"As surgeons, we can treat breast cancer to the best of our ability according to the stage that it presents, but to truly maximise outcomes, we must exit the hospital and focus on screening and detection. Breast cancer is a silent epidemic – and it is doubling every generation – so it is critical that we highlight this issue and drive understanding on how we can make sure women walk through the door earlier to seek help, when the chance of cure is high."
In a bid to highlight the importance of early detection for breast cancer, A/Prof Mikael Hartman and Dr Philip Lau went on an epic motorcycle journey from Singapore to Sweden in 2014. During the ride, they met breast cancer patients across 17 countries to understand how cultural factors shape attitudes to the disease. The duo also spoke with their medical counterparts in various countries along the route and teamed up with anthropologists to study help-seeking behaviour and drivers that can maximise the chance of early detection and treatment.
Trained at the renowned Karolinska Institute in Sweden, A/Prof Hartman received his medical board certification in General Surgery in 2005 and went on to complete his doctoral studies in the field of epidemiology in 2007, specialising in the field of breast cancer etiology and prognostication as well as inheritance of cancer prognosis. He was co-recipient of the Breast Cancer Concept Award, US Army, in 2002 and 2006.
In 2009, he began practising in Singapore at NUH. Seeing more breast cancer cases in six months than in his past ten years at Karolinska, he quickly recognised the disease presentation for breast cancer in Singapore and Southeast Asia was very different from Stockholm. Women were presenting later, which decreased the chance of a good outcome. He also noted that overall, breast cancer rates in Southeast Asia were rising.
These factors drove him to embark on The Long Ride with Dr Lau, an awareness campaign to highlight breast cancer screening and gain deeper insight into the cultural and societal nuances that could be tapped into so as to increase detection rates.
Precision screening for better breast cancer detection
As part of his extensive work in breast cancer etiology and prognostication, A/Prof Hartman has led numerous studies on breast cancer as the lead investigator of the Saw Swee Hock School of Public Health's Breast Cancer Prevention Programme (BCPP). BCPP focuses on enhancing breast screening, understanding the different stages of breast cancer and genomics and driving personalised medicine.
One of its most recent studies is the BREAst screening Tailored for HEr (BREATHE) programme, part of a precision medicine drive to identify the genetic and non-genetic risk factors of breast cancer. BREATHE aims to recruit 5,000 women to undergo a risk screening survey and cheek swab. With this data, the team provides a risk report to help women understand and act on their risk, such as undergo a mammogram.
The BREATHE Study strives to better tailor screening schedules according to risk profiles. This targeted approach will mean optimising healthcare resources to screen women-at-risk more regularly and at an earlier age, while screening women who at low risk less.
Tapping into AI for faster, more accurate diagnoses
With a scarcity of radiologists around the world and particularly in the Asian region, the accurate and timely reading of mammogram is a challenge. To overcome this, A/Prof Hartman has started a company to look into the use of artificial intelligence to assess mammograms. This technology has the potential to act as an adjunct assistant to radiologists and support the early detection of breast cancer.
A spray of protection against COVID-19
Beyond his work in breast cancer, A/Prof Hartman was also part of a team of NUH clinician-scientists to prove that using a povidone-iodine throat spray three times a day, or the oral drug hydroxychloroquine once daily, reduced the likelihood of getting infected by Sars-CoV-2. The study recruited over 3,000 healthy young migrant workers who quarantined. Conducted in May 2020 during the height of the pandemic in Singapore, this discovery proved a useful and practical way to curb the spread of the virus through the repurposing of accessible existing drugs at a time when infection was widespread and when vaccinations were not yet available.