It used to be one in every 24 women in Hong Kong who got breast cancer. Last year it was one in 23 and this year it was one in 22. Nobody knows why the numbers are increasing. Hong Kong women were also more likely to get breast cancer earlier than white women, according to a top doctor. In western women, the average age is in the 40s to 50s - normally after menopause, but in Asian women, the cancer can arrive earlier, which is why doctors encourage women in Hong Kong to carry out medical checks from their mid-30s onwards. 'One of the things that we have noticed is that the incidents of breast cancer are increasing,' said Ava Kwong, chief of the breast surgery division at Queen Mary Hospital and the director of the Hong Kong Hereditary and High Risk Breast Cancer Programme. It's also been noted that Hong Kong women, and Chinese in general, for reasons that have not yet been ascertained, are likely to get cancer earlier than their western counterparts. Dr Kwong, for example, has a patient who is just 26 years old. 'In Hong Kong, 12 per cent of all the women with breast cancer are under 40. We are not sure whether it is our population pattern, but it is still much higher than among whites. The age group where the breast cancer increase is more noticeable is between the ages of 40 and 50,' she said. This is still decidedly earlier than among whites where more cases occur when women are in their 50s. 'Normally in whites the breast cancer is more post-menopausal. But it appears that genetics may be more important in the Asian population and might explain why there are more cases in younger women,' she said. The Pink Revolution, on October 26, is part of an annual effort to highlight the benefits of regular screening and early diagnosis. In addition to a publicity campaign, volunteers will provide information to shoppers at malls on how easy it is to go for a check-up and the trauma this can save them if they have cancer and it is detected early. Dr Kwong doesn't want women to be scared, she just wants them to notice any abnormalities in their breasts early. Hong Kong women also tend to have more dense breast tissue, she said. It's imperative that by checking them on a monthly basis, women get to know their own breasts, otherwise it's difficult to tell if there is a new lump. Instead of women being scared, there is a safe and easy way for them to ensure that they can have the peace of mind of knowing they haven't got it, or if they have, they can catch it early enough to do something about it and save their lives without the trauma of undergoing major surgery. A major problem in Hong Kong, said Dr Kwong, was that in many cases by the time it was detected by doctors here, the breast cancer had moved on to between stage one and two - which requires more invasive surgery - often requiring the breast to be rebuilt if the patient chose to do so. If it was detected at the optimum stage zero, there would be an almost complete survival rate. If it was picked up at stage two, around 80 per cent of breast cancer patients survive, at stage three under 60 per cent and at stage four 20 to 30 per cent. Dr Kwong was also keen to advertise new technology and a programme that could help save other female members in the families of breast cancer patients. The Hong Kong Sanatorium and Hospital set up the Comprehensive Oncology Centre in March. In collaboration with Stanford University and two local medical facilities, Dr Kwong and her medical staff are conducting comprehensive genetic tests on women whose sister, mother, aunt or another relative have already been diagnosed with breast cancer. The test is also conducted on female relatives of men who have suffered breast cancer. What they are looking for is a condition known as a BCRA gene mutation. Eighty-five per cent of people with this gene mutation might develop breast cancer, while 51 per cent might develop ovarian cancer as the two cancers are linked. Previously blood samples were sent to the US and had proven costly and time-consuming. Now the tests could be fully carried out in Hong Kong, said Dr Kwong, although she had yet to persuade government health authorities to finance them. It was now funded through donations, though the Hong Kong Cancer Fund wanted to finance it, said Dr Kwong. Through this the Hong Kong Hereditary Breast Cancer Family Registry is gradually being extended. 'The idea is to test someone in the family first who has breast cancer. The pick-up rate of the mutation will be higher if she is young and has breast cancer.' Her children or siblings are likely to have around a 50 per cent chance of also contracting breast cancer. There was also genetic counselling, said Dr Kwong who soon hoped to employ Chinese-speaking professionals in this field. If other relatives have the mutation, this increases their risk of breast cancer by 50 times and ovarian cancer by 10 times, compared with the general public. These relatives can be counselled on their options. They can opt for a doctor to keep a closer eye on them and undergo regular mammogram and ultrasound tests. If the possibilities are high that they will contract another breast or ovarian cancer, they might opt for a mastectomy to virtually eliminate that likelihood. Increasingly sophisticated breast rebuilding surgery means it no longer presents the same traumatic physical change it used to. The results from the programme are starting to speak for themselves in the number of relatives whose cancer can be caught before it becomes life-threatening. But Dr Kwong said the message on self-checking had to get out there. 'At the moment, it's believed that only 12 per cent of women in Hong Kong do a monthly self-examination,' she said. 'The message also seems to be you don't start screening until 50.' Detection device Mammograms aren't very comfortable, but they are an incredibly effective tool for saving lives. The breast is exposed to a low-dose X-ray system which creates an image of the inside of the breast. A small dose of ionising radiation creates images for doctors to check the breast tissue. A mammogram can detect changes inside breasts up to two years before patients or their doctors would be able to feel them. It's a fantastic early warning system.