significant influences of the physical and social environment. Breast cancer has been known to stem from a variety of risk factors spanning genetic and non-genetic factors such as food and other lifestyle choices.

It is this truth that fuelled Dr. Jingmei Li’s quest to understand breast cancer risk factors. For the past 15 years, with a career spanning Sweden all the way back to Singapore, Dr. Li has been involved in the development of multiple breast cancer risk models. Together with clinical collaborators in Singapore, she is applying these risk models in a real-world setting through the BREAst screening Tailored for HEr (BREATHE) study funded by JurongHealth and PRECISE. The project aims to bridge the gap between scientific findings and making informed decisions in the clinical setting. The clamour for precision medicine in cancer research has been commonplace for some time now, yet is very rarely applied to the bedside. “BREATHE is one of the few initiatives in Asia to pilot risk-based screening for breast cancer”, Dr. Li muses. “My personal hope is that the results from breast cancer risk prediction tools will be commonplace in health screening reports.”, she adds.

Early detection saves lives

In 2002, the Singapore government launched the BreastScreen Singapore campaign. This national campaign advocates the early detection of breast cancer in women aged 50-69. A study reports that only 66% of the population covered by this program have had a mammogram, while 50% of those participants were not up to speed in terms of the suggested screening frequency.  It is of interest to understand how a low turnout is reported for a publicly-available early detection program.

Dr. Li highlights that perceived cost is a major factor, as well as the preference for traditional medicine. “We find that children, too, play a big, yet underrated, role in their mother’s health behaviour,” she noted. As such, expanding the investigations on the influence of a woman’s support structure to the attitude towards breast cancer screening is worth investigating. “Other works to investigate how we can engage spouses and other members of a woman’s support structure are ongoing. Breast cancer is not just a woman’s disease. There is of course the patient, but children, husbands, parents, friends, colleagues, and many others are involved in the journey. Forming a team or an alliance if you may”, Dr. Li adds.

If the best weapon available in one’s armoury, to defeat a complex disease like breast cancer, is early detection, Dr. Li takes it a step further. Through BREATHE, Dr. Li envisions a personalised, risk-based screening approach to the Asian population. Her breast cancer prediction toolbox consists of data-driven, individual-centric and value-based care approaches. Imagine how a game sequence influences one to select from a suite of weapons, potions, and magic spells —Dr. Li strongly calls out to women with a higher predisposition to breast cancer to choose to undergo available screening procedures which include mammography. “Mammography can find tumours at a stage so small that they cannot be felt. Tumours are most treatable when they are small, hence early detection plays a big role in controlling the breast cancer burden”, Dr. Li notes.

Another motivation being explored to strengthen mammography turnout is setting up cues. Invitations to screen, reminders, specific appointments, and promotional flyers may alter the behaviour and attitude of women towards screening procedures, which are worth exploring.

Painting the town pink

“Am I at a higher risk of developing breast cancer than my peers?” One wonders, while Dr. Li works to uncover these predispositions. In the grand scheme of things, science has always looked for ways to trump diseases. Dr. Li’s decision to rally for a more empowered screening campaign takes a lot of tenacity and passion.  The motivation behind working on the bench for something that is applied bedside? A statement by her PhD supervisor that goes, “As a doctor, I help one patient at a time. As a researcher, my findings can potentially help millions”.  

And that is exactly what Dr. Li aims to pursue in this quest. “Society needs science. Science needs you. Help us help you!”, she exclaims.

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