Breast Cancer in Asia

  • Cheng-Har Yip
Part of the Methods in Molecular Biology book series (MIMB, volume 471)


Breast cancer is the commonest cancer in most countries in Asia. The incidence rates remain low, although increasing at a more rapid rate than in western countries, due to changes in the lifestyle and diet. There are many differences between breast cancer in Asia compared with western countries. The mean age at onset is younger than in the west, and unlike the west, the age-specific incidence decreases after the age of 50 years. Because there is no population-based breast cancer screening program in the majority of Asian countries, the majority of patients present with advanced disease. There is a higher proportion of hormone receptor-negative patients, and some evidence that the cancers in Asia are of a higher grade. Most of the Asian countries are low- and middle-income countries, where access to effective care is limited. Because of the late detection and inadequate access to care, survival of women with breast cancer in Asia is lower than in western countries. Improving breast health in most of the Asian countries remains a challenge that may be overcome with collaboration from multiple sectors, both public and private.

Key words

Breast cancer epidemiology survival histopathology screening treatment 


  1. 1.
    Parkin DM, Whelan SL, Ferlay J, Storm H (2005) Cancer incidence in five continents, volumes I–VIII. IARC CancerBase no. 6. IARC Press, Lyon, France ( Scholar
  2. 2.
    Seow A, Duffy SW, McGee MA, Lee J, Lee HP. (1996). Breast cancer in Singapore: trends in incidence 1965–1992. Int J Epidemiol25, 40–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Yang BH, Parkin DM, Cai L, Zhang ZF. (2004). Cancer burden and trends in the Asian Pacific Rim Region. Asian Pac. J Cancer Prev5, 96–117.PubMedGoogle Scholar
  4. 4.
    Ziegler RG, Hoover RN, Pike MC, et al. (1993). Migration patterns and breast cancer risk in Asian-American women. J Natl Cancer Inst85, 1819–27.CrossRefPubMedGoogle Scholar
  5. 5.
    Bray F, McCarron P, Parkin DM. (2004). The changing global patterns of female breast cancer incidence and mortality. Breast Cancer Res 6, 229–39.CrossRefPubMedGoogle Scholar
  6. 6.
    Lim GCC, Halimah Y (eds). (2004). Cancer incidence in Malaysia 2003. National Cancer Registry, Kuala Lumpur, Malaysia.Google Scholar
  7. 7.
    Yip CH, Taib NA, Mohamed I. (2006). Epidemiology of breast cancer in Malaysia. Asian Pac J Cancer Prev7, 369–74.PubMedGoogle Scholar
  8. 8.
    Son BH, Kwak BS, Kim JK, et al. (2006). Changing patterns in the clinical characteristics of Korean patients with breast cancer during the last 15 years. Arch Surg141, 155–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Henderson BE, Ross R, Bernstein L. (1988). Estrogens as a cause of human cancer: the Richard and Hinda Rosenthal Foundation Award Lecture. Cancer Res48, 246–53.PubMedGoogle Scholar
  10. 10.
    Moolgavkar SH, Stevens RG, Lee JA. (1979). Effect of age on incidence of breast cancer in females. J Natl Cancer Inst62, 493–501PubMedGoogle Scholar
  11. 1 1.
    1 1. Minami Y, Tsubono Y, Nishima Y, Ohuchi N, Shibuya D, Hisamichi S. (2004). The increase in female breast cancer incidence in Japan: emergence of a birth cohort effect. Int J Cancer108, 901–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Yoshimoto M, Tada K, Hori H, et al. (2004). Improvement in the prognosis of Japanese breast cancer patients from 1946–2001: an institutional review. Jpn J Clin Oncol34, 457–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Hisham AN, Yip CH. (2003). Spectrum of breast cancer in Malaysian women: an overview. World J Surg27, 921–23.CrossRefPubMedGoogle Scholar
  14. 14.
    Aggarwal G, Pradeep PV, Aggarwal V, Yip CH, Cheung PS. (2007). Spectrum of breast cancer in Asian women. World J Surg31, 1031–40.CrossRefPubMedGoogle Scholar
  15. 15.
    Remenick L. (2006). The challenge of early breast cancer detection among immigrant and minority women in multicultural societis. Breast J12, S103–S110.CrossRefGoogle Scholar
  16. 16.
    Parsa P, Kandiah M, Abdul Rahman H, Mohd Zulkefli NA. (2006). Barriers for breast cancer screening among Asian women: a mini literature review. Asian Pac J Cancer Prev7, 509–14.PubMedGoogle Scholar
  17. 17.
    Hebert JR, Ghumare SS, Gupta PC. (2006). Stage at diagnosis and relative differences in breast and prostate cancer incidence in India: comparison with the United States. Asian Pac J Cancer Prev7, 547–55.PubMedGoogle Scholar
  18. 18.
    Al-Moundhari M, Al-Bahrani B, Pervez J, et al. (2004). The outcome of treatment of breast cancer in a developing country–Oman. Breast13, 139–45.CrossRefGoogle Scholar
  19. 19.
    Vahdaninia1 M, Montazeri A. (2004). Breast cancer in Iran: a survival analysis. Asian Pac J Cancer Prev5, 223–25.PubMedGoogle Scholar
  20. 20.
    Ahn SH, Yoo KY. (2006). The Korean Breast Cancer Society. Chronological changes of clinical characteristics in 31,115 new breast cancer patients among Koreans during 1996–2004. Breast Cancer Res Treat99, 209–14.CrossRefPubMedGoogle Scholar
  21. 21.
    21.Tan EY, Wong HB, Ang BK, Chan MY. (2005). Locally advanced and metastatic breast cancer in a tertiary hospital. Ann Acad Med Singap34, 595–601.PubMedGoogle Scholar
  22. 22.
    22..Klonoff-Cohen HS, Schaffroth LB, Edel-stein SL, Molgaard C, Saltzstein SL. (1998). Breast cancer histology in Caucasians, African Americans, Hispanics, Asians and PacificIs-landers. Ethn Health3, 189–98.CrossRefPubMedGoogle Scholar
  23. 23.
    Sakamoto G, Sugano H. (1991). Pathology of breast cancer: present and prospect in Japan. Breast Cancer Res Treat18, S581–S583.CrossRefGoogle Scholar
  24. 24.
    Harirchi I, Karbakhsh M, Kashefi A, Momtahen AJ. (2004). Breast cancer in Iran: results of a multicentre study. Asia Pac J Cancer Prev 5, 24–7.Google Scholar
  25. 25.
    CH Yip, LM Looi. (1996). Breast cancer in Malaysian women–pathological features and treatment. Asian J Surg 19, 112.Google Scholar
  26. 26.
    Gapstur SM, Dupuis J, Gann P, Collila S, Winchester DP. (1996). Hormone receptor status of breast tumors in black, Hispanic, and non-Hispanic white women. An analysis of 13,239 cases. Cancer 77, 1465–71.CrossRefPubMedGoogle Scholar
  27. 27.
    Li CI Malone KE, Daling JR. (2002). Differences in breast cancer hormone receptor status and histology by race and ethnicity among women 50 years of age and older. Cancer Epidemiol Biomarkers Prev 11, 601–7.Google Scholar
  28. 28.
    Desai SB, Moonim MT, Gill AK, Punia RS, Naresh KN, Chinoy RF. (2000) Hormone receptor status of breast cancer in India: a study of 798 tumours. Breast 9, 267–70.CrossRefPubMedGoogle Scholar
  29. 29.
    29.Navani S, Bhaduri AS. (2005). High incidence of oestrogen receptor negative progesterone receptor positive phenotype in Indian breast cancer: fact or fiction? Indian J Pathol Microbiol 48, 199–201.PubMedGoogle Scholar
  30. 30.
    Aryandono T, Harijadi, Soeripto. (2006). Hormone receptor status of operable breast cancer patients in Indonesia: correlation with other prognostic factors and survival. Asian Pac J Cancer Prev 7, 321–4.PubMedGoogle Scholar
  31. 31.
    31.Sughayer MA, Al-Khawaja MM, Massarweh S, Al-Masri M. (2006). Prevalence of hormone receptors and HE2/neu in breast cancer cases in Jordan. Pathol Oncol Res 12, 83–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Chow LW, Ho P. (2000). Hormonal receptor determination of 1,052 Chinese breast cancers. J Surg Oncol 75, 172–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Li CI, Daling JR, Malone KE. (2003). Incidence of invasive breast cancer by hormone receptor status from 1992 to 1998. J Clin Oncol 21, 28–34.CrossRefPubMedGoogle Scholar
  34. 34.
    Pujol P, Hilsenbeck SG, Chamness GC, Elledge RM. (1994). Rising levels of estrogen receptor in breast cancer over 2 decades. Cancer 74, 1601–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Bloom HJG, Richardson WW. (1957) His-tological grading and prognosis in breast cancer. Br J Cancer 11, 359–77.PubMedGoogle Scholar
  36. 36.
    Elston CW, Ellis IO. (2002). Pathological prognostic factors in breast cancer. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 41, 154–61.CrossRefPubMedGoogle Scholar
  37. 37.
    Aryandono T, Harijadi, Soeripto. (2006). Survival from operable breast cancer: p r ognostic factors in Yogyakarta, Indonesia. Asian Pac J Cancer Prev6, 455–9.Google Scholar
  38. 38.
    Zhang T, Tu X, Xu W. (1998). A study of prognostic factors in breast cancer: histological grading. Zhong Hua Bing Li Xue Za Zhi27, 405–7Google Scholar
  39. 39.
    Meyer JS, Alvarez C, Milikowski C, et al. (2005). Breast carcinoma malignancy grading by Bloom—Richardson system vs proliferation index: reproducibility of grade and advantages of proliferation index. Mod Pathol18, 1067–78.CrossRefPubMedGoogle Scholar
  40. 40.
    40 Sikka M, Agarwal S, Bhatia A. (1999). Interobserver agreement of the Nottingham histologic grading scheme for infiltrating duct carcinoma breast. Indian J Cancer36, 149–53.PubMedGoogle Scholar
  41. 41.
    Menard S, Taqliabue E, Campiqlio M, Pupa SM. (2000). Role of HER2 gene overepression in breast carcinoma. J Cell Physiol182, 150–62.CrossRefPubMedGoogle Scholar
  42. 42.
    Homael-Shandiz F, Ghavam-Nassiri MR, Sharif N, et al. (2006). Evaluation of the relationship between human epidermal growth factor receptor-2/neu (c-erbB-2) amplification and pathologic grading in patients with breast cancer. Saudi Med J27, 1810–4.Google Scholar
  43. 43.
    Cianfrocca M, Goldstein LJ. (2004). Prognostic and predictive factors in early stage breast cancer. Oncologist9, 606–16.CrossRefPubMedGoogle Scholar
  44. 44.
    Sankaranarayanan R, Swaminathan R, Black RJ. (1996). Global variations in cancer survival. Cancer8, 2461–4.CrossRefGoogle Scholar
  45. 45.
    Pal SK, Mittal B. (2004). Fight against cancer in countries with limited resources: the post-genomic era scenario. Asian Pac J Cancer Prev5, 328–33.PubMedGoogle Scholar
  46. 46.
    Parkin DM, Bray F, Ferlay J, Pisani P. (2005). Global cancer statistics, 2002. CA Cancer J Clin55, 74–108.CrossRefPubMedGoogle Scholar
  47. 47.
    Moore MA, Kazuo T, Pham Hoang Anh, et al. (2003). Grand challenges in global health and the practical prevention program? Asian focus on cancer prevention in females of the developing world. Asian Pac J Cancer Prev4, 153–65.PubMedGoogle Scholar
  48. 48.
    Shapiro S, Venet W, Strax P, et al. (1988). Periodic screening for breast cancer: the Health Insurance Plan project and its sequelae, 1963–1986. Johns Hopkins University Press, Baltimore, MD.Google Scholar
  49. 49.
    Nystrom Lrutqvist LE, Wall S, et al. (1993). Breast screening with mammography: overview of the Swedish Randomized Trials. Lancet17, 973–8.CrossRefGoogle Scholar
  50. 50.
    Roberts MM, Alexander FE, Anderson TJ, et al. (1990) Edinburgh trial of screening for breast cancer: mortality at 7 years. Lancet335, 241–6.CrossRefPubMedGoogle Scholar
  51. 51.
    Andersson I, Aspergren K, Janzon L, et al. (1988). Mammographic screening and mortality from breast cancer: the Malmo mammographic screening trial. BMJ297, 943–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Frisell J, Eklund G, Hellstrom L, et al. (1991). Randomized study of mammography screening-preliminary report on mortality in the Stockholm trial. Breast Cancer Res Treat18, 49–56.CrossRefPubMedGoogle Scholar
  53. 53.
    Miller AB, To T, Baines CJ, Wall C. (2002). The Canadian National Breast Screening Study 1: breast cancer mortality after 11 to 16 years of follow-up. A randomized screening trial of mammography in women aged 40–49 years. Ann Intern Med137, 305–12.PubMedGoogle Scholar
  54. 54.
    Ng EH, Ng FH, Tan PH, Low SC, Chiang G, et al. (1998). Results of intermediate measures from a population based randomized trial of mammographic screening-prevalence and detection of breast carcinoma among Asian women. Cancer82, 1521–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Leung GM, Lam TH, Thach TQ, Hedley AJ. (2002). Will screening mammography in the east do more harm than good? Am J Public Health92, 1841–6.CrossRefPubMedGoogle Scholar
  56. 56.
    Hill D, White V, Jolley D, Mapperson K. (1988). Self examination of the breast: is it beneficial? A meta-analysis of studies investigating breast self-examination and extent of disease in patients with breast cancer. BMJ297, 271–5.CrossRefPubMedGoogle Scholar
  57. 57.
    Thomas DB, Gao DL, Ray RM, Wang WW, Allison CJ, et al. (2002). Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst94, 1445–57.PubMedGoogle Scholar
  58. 58.
    Hackshaw AK, Paul EA. (2003). Breast Self examination and death from breast cancer: a meta-analysis. Br J Cancer88, 1047–53.CrossRefPubMedGoogle Scholar
  59. 59.
    Bancej C, Decker K, Chiarelli A, Harrison M, Turner D, Brisson J. (2003). Contribution of CBE to mammography screening in the early detection of breast cancer. J Med Screen10, 16–21.CrossRefPubMedGoogle Scholar
  60. 60.
    Oestreicher N, White E, Lehman CD, Man-delson MT, Porter PL, Taplin SH. (2002). Predictors of sensitivity of CBE. Breast Cancer Res Treat76, 73–81.CrossRefPubMedGoogle Scholar
  61. 61.
    Weiss NS. (2003). Breast cancer mortality in relation to CBE and BSE. Breast J9, S86–S89CrossRefPubMedGoogle Scholar
  62. 62.
    Pisani P, Parkin DM, Ngelangel C, Esteban D, et al. (2006). Outcome of screening by clinical examination of the breast in a trial in the Philippines. Int J Cancer118, 149–54.CrossRefPubMedGoogle Scholar
  63. 63.
    Parisa P, Kandiah M, Abdul Rahman H, Mohd Zulkefli NA. (2006). Barriers to breast cancer screening among Asian women: a mini literature review. Asian Pac J Cancer Prev7, 509–514.Google Scholar
  64. 64.
    Varun G. (2001). Are incentives everything? Payment mechanisms for health care providers in developing countries. World Bank Policy Research Working Paper No. 2624. (
  65. 65.
    Goldhirsch A, Glick JH, Gelber RD, Coates AS, Thurlimann B, Senn HJ. (2005). Meeting highlights: international expert consensus on the primary therapy of early breast cancer. Ann Oncol16, 1569–83.CrossRefPubMedGoogle Scholar
  66. 66.
    Carlson RW, Anderson BO, Burstein HJ, Cox CE, Edge SB, Farrar WB, et al. (2005) Breast cancer. J Natl Compr Canc Netw3, 238–89.PubMedGoogle Scholar
  67. 67.
    World Health Organization. (2002). Executive summary of the national cancer control programmes: policies and managerial guidelines. World Health Organization, Geneva, Switzerland.Google Scholar
  68. 68.
    Smith RA, Caleffi M, Albert US, Chen TH, Duffy SW, Franceschi D, et al. (2006). Breast cancer in limited-resource countries: early detection and access to care. Breast J 12, S16–S26.CrossRefPubMedGoogle Scholar
  69. 69.
    Shyyan R, Masood S, Badwe RA, Errico KM, Liberman L, Ozmen V, et al. (2006). Breast cancer in limited-resource countries: diagnosis and pathology. Breast J 12, S27–S37.CrossRefPubMedGoogle Scholar
  70. 70.
    Eniu A, Carlson RW, Aziz Z, Bines J, Hortobagyi GN, Bese NS, et al. (2006). Breast cancer in limited-resource countries: treatment and allocation of resources. Breast J12, S38–S53.CrossRefPubMedGoogle Scholar
  71. 71.
    Anderson BO, Yip CH, Ramsey SD, Bengoa R, Braun S, Fitch M, et al. (2006). Breast cancer in limited-resource countries: health care systems and public policy. Breast J12, S54–S69.CrossRefPubMedGoogle Scholar
  72. 72.
    Anderson BO, Shyyan R, Eniu A, Smith RA, Yip CH, Bese NS, et al. (2006). Breast cancer in limited-resource countries: an overview of the Breast Health Global Initiative 2005 guidelines. Breast J12., S3–S15.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Cheng-Har Yip
    • 1
  1. 1.Department of SurgeryUniversity Malaya, Medical CentreKuala LumpurMalaysia

Personalised recommendations