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Anthea Rowan

American actress Olivia Munn, who has starred in Date Night, X-Men: Apocalypse and The Newsroom, credits her doctor for saving her life.
Munn had a mammogram that was negative; moreover, a robotic test that checked for 90 cancer genes – including the BRCA mutation, which raises the risk for breast cancer – came back clear.
But obstetrician and gynaecologist Thaïs Aliabadi, co-host of the podcast She MD, conducted a risk assessment for breast cancer on Munn anyway.
The assessment suggested Munn had a 37 per cent lifetime risk of getting breast cancer, prompting Aliabadi to send her for an MRI scan.
Ask your doctor to calculate your risk cancer assessment score
Olivia Munn, actress, on Instagram
That led to an ultrasound, and then a biopsy which revealed that Munn had luminal B breast cancer, an aggressive and fast-moving subtype.
She had a double mastectomy a month later.












View this post on Instagram























A post shared by o l i v i a (@oliviamunn)



“I’m lucky. We caught it with enough time that I had options,” she wrote on Instagram.
“I want the same for any woman who might have to face this one day. Ask your doctor to calculate your risk cancer assessment score.
“Dr Aliabadi says that if that number is greater than 20 per cent, you need annual mammograms and breast MRIs starting at age 30.”
There are four main subtypes of breast cancer: luminal A, luminal B, triple-negative and HER2-positive.
Luminal A is the most common – nearly 70 per cent of breast cancers are luminal A; only about 10 per cent are luminal B.
Risk factors for the type Munn had – luminal B – include having a first child later in life; Munn had her son when she was 41.
Hong Kong stand-up comediennes’ serious message: breast checks save lives
Women with luminal B tumours are often diagnosed at a younger age than those with luminal A and tend to face a poorer prognosis.
According to the American College of Obstetricians and Gynaecologists, one in every eight women will suffer breast cancer in her life. It was the most common cancer in women in 157 countries in 2022.
For most women, the average risk of developing breast cancer is 10 to 12 per cent.
Assessing breast cancer risk
Two commonly applied tools help doctors evaluate a patient’s risk for developing breast cancer in their lifetime as well as within the next five years.
The Breast Cancer Risk Assessment Tool, or Gail Model, is based on data from American women. The Tyrer-Cuzick, or IBIS, model, is based on UK data.
Both tools consider a woman’s personal and family history, including whether they have children and what age they were when they had them.
Know your family medical history: your health could depend on it
Dr Polly Cheung is founder of the Hong Kong Breast Cancer Foundation and founding president of the Hong Kong Society of Breast Surgeons. She says these risk-assessment tools may not be as accurate in Asian women. Their value, though, is to guide women to have more frequent screening or additional breast imaging.
There are racial variations, agrees Professor Ava Kwong, a clinical professor at the University of Hong Kong and chairman of the Hong Kong Hereditary Breast Cancer Family Registry.
“A lot of the existing models, be it prediction for breast cancers or genetic mutations, are based on data gathered in the West,” Kwong says, so they may not be totally accurate when applied to Asians or people of other races.

Risk calculation is more accurate when genetic information is available, Kwong says.
Having data on both clinical risk and genetic risk increases the accuracy of cancer prediction, but there is “still a need to optimise them to address the ethnic diversity and accuracy of use in different races and ethnicities”, she says.
Mammograms best for early detection
Women with a family history of breast cancer or BRCA gene mutation have an increased risk of breast cancer compared to average-risk women. In women with a genetic predisposition, the risk can rise to as high as 60 to 80 per cent.
2 rare gene mutations increase breast, ovarian cancer risk: Hong Kong research
Age is the most important risk factor for women without a family history of breast cancer or a BRCA gene mutation, says Cheung. The best available early detection method is regular screening by 3D mammogram.
Risk assessment tools guide doctors in advising a patient to start screening at an earlier age, to have more frequent mammograms, or to have an ultrasound or MRI scan as well, Cheung says.
Data has shown that MRI – magnetic resonance imaging – has much higher sensitivity: 70 to 100 per cent in the initial screening setting compared to 40 per cent or less for mammogram screening.
The primary concern with MRI scans, Kwong says, is a high false positive rate, although this has improved in recent years.
How AI can help doctors detect early breast cancer: ‘we are complementary’
The Hong Kong government has a working group on cancer prevention and screening that makes different recommendations based on a woman’s breast cancer risk.
Women at high risk, such as those who are carriers of confirmed BRCA1 or BRCA2 gene mutations, or who have a family history of breast cancer, should ask their doctor about annual mammography screening and the age at which this should start.
Women at moderate risk, for example, women with a family history of one first-degree female relative – a parent, sibling or child – diagnosed with breast cancer under the age of 50, or two diagnosed over the age of 50, should be screened every two years.
I asked experts how best to prevent breast cancer after my own mass was found
Women aged 44 to 69 with any combination of risk factors – a history of breast cancer among first-degree relatives, a prior diagnosis of benign breast disease, a high body-mass index and physical inactivity – should also consider a mammogram every two years.
How to mitigate breast cancer risk
Breast screening through mammogram remains an important tool. It has proved itself in a reduction in breast-cancer deaths, and detecting cancer at earlier stages.

Mammograms can often be supplemented with ultrasound screening depending on breast density, says Cheung.
Taiwan has provided nationwide, free mammographs done every two years since 2004. A 2016 study linked the introduction of this programme to a 41 per cent reduction in breast cancer deaths, and a 30 per cent reduction in breast cancer diagnoses that were stage 2 or higher.
“This not only saves lives, but also saves treatment costs,” says Cheung.
Why regular mammograms can be lifesavers: they spot breast cancer early
In Hong Kong, breast cancer has been the most common cancer affecting woman since 1994. The latest figures from the Hong Kong Cancer Registry show more than 6,000 women were diagnosed with breast cancer in 2021, and Hong Kong women have a 7 to 8 per cent lifetime risk of getting breast cancer.
What can women do to manage risk?
Eat a healthy diet, cut down on fats, manage stress, take regular exercise, stop smoking, moderate alcohol consumption.

Check your breasts monthly and take notice of any signs of change – lumps, puckering of skin, discharge from the nipples.
Most importantly, book that mammogram. They may be uncomfortable. But they are potentially life-saving.
Like what you read? Follow SCMP Lifestyle on Facebook, Twitter and Instagram. You can also sign up for our eNewsletter here.


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Wellness

How actress Olivia Munn’s life was saved through a breast cancer risk assessment, and why women need mammograms regularly

An instagram post by actress Olivia Munn, who had a double  mastectomy after being diagnosed with breast cancer. Photo: Instagram/@oliviamunn

A doctor gives a woman a mammogram. 3d mammograms are still the best available means of detecting breast cancer early, a Hong Kong doctor says. Photo: Shutterstock

Dr Polly Cheung. Photo: Dr Polly Cheung

Professor Ava Kwong, chairman of the Hong Kong Hereditary Breast Cancer Family Registry and a clinical professor at the University of Hong Kong. Photo: Professor Ava Kwong

Olivia Munn and partner John Mulaney with their son, Malcolm. Photo: Instagram/@oliviamunn

How a breast cancer survivor transformed her life with positive thinking, more sleep, healthy eating and smarter workouts

After her cancer diagnosis, Lim began taking a more balanced approach when working out, neither overdoing or under-doing it.
Photo: Julianne Danielle Lim


Breast cancer turned Julianne Danielle Lim’s life upside down, but after hitting rock bottom she turned her life around through positive thinking and lifestyle changes. Now her cancer is in remission and she’s helping others. Photo: Julianne Danielle Lim

Lim says she “couldn’t believe it” when her doctor told her she had an aggressive form of breast cancer. Photo: Julianne Danielle Lim

Lim, whose cancer has been in remission since 2021, is keen to share her story with others. Photo: instagram/@juliannedanielle

After her cancer diagnosis, Lim began taking a more balanced approach when working out, neither overdoing or under-doing it. Photo: Julianne Danielle Lim 

How to deal with a cancer diagnosis: focus on treatment options, stay positive, doctor says; survivor advises asking questions and letting emotions out

Chang Hsiu-yun, a Pilates instructor at the Hong Kong Cancer Fund, at one of the fund’s support centres in Kwai Chung. The cancer survivor and a doctor give their advice on how to deal with a cancer diagnosis. Photo: Jonathan Wong

Chang exercises at a Hong Kong Cancer Fund support centre, in Kwai Chung. Photo: Jonathan Wong

Dr Ho Lap-yin is a urologist and a medical adviser for the Hong Kong Cancer Fund. Photo: Dr Ho Lap-yin

Why more cancer is being diagnosed in younger people – and how lifestyle changes reduce the risk

Actor Chadwick Boseman died from cancer aged 43. Photo: AFP

Diagnoses of cancer – especially colorectal cancer – are increasing among under-50s, even as global cancer deaths decrease. Simple lifestyle and diet changes - more exercise, fewer sugary drinks, less ultra-processed food - can offset that increased risk. Photo: Shutterstock

Chadwick Boseman in a still from “Black Panther”. The actor died from colon cancer aged 43. Photo: Marvel Studios

Cancer among younger people is rising globally. 20 per cent of all colorectal cancer diagnoses in 2019 were in patients younger than 55. Photo: Shutterstock

Dr Ashley Cheng is clinical director of oncology at the CUHK Medical Centre. Photo: Dr Ashley Cheng

Cancer campaigner Dame Deborah James (pictured with her brother Benjamin James) at the Royal Ascot horse racing event in the UK in 2022. She was diagnosed with bowel cancer aged 35 and died that year, aged 40. Photo: David Benett/Getty Images

How to fight cancer: Thai Buddhist yogi leans on alternative therapies before accepting conventional ones in lengthy disease battle

A good attitude and a belief in the healing power of your body are important, says Thai Buddhist Siriluck, who has fought cancer for 16 years, but  accepts conventional treatment is vital, too. Photo: Xiaomei Chen

When fighting cancer, a good attitude and a belief in the healing power of your body are important, says Thai Buddhist Siriluck (above), but accepts conventional treatment is vital, too. Photo: Xiaomei Chen

Siriluck in her garden in Sai Kung, Hong Kong. She has been battling cancer for 16 years. Photo: Xiaomei Chen

Siriluck hiking with her dog Song in Hong Kong, in November 2023. Photo: Siriluck

Siriluck practising yoga at home. Photo: Xiaomei Chen

Every day, Siriluck drinks a green juice made from leaves, herbs and spices from her garden. Photo: Xiaomei Chen

Lifestyle

Health & Wellness

Health

Actress’ mammogram came back negative, but breast cancer risk assessment prompted tests that found tumours and led to Munn having a double mastectomy
Risk assessment tools look at family history and other factors to help doctors evaluate a patient’s chances of developing breast cancer


Date Night actress’ mammogram and a genetic test didn’t flag her breast cancer, but a risk assessment did. So what are they, how do they work, and is having regular mammograms still important?


How actress Olivia Munn’s life was saved through a breast cancer risk assessment, and why women need mammograms regularly

Actress’ mammogram came back negative, but breast cancer risk assessment prompted tests that found tumours and led to Munn having a double mastectomy Risk assessment tools look at family history and other factors to help doctors evaluate a patient’s chances of developing breast cancer

Actress’ mammogram came back negative, but breast cancer risk assessment prompted tests that found tumours and led to Munn having a double mastectomy

Risk assessment tools look at family history and other factors to help doctors evaluate a patient’s chances of developing breast cancer