Regarding breast cancer, there is little difference between Asians, including Koreans, and Westerners.
One of the striking differences may be the age of the patients. In the West, breast cancer is increasing with age. In Korea and other Asian countries, however, relatively young women in their 40s and early 50s develop breast cancer.
The main difference is the support system for breast cancer patients, which helps them balance treatment, work and family life. In the US, medical facilities provide well-organized support systems for patients, usually older women. However, many younger patients in Korea cannot receive such support.
That explains why Professor Kim Hee-jung of the Breast Surgery Department of Asan Medical Center set up a breast cancer clinic within the AMC about ten years ago. In addition to providing medical treatment, the center also helps patients deal with a variety of personal issues ranging from solving other health problems caused by chemotherapy to having and raising children and even maintaining their careers.
“The younger the patients, the more important this support becomes,” said Kim.
According to Kim, the proportion of breast cancer patients aged 40 or younger in Korea since 2015 has been between 10 and 13 percent, about twice as high as in Western countries. Fortunately, the five-year survival rate for breast cancer in Korea is 92.7 percent, higher than other cancers.
Professor Kim Hee-jung of the Breast Surgery Department of Asan Medical Center shares her experience treating young and foreign patients during a recent interview with Korea Biomedical Review at her hospital office in southeast Seoul.
There are few differences in breast cancer treatment between Korea and Western countries, she said, noting that there are some areas where Korean doctors excel in surgery.
However, Korea lags far behind the US and some advanced European countries when it comes to supportive care, said the AMC professor in a recent interview with Korea Biomedical Review.
“Breast cancer patients naturally express concern about the treatment they will receive,” said Kim. “In addition, young women diagnosed with breast cancer are concerned about their present and future as they will encounter various problems related to fertility, intimacy, child rearing, finances and the workplace.”
Importance of psychological, social support
Many young cancer patients, who have just started their jobs to bring their long preparatory work to fruition, tend to think that their breast cancer diagnosis has put an end to their dreams, she explained.
Professor Kim lamented the lack of psychological and social support for these matters in Korea.
She recalled her experiences at a Harvard University breast cancer center as a junior physician.
“Although breast cancer patients under the age of 40 were uncommon in the US, I was amazed at how well the center treated and supported the concerns of a few young breast cancer patients, and realized the importance of psychosocial support measures as much as treatment,” she said. . “I then decided that Korea also needed a similar facility and program and after returning to Korea, I started a young breast cancer clinic at the AMC.”
Young Breast Cancer Center has a multidisciplinary collaborative system between surgery, oncology, radiology, obstetrics and gynecology, and psychology. AMC has been voted the best Korean hospital by Newsweek, an American magazine that gave the highest marks to the country’s oncology, cardiology and endocrinology departments.
“The clinic diagnoses breast cancer and provides counseling for psychosocial problems facing patients,” she said. “Since we cannot hope that government medical policies will change abruptly, the center has begun several cohort studies of breast cancer patients.”
Kim explained that the purpose of the cohort study is to set a standard for counseling from the initial diagnosis phase.
“Counseling can include topics about whether or not the patient wants to become pregnant in the future, and if so, how they will prepare for a future pregnancy,” she said. “Whether they want a child or not, chemotherapy can lead to menopause, and we’re also discussing how they would prepare for it.”
Based on such consultations, the hospital can pre-freeze the patient’s embryo or perform additional treatments so that the chemotherapy doesn’t damage the patient’s ovaries too much, she added.
Despite the great need for such counseling, the reality in Korea is that doctors are often busy explaining the breast cancer treatment process to patients.
“If such a consultation is absent or delayed, we cannot offer patients fertility options, or the patient may simply give up future fertility plans for fear of getting medical treatment too late,” she said. “Therefore, the study is designed to find the optimal consultation method, so that patients do not have to report that they will have a child after treatment.”
Kim also stressed that the center’s study of the treatment of complications in young patients is important, as they receive more comprehensive treatments than their older counterparts because of their young age.
“Additional treatments can lead to other diseases, such as osteoporosis, cardiovascular disease, hair loss, urinary system diseases,” she said. “It is therefore important to set up a program to detect and prevent such complications.”
Breast cancer and risk of osteoporosis
Kim explained that the center’s cohort studies would ultimately help patients continue treatment and increase their survival rate by establishing a system in which patients can be consulted about the issues they may encounter through therapy.
Kim has published some remarkable studies in magazines through her works at the center.
“A major study has confirmed that premenopausal breast cancer patients under 55 years old after chemotherapy should pay attention to bone health,” she said. “As I mentioned earlier, young breast cancer patients often receive more chemotherapy than older patients and take longer drugs.”
In the past, patients focused only on breast cancer treatment. But today, even if a 45-year-old patient completes 10 years of treatment, they are still 55 and are no longer considered old, she noted.
“In the study, we confirmed that patients who received chemotherapy or hormone suppression therapy for more than five years showed a significant decrease in their bone density,” she said. “If hospitals neglect this process, the patient could develop osteoporosis in later years.”
Kim emphasized that patients whose bone density decreases as a result of chemotherapy, hormone therapy, or both, should receive supplements or make lifestyle adjustments.
Kim also revealed her plans to share the system with other Asian countries as they also face similar problems due to a similar medical infrastructure.
“Korea is not the only Asian country that does not provide complementary care beyond medical treatment. Most other Asian countries have similar health care facilities,” she said. “That’s why we’re trying to make sure that not only Korean patients but Asian patients can be treated under the same system.”
The hospital is working to share its knowledge from the center through Asian Breast Cancer Network.
Kim’s efforts, the AMC’s medical reputation and the hospital’s excellent infrastructure, including enthusiastic and skilled translators, have combined to attract the largest number of foreign patients, including breast cancer patients, to Korea.
Foreign patient-friendly medical institution
Kim currently runs a clinic specializing in the treatment of foreign breast cancer patients at AMC’s International Medical Center and treats approximately 150-200 breast cancer patients annually.
“When I first started working in the hospital, we received a lot of patients from Asian countries, such as Japan, China and Vietnam,” said Kim. “Now we are seeing an increase in the number of patients from the Middle East.”
More recently, the hospital has begun to treat foreigners who are unable to return home due to the Covid-19 outbreak.
“I have treated several relatives of US soldiers stationed at the military base in Pyeongtaek,” she said. “They visited the hospital because they wanted to be treated in Korea instead of going back to the US”
When asked about some memorable experiences treating foreign patients, Kim recalled her recent experience treating a relative in the United States military.
“When breast cancer is diagnosed, patients naturally become sad,” she said. “However, the degree of depression during the treatment process is more severe in Korean patients than in their foreign counterparts.”
Still, Kim was surprised when the entire family member of the American patient took an active part in the treatment process while trying to stay as optimistic as possible. “The whole family came into the treatment room during the first session and asked several questions about the process after hearing my explanation,” she said. “The family remained optimistic during treatment.”
Kim noted that this optimism helped her team successfully shrink the tumor before surgery through chemotherapy.
Kim explained that the patient has since returned to the US after surgery.
“I was twice amazed at their act. Before returning home, the patient’s family expressed their intention to make a donation, emphasizing that the family had received a lot from the AMC’s treatment path”, she said. “This was an overwhelming experience as the family was not financially endowed.”