[Special Series on Distinguished Doctors]Guardian of breast cancer patients: Professor Kim Hee-jung of Asan Medical Center

There is little difference between Asians, including Koreans, and Westerners as far as breast cancer is concerned.

One of the noticeable differences could be patients’ ages. In the West, breast cancer increases with age. In Korea and other Asian countries, however, relatively young women in their 40s and early 50s get breast cancer.

The most significant difference is the support system for breast cancer patients, helping them find a balance between treatment, work, and family life. In the U.S., medical institutions provide well-organized supportive systems for patients, mostly older women. Far younger patients in Korea cannot have such supports, however.

That explains why Professor Kim Hee-jung of the Department of Breast Surgery at Asan Medical Center set up a breast cancer clinic within AMC a decade ago from now. The center not only offers medical treatments but helps patients cope with various personal problems, 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 these supports become,” Kim said.

According to Kim, the share of breast cancer patients aged 40 or younger has ranged between 10 to 13 percent in Korea since 2015, about twice higher than 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 Department of Breast Surgery at Asan Medical Center talks about her experience treating young and foreign patients during a recent interview with Korea Biomedical Review at her hospital office in southeastern Seoul.

There are few differences in treating breast cancer between Korea and Western nations, she said, noting that there are some areas where Korean physicians excel in surgery.

“However, Korea lags far behind the U.S. and some advanced European countries when it comes to supportive care,” the AMC professor said in a recent interview with Korea Biomedical Review.

"Breast cancer patients, of course, express concerns about the treatment they will receive," Kim said. "Besides, young women diagnosed with breast show worries about their present and future, as they will run into various problems associated with fertility, intimacy, child-rearing, finance, and the workplace."

Importance of psychological, social support

Many young cancer patients, who have just started their job careers to blossom their long preparatory works, tend to think their breast cancer diagnosis has put an end to their dreams, she explained.

Professor Kim lamented the lack of psychological and social supports for these matters in Korea.

She recalled her experiences at a breast cancer center run by Harvard University as a junior doctor.

"Even though breast cancer patients under 40 were uncommon in the U.S., I was amazed how well the center addressed and supported concerns of a few young breast cancer patients, realizing the importance of psycho-social support measures as much as treatment," she said. "I decided then that Korea also needs a similar facility and program and started a young breast cancer clinic in AMC after I returned to Korea."

Young Breast Cancer Center has a multi-disciplinary collaboration system among surgery, oncology, radiology, obstetrics and gynecology, and psychology. AMC has been selected as the best Korean hospital by Newsweek, a U.S. magazine, which gave the highest marks to its oncology, cardiology, and endocrinology departments in this country.

"The clinic diagnoses breast cancer and provides advice for any psycho-social problems facing patients," she said. "Since we cannot hope the government's medical policy will change abruptly, the center has started several cohort studies into breast cancer patients."

Kim explained that the cohort research aims to set a standard on conducting counseling from the initial diagnosis stage.

"Counseling can include topics on whether or not the patient wants to become pregnant in the future, and, if so, how they will prepare for future pregnancy," she said. "Whether they want to have a child or not, chemotherapy can lead to menopause, and we also discuss how they would prepare for it."

Based on such consultations, the hospital can freeze the patient's embryo in advance or conduct supplementary treatments so that the chemotherapy does not damage the patient's ovaries too much, she added.

Despite the high need for such counseling, the reality in Korea is that physicians often find themselves busy explaining the breast cancer treatment process to the patient.

"If such a consultation is absent or delayed, we cannot offer fertility options to patients, or the patient may just give up future fertility plans for fear of receiving medical treatment too late," she said. "Therefore, the study aims to find out the optimal consultation method so that patients do not have to give up bearing a child after the treatment."

Kim also stressed that the center's study on treating complications for young patients is important as they receive more extensive 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 disease," she said. "Therefore, it is important to set up a program to track and prevent such complications."

Breast cancer and risk of osteoporosis

Kim explained that the center's cohort studies would ultimately help patients continue receiving treatment and increase their survival rate by establishing a system where patients can receive consultation about the problems they may face from therapy.

Kim has published some noticeable studies in journals through her works at the center.

"An important study has confirmed that premenopausal breast cancer patients under 55 should pay attention to bone health after chemotherapy," she said. "As I said before, young breast cancer patients often receive more chemotherapy than older patients and take medicine for a longer time."

In the past, patients only focused on treating breast cancer. However, nowadays, even if a 45-year-old patient completes 10 years of treatment, they are still 55, not considered old anymore, she noted.

"In the study, we confirmed that patients receiving 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 can have osteoporosis in later years."

Kim emphasized that patients whose bone density decrease due to chemotherapy, hormone therapy, or both have to receive supplements or correct lifestyle habits.

Kim also revealed her plans to share the system with other Asian countries, as they also face similar problems because of similar medical infrastructure.

"Korea is not the only Asian country that fails to provide additional care outside of the medical treatment. Most other Asian countries have similar health care settings," she said. "Therefore, we are trying to ensure that not only Korean patients but also Asian patients can receive treatment under the same system."

The hospital is working to share its knowledge gained from the center through Asian Breast Cancer Network.

Kim’s efforts, AMC’s medical reputation, and the hospital’s excellent infrastructure, including enthusiastic and capable translating staff, have combined to attract the largest number of foreign patients, including breast cancer patients, in Korea.

Foreign patient-friendly medical institution

Kim currently runs a clinic specialized in treating foreign breast cancer patients at AMC's International Medical Center and treats about 150-200 breast cancer patients annually.

"When I first started working at the hospital, we received many patients from Asian countries, such as Japan, China, and Vietnam," Kim said. "Now, we are seeing an increase in patients from the Middle East."

More recently, the hospital has started treating foreigners who cannot return home due to the Covid-19 outbreak.

"I have been treating several family members of U.S. soldiers stationed at the military base in Pyeongtaek," she said. "They visited the hospital as they wanted to receive treatment in Korea rather than going back to the U.S."

Asked about some memorable experiences treating foreign patients, Kim recollected her recent experience treating a family member of the U.S. army.

"When diagnosed with breast cancer, patients, of course, tend to get sad," she said. "However, the degree of depression is more severe among Korean patients throughout the treatment process than their foreign counterparts."

Even so, Kim was amazed when the entire family member of the U.S. patient actively participated in the treatment process while trying to remain as optimistic as possible. "The whole family came into the treatment room during the first session and asked various questions about the process after hearing my explanation," she said. "Throughout the treatment, the family maintained their optimism."

Kim noted that such optimism helped her team successfully reduce the size of the tumor before operation through chemotherapy.

Kim explained that the patient has since returned to the U.S. after having surgery.

"I was astonished twice with their act. Before returning home, the patient's family expressed their intention to make a donation stressing that the family had received a lot from during the treatment process at AMC," she said. "This was an overwhelming experience as the family was not financially endowed."