Skip to main content
SpringerLink
Log in

Breast Cancer in South East Asia: Comparison of Presentation and Outcome Between a Middle Income and a High Income Country

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

There are large differences in socio-economic growth within the region of South East Asia, leading to sharp contrasts in health-systems development between countries. This study compares breast cancer presentation and outcome between patients from a high income country (Singapore) and a middle income country (Malaysia) in South East Asia.

Methods

Within the Singapore Malaysia Breast Cancer Registry we identified all consecutive patients diagnosed with breast cancer between 1993 and 2007 at the National University Hospital in Singapore (high income country, n = 2,141) and the University of Malaya Medical Center in Kuala Lumpur, Malaysia (middle income country, n = 3,320). We compared demographics, tumor characteristics, treatment patterns, and survival between patients from both countries.

Results

In Malaysia, patients were less often diagnosed with in situ breast cancer (adjusted odds ratio [ORadj] 0.2; 95 % confidence interval [95 % CI] 0.1–0.3), more likely to be diagnosed with late stage (III and IV) disease (ORadj for stage III 1.6; 95 % CI 1.3–2.0; ORadj for stage IV 1.2; 95 % CI 1.1–1.4) as compared to patients from Singapore. Univariate analysis showed that Malaysian patients were at a 72 % increased risk of death as compared to Singaporeans. After adjusting for other prognostic factors, the risk decreased by only 5 % (ORadj 1.67, 95 % CI 1.44–1.92).

Conclusions

Differences in way of presentation (except stage and tumor size) and treatment of breast cancer patients from the two countries are small. The overall survival of breast cancer patients from Malaysia is much lower than that of Singaporean patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Yip CH (2009) Breast cancer in Asia. Methods Mol Biol 471:51–64

    Article  PubMed  Google Scholar 

  2. Yip CH, Cazap E, Anderson BO et al (2011) Breast cancer management in middle-resource countries (MRCs): consensus statement from the Breast Health Global Initiative. Breast 20(Suppl 2):S12–S19

    Article  PubMed  Google Scholar 

  3. Ravdin PM, Cronin KA, Howlader N et al (2007) The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 356:1670–1674

    Article  PubMed  CAS  Google Scholar 

  4. Wang PP, Cao Y (1996) Incidence trends of female breast cancer in Saskatchewan, 1932–1990. Breast Cancer Res Treat 37:197–207

    Article  PubMed  CAS  Google Scholar 

  5. Fontenoy AM, Leux C, Delacour-Billon S et al (2010) Recent trends in breast cancer incidence rates in the Loire-Atlantique, France: a decline since 2003. Cancer Epidemiol 34:238–243

    Article  PubMed  CAS  Google Scholar 

  6. Takiar R, Srivastav A (2008) Time trend in breast and cervix cancer of women in India—(1990–2003). Asian Pac J Cancer Prev 9:777–780

    PubMed  Google Scholar 

  7. Medina VM, Laudico A, Mirasol-Lumague MR et al (2010) Cumulative incidence trends of selected cancer sites in a Philippine population from 1983 to 2002: a joinpoint analysis. Br J Cancer 102:1411–1414

    Article  PubMed  CAS  Google Scholar 

  8. Sim X, Ali RA, Wedren S et al (2006) Ethnic differences in the time trend of female breast cancer incidence: Singapore, 1968–2002. BMC Cancer 6:261

    Article  PubMed  Google Scholar 

  9. Seow A, Koh WP, Chia KS et al. (2004) Trends In Cancer Incidence In Singapore 1968–2002 Singapore Cancer Registry, Singapore

  10. Hirabayashi Y, Zhang M (2009) Comparison of time trends in breast cancer incidence (1973–2002) in Asia, from cancer incidence in five continents, Vols IV–IX. Jpn J Clin Oncol 39:411–412

    Article  PubMed  Google Scholar 

  11. Ministry of Health http://www.moh.gov.sg/mohcorp/statistics.aspx?id=5524. Accessed July 2011

  12. World Bank. Country Classification http://data.worldbank.org/country/singapore. Accessed July 2011

  13. Department of Statistics Singapore http://www.singstat.gov.sg/stats/latestdata.html. Accessed July 2011

  14. Lim M-K (2009) Health Care Reforms in Singapore: Six Countries, Six Reform Models: The Health Care Reform, World Scientific Publishing Co. Pte. Ltd

  15. Malaysia. US Department of State (2010) http://www.state.gov/r/pa/ei/bgn/2777.htm

  16. World Bank. Country classification. http://data.worldbank.org/country/malaysia. Accessed July 2011

  17. Barraclough S (1997) The growth of corporate private hospitals in Malaysia: policy contradictions in health system pluralism. Int J Health Serv 27:643–659

    Article  PubMed  CAS  Google Scholar 

  18. Francis T (2009) Health care in Malaysia: the dynamics of provision, financing and access. In: Barraclough S (ed) Heng Leng Chee SB. Routledge, London

    Google Scholar 

  19. Newman LA, Mason J, Cote D et al (2002) African-American ethnicity, socioeconomic status, and breast cancer survival. Cancer 94:2844–2854

    Article  PubMed  Google Scholar 

  20. Kogevinas M Pearce N, Susser M et al., eds. (1997) Social Inequalities and Cancer. IARC Scientific Publications no. 138, Lyon, France

  21. Webster TF, Hoffman K, Weinberg J et al (2008) Community- and individual-level socioeconomic status and breast cancer risk: multilevel modeling on Cape Cod, Massachusetts. Environ Health Perspect 116:1125–1129

    Article  PubMed  Google Scholar 

  22. Barbone F, Filiberti R, Franceschi S et al (1996) Socioeconomic status, migration and the risk of breast cancer in Italy. Int J Epidemiol 25:479–487

    Article  PubMed  CAS  Google Scholar 

  23. Ferlay J, Shin H-R, Bray F et al (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917

    Article  PubMed  CAS  Google Scholar 

  24. Singapore Cancer Registry Report (2010) Trends in cancer incidence in Singapore 1968–2007. http://www.nrdo.gov.sg/

  25. Yip CH, Taib NA, Mohamed I (2006) Epidemiology of breast cancer in Malaysia. Asian Pac J Cancer Prev 7:369–374

    PubMed  Google Scholar 

  26. Bouchardy C, Verkooijen HM, Fioretta G (2006) Social class is an important and independent prognostic factor of breast cancer mortality. Int J Cancer 119:1145–1151

    Article  PubMed  CAS  Google Scholar 

  27. Pathy NB, Yip CH, Taib NA et al (2011) Breast cancer in a multi-ethnic Asian setting: results from the Singapore-Malaysia Hospital-based breast cancer registry. Breast 20(Suppl 2):S75–S80

    Article  PubMed  Google Scholar 

  28. Lim SE, Back M, Quek E et al (2007) Clinical observations from a breast cancer registry in Asian women. World J Surg 31:1387–1392

    Article  PubMed  Google Scholar 

  29. Sant M, Allemani C, Capocaccia R et al (2003) Stage at diagnosis is a key explanation of differences in breast cancer survival across Europe. Int J Cancer 106:416–422

    Article  PubMed  CAS  Google Scholar 

  30. Gondos A, Bray F, Brewster DH et al (2008) Recent trends in cancer survival across Europe between 2000 and 2004: a model-based period analysis from 12 cancer registries. Eur J Cancer 44:1463–1475

    Article  PubMed  CAS  Google Scholar 

  31. Pineda MD, White E, Kristal AR et al (2001) Asian breast cancer survival in the US: a comparison between Asian immigrants, US-born Asian Americans and Caucasians. Int J Epidemiol 30:976–982

    Article  PubMed  CAS  Google Scholar 

  32. Moller H, Sandin F, Bray F et al (2010) Breast cancer survival in England, Norway and Sweden: a population-based comparison. Int J Cancer 127:2630–2638

    Article  PubMed  CAS  Google Scholar 

  33. Redaniel MT, Laudico A, Mirasol-Lumague MR et al (2010) Breast cancer survival in different country settings: comparisons between a Filipino resident population, Filipino-Americans and Caucasians. Breast 19:109–114

    Article  PubMed  Google Scholar 

  34. Li CI, Malone KE, Daling JR (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163:49–56

    Article  PubMed  Google Scholar 

  35. Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24:2137–2150

    Article  PubMed  Google Scholar 

  36. Curado MP, Voti L, Sortino-Rachou AM (2009) Cancer registration data and quality indicators in low and middle income countries: their interpretation and potential use for the improvement of cancer care. Cancer Causes Control 20:751–756

    Article  PubMed  Google Scholar 

  37. Sankaranarayanan R, Swaminathan R, Brenner H et al (2009) Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol 11:165–173

    Article  PubMed  Google Scholar 

  38. Dahlui M, Ramli S, Bulgiba AM (2011) Breast cancer prevention and control programs in Malaysia. Asian Pac J Cancer Prev 12:1631–1634

    PubMed  Google Scholar 

  39. Eley JW, Hill HA, Chen VW et al (1994) Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA 272:947–954

    Article  PubMed  CAS  Google Scholar 

  40. Ooi SL, Martinez ME, Li CI (2011) Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res Treat 127:729–738

    Article  PubMed  Google Scholar 

  41. Schopper D, de Wolf C (2009) How effective are breast cancer screening programmes by mammography? Review of the current evidence. Eur J Cancer 45:1916–1923

    Article  PubMed  Google Scholar 

  42. Kuhl CK, Schrading S, Leutner CC et al (2005) Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol 23:8469–8476

    Article  PubMed  Google Scholar 

  43. Kaffashian F, Godward S, Davies T et al (2003) Socioeconomic effects on breast cancer survival: proportion attributable to stage and morphology. Br J Cancer 89:1693–1696

    Article  PubMed  CAS  Google Scholar 

  44. Lee-Feldstein A, Anton-Culver H, Feldstein PJ (1994) Treatment differences and other prognostic factors related to breast cancer survival. Delivery systems and medical outcomes. JAMA 271:1163–1168

    CAS  Google Scholar 

  45. Early Breast Cancer Trialists’ Collaborative Group (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717

    Article  Google Scholar 

  46. Chong HY, Taib NA, Rampal S et al (2011) Treatment options for locally advanced breast cancer—experience in an Asian tertiary hospital. Asian Pac J Cancer Prev 11:913–917

    Google Scholar 

  47. Holmes MD, Chen WY, Feskanich D et al (2005) Physical activity and survival after breast cancer diagnosis. JAMA 293:2479–2486

    Article  PubMed  CAS  Google Scholar 

  48. Taib NA, Yip CH, Low WY (2011) Recognising symptoms of breast cancer as a reason for delayed presentation in Asian Women—the psycho-socio-cultural model for breast symptom appraisal: ppportunities for intervention. Asian Pac J Cancer Prev 12:1601–1608

    PubMed  Google Scholar 

  49. Schonberg MA, Marcantonio ER, Li D et al (2009) Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol 28:2038–2045

    Article  Google Scholar 

  50. Early Breast Cancer Trialists’ Collaborative Group (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet 378:1707–1716

    Article  Google Scholar 

  51. Nakul S, Mikael H, Zakir H et al (2011) Impact of older age on presentation, management and outcome of breast cancer in the multi-ethnic Asian population of Singapore. J Geriatric Oncol 2:50–57

    Article  Google Scholar 

  52. Krell J, James CR, Shah D et al (2011) Human epidermal growth factor receptor 2-positive breast cancer relapsing post-adjuvant trastuzumab: pattern of recurrence, treatment and outcome. Clin Breast Cancer 11:153–160

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The Malaysian data were supported by HIR Grant UM.C/HlR/MOHE/06 from the Ministry of Higher Education, Malaysia. Nirmala Bhoo-Pathy was funded by the European Union through a PhD fellowship grant (AsiaLink program MY/AsiaLink/044[128–713]). This work was funded by the NUS Initiative to Improve Health in Asia (NIHA) Grant. Official Project Number: NIHA-2011-1-001. The authors are grateful to Kimberley S. K. Chua, Senior Research Coordinator at the National University Hospital, Singapore, for her help in data collection and verification.

Conflict of interest

All authors indicate no potential conflict of interest.

Author information

Authors and Affiliations

  1. Saw Swee Hock School of Public Health, National University of Singapore, MD3 16 Medical Drive, Singapore, 117597, Singapore

    Nakul Saxena, Mikael Hartman & Helena M. Verkooijen

  2. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, MD3 16 Medical Drive, Singapore, 117597, Singapore

    Mikael Hartman & Philip Iau

  3. National Clinical Research Centre, Level 3, Dermatology Block, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia

    Nirmala Bhoo-Pathy

  4. Julius Center for Health Sciences and Primary Care, University Medical Center, PO Box 85500, 3508 GA, Utrecht, The Netherlands

    Nirmala Bhoo-Pathy

  5. Leeds Institute for Health Sciences, Faculty of Medicine and Health Sciences, University of Leeds, Charles Thackrah Building, 102 Clarendon Road, Leeds, LS2 9LJ, United Kingdom

    Jennifer N. W. Lim

  6. Department of Community Medicine, United Arab Emirates University, PO Box 17666, Al-Ain, United Arab Emirates

    Tar-Ching Aw

  7. Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia

    Nur Aishah Taib & Cheng-Har Yip

  8. Department of Hematology Oncology, National University Cancer Institute, National University Health System Singapore, Singapore, 119228, Singapore

    Soo-Chin Lee

  9. Department of Radiology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands

    Helena M. Verkooijen

Authors
  1. Nakul Saxena
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mikael Hartman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nirmala Bhoo-Pathy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer N. W. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tar-Ching Aw
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philip Iau
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nur Aishah Taib
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Soo-Chin Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Cheng-Har Yip
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Helena M. Verkooijen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mikael Hartman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saxena, N., Hartman, M., Bhoo-Pathy, N. et al. Breast Cancer in South East Asia: Comparison of Presentation and Outcome Between a Middle Income and a High Income Country. World J Surg 36, 2838–2846 (2012). https://doi.org/10.1007/s00268-012-1746-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-012-1746-2

Keywords

Search

Navigation