Causes and risk factors

from: http://www.nhs.uk/Conditions/Cancer-of-the-breast-female/Pages/Causes.aspx
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Causes and risk factors 

The causes of breast cancer are not fully understood. This means it is difficult to say why one woman may develop breast cancer and another may not.

Some things, known as risk factors, can change the likelihood that someone may develop breast cancer. There are some factors you cannot do anything about. Others, you can change.

Age

The risk of developing breast cancer increases as you get older. Breast cancer is most common among women over 50 who have been through the menopause. Eight out of 10 cases of breast cancer occur in women over 50.

All women between 50 and 70 years of age should be screened for breast cancer every three years as part of the NHS Breast Screening Programme. Women over the age of 70 are still eligible to be screened and can arrange this through their GP or local screening unit. Currently, there are ongoing pilot studies looking at widening the screening age range to 47-73.

Family history

If you have close relatives who have had breast cancer or ovarian cancer, you may have a higher risk of developing breast cancer. However, as breast cancer is the most common cancer in women, it is possible for it to occur more than once in the same family by chance.

Most breast cancer cases are not hereditary (they do not run in families). However, particular genes, known as BRCA1 and BRCA2, can increase your risk of developing both breast and ovarian cancer. It is possible for these genes to be passed on from a parent to their child. A third gene (TP53) is also associated with increased risk of breast cancer.

If you have, for example, two or more close relatives from the same side of your family (such as your mother, sister or daughter) who have had breast cancer under the age of 50, you may be eligible for surveillance for breast cancer or for genetic screening to look for the genes that make developing breast cancer more likely. If you are worried about your family history of breast cancer, discuss it with your GP.

Previous diagnosis of breast cancer

If you have previously had breast cancer or early non-invasive cancer cell changes contained within breast ducts, you have a higher risk of developing it again, either in your other breast or in the same breast again.

Previous benign breast lump

A benign breast lump does not mean you have breast cancer, but certain types of lump may slightly increase your risk of developing it. Certain benign changes in your breast tissue, such as atypical ductal hyperplasia (cells growing abnormally in ducts) or lobular carcinoma in situ (abnormal cells inside your breast lobes), can make getting breast cancer more likely.

Breast density

Your breasts are made up of thousands of tiny glands (lobules), which produce milk. This glandular tissue contains a higher concentration of breast cells than other breast tissue, making it denser. Women with more dense breast tissue may have a higher risk of developing breast cancer because there are more cells that can become cancerous.

Dense breast tissue can also make a breast scan (mammogram) harder to read because it makes any lumps or areas of abnormal tissue harder to spot. Younger women tend to have denser breasts. As you get older, the amount of glandular tissue in your breasts decreases and is replaced by fat, so your breasts become less dense.

Exposure to oestrogen

In some cases, breast cancer cells can be stimulated to grow by the female hormone oestrogen. Your ovaries, where your eggs are stored, begin to produce oestrogen when you start puberty in order to regulate your periods.

Your risk of developing breast cancer may rise slightly with the amount of oestrogen your body is exposed to. For example, if you started your periods at a young age and entered menopause at a late age, you will have been exposed to oestrogen over a longer period of time. In the same way, not having children, or having children later in life, may slightly increase your risk of developing breast cancer because your exposure to oestrogen is uninterrupted by pregnancy.

Being overweight or obese

If you have been through the menopause and are overweight orobese, you may be more at risk of developing breast cancer. This is thought to be linked to the amount of oestrogen in your body, as being overweight or obese after the menopause causes more oestrogen to be produced.

Being tall

If you are taller than average, you are more likely to develop breast cancer than someone who is shorter than average. This may be due to interactions between genes, nutrition and hormones, but the reason is not fully understood.

Alcohol

Your risk of developing breast cancer can increase with the amount of alcohol you drink. Research shows that, for every 200 women who regularly have two alcoholic drinks a day, there are three more women with breast cancer compared with women who do not drink at all.

Radiation

Certain medical procedures that use radiation, such as X-rays and CT scans, may slightly increase your risk of developing breast cancer. If you had radiotherapy to your chest area for Hodgkin's lymphoma when you were a child, you should have already received a written invitation from the Department of Health for a consultation with a specialist to discuss your increased risk of developing breast cancer. See your GP if you were not contacted or you did not attend a consultation.

If you currently need radiotherapy for Hodgkin's lymphoma, your specialist should discuss the risk of breast cancer before your treatment begins.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is associated with a slightly increased risk of developing breast cancer. Both combined HRT and oestrogen-only HRT can increase your risk of developing breast cancer, although the risk is slightly higher if you take combined HRT.

It is estimated there will be an extra 19 cases of breast cancer for every 1,000 women taking combined HRT for 10 years. The risk continues to increase slightly the longer you take HRT, but returns to normal once you stop taking it.

Want to know more?

• Breakthrough Breast Cancer: Breast cancer risk factors
• Breast Cancer Care: Risk
• Cancer Research UK: Breast cancer risks and causes
• Live Well: Breast cancer genes
• Macmillan: Breast cancer causes and risk factors

Page last reviewed: 09/07/2012

Next review due: 09/07/2014

key statistics about breast cancer

from: http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics
-----

What are the key statistics about breast cancer?

Breast cancer is the most common cancer among American women, except for skin cancers. About 1 in 8 (12%) women in the US will develop invasive breast cancer during their lifetime.

The American Cancer Society's estimates for breast cancer in the United States are for 2013:

• About 232,340 new cases of invasive breast cancer will be diagnosed in women.
• About 64,640 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer).
• About 39,620 women will die from breast cancer

After increasing for more than 2 decades, female breast cancer incidence rates began decreasing in 2000, then dropped by about 7% from 2002 to 2003. This large decrease was thought to be due to the decline in use of hormone therapy after menopause that occurred after the results of the Women's Health Initiative were published in 2002. This study linked the use of hormone therapy to an increased risk of breast cancer and heart diseases. Incidence rates have been stable in recent years.

Breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer. The chance that breast cancer will be responsible for a woman's death is about 1 in 36 (about 3%). Death rates from breast cancer have been declining since about 1989, with larger decreases in women younger than 50. These decreases are believed to be the result of earlier detection through screening and increased awareness, as well as improved treatment.

At this time there are more than 2.9 million breast cancer survivors in the United States. (This includes women still being treated and those who have completed treatment.) Survival rates are discussed in the section “How is breast cancer staged?”

Last Medical Review: 08/23/2012
Last Revised: 02/26/2013

from: http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-breast-cancer-types
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Types of breast cancers

There are several types of breast cancer, but some of them are quite rare. In some cases a single breast tumor can be a combination of these types or be a mixture of invasive and in situ cancer.

Ductal carcinoma in situ

Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is the most common type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts but have not spread through the walls of the ducts into the surrounding breast tissue.

About 1 in 5 new breast cancer cases will be DCIS. Nearly all women diagnosed at this early stage of breast cancer can be cured. A mammogram is often the best way to find DCIS early.

When DCIS is diagnosed, the pathologist (a doctor specializing in diagnosing disease from tissue samples) will look for areas of dead or dying cancer cells, called tumor necrosis, within the tissue sample. If necrosis is present, the tumor is likely to be more aggressive. The term comedocarcinoma is often used to describe DCIS with large areas of necrosis. The pathologist will also note how abnormal the cells appear, especially the part of cells where DNA is found (the nucleus).

Lobular carcinoma in situ

This is not a true cancer or pre-cancer, and is discussed in the section “What are the risk factors for breast cancer?”

Invasive (or infiltrating) ductal carcinoma

This is the most common type of breast cancer. Invasive (or infiltrating) ductal carcinoma (IDC) starts in a milk duct of the breast, breaks through the wall of the duct, and grows into the fatty tissue of the breast. At this point, it may be able to spread (metastasize) to other parts of the body through the lymphatic system and bloodstream. About 8 of 10 invasive breast cancers are infiltrating ductal carcinomas.

Invasive (or infiltrating) lobular carcinoma

Invasive lobular carcinoma (ILC) starts in the milk-producing glands (lobules). Like IDC, it can spread (metastasize) to other parts of the body. About 1 invasive breast cancer in 10 is an ILC. Invasive lobular carcinoma may be harder to detect by a mammogram than invasive ductal carcinoma.

Less common types of breast cancer

Inflammatory breast cancer: This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead, inflammatory breast cancer (IBC) makes the skin on the breast look red and feel warm. It also may give the breast skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or infection, but by cancer cells blocking lymph vessels in the skin. The affected breast may become larger or firmer, tender, or itchy.

In its early stages, inflammatory breast cancer is often mistaken for an infection in the breast (called mastitis) and treated as an infection with antibiotics. If the symptoms are caused by cancer, they will not improve, and a biopsy will find cancer cells. Because there is no actual lump, it might not show up on a mammogram, which can make it even harder to find it early. This type of breast cancer tends to have a higher chance of spreading and a worse outlook (prognosis) than typical invasive ductal or lobular cancer. For more details about this condition, see our document,Inflammatory Breast Cancer.

Triple-negative breast cancer: This term is used to describe breast cancers (usually invasive ductal carcinomas) whose cells lack estrogen receptors and progesterone receptors, and do not have an excess of the HER2 protein on their surfaces. (See the section, "How is breast cancer diagnosed?" for more detail on these receptors.) Breast cancers with these characteristics tend to occur more often in younger women and in African-American women. Triple-negative breast cancers tend to grow and spread more quickly than most other types of breast cancer. Because the tumor cells lack these certain receptors, neither hormone therapy nor drugs that target HER2 are effective treatments (but chemotherapy can still be useful if needed).

Paget disease of the nipple: This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple and then to the areola, the dark circle around the nipple. It is rare, accounting for only about 1% of all cases of breast cancer. The skin of the nipple and areola often appears crusted, scaly, and red, with areas of bleeding or oozing. The woman may notice burning or itching.

Paget disease is almost always associated with either ductal carcinoma in situ (DCIS) or infiltrating ductal carcinoma. Treatment often requires mastectomy. If no lump can be felt in the breast tissue, and the biopsy shows DCIS but no invasive cancer, the outlook (prognosis) is excellent. If invasive cancer is present, the prognosis is not as good, and the cancer will need to be staged and treated like any other invasive cancer.

Phyllodes tumor: This very rare breast tumor develops in the stroma (connective tissue) of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Other names for these tumors include phylloides tumor andcystosarcoma phyllodes. These tumors are usually benign but on rare occasions may be malignant.

Benign phyllodes tumors are treated by removing the tumor along with a margin of normal breast tissue. A malignant phyllodes tumor is treated by removing it along with a wider margin of normal tissue, or by mastectomy. Surgery is often all that is needed, but these cancers might not respond as well to the other treatments used for more common breast cancers. When a malignant phyllodes tumor has spread, it can be treated with the chemotherapy given for soft-tissue sarcomas (this is discussed in detail in our document, Sarcoma - Adult Soft Tissue Cancer.

Angiosarcoma: This form of cancer starts in cells that line blood vessels or lymph vessels. It rarely occurs in the breasts. When it does, it usually develops as a complication of previous radiation treatments. This is an extremely rare complication of breast radiation therapy that can develop about 5 to 10 years after radiation. Angiosarcoma can also occur in the arms of women who develop lymphedema as a result of lymph node surgery or radiation therapy to treat breast cancer. (For information on lymphedema, see the section, "How is breast cancer treated?") These cancers tend to grow and spread quickly. Treatment is generally the same as for other sarcomas. See our document,Sarcoma - Adult Soft Tissue Cancer.

Special types of invasive breast carcinoma

There are some special types of breast cancer that are sub-types of invasive carcinoma. These are often named after features seen when they are viewed under the microscope, like the ways the cells are arranged.

Some of these may have a better prognosis than standard infiltrating ductal carcinoma. These include:

• Adenoid cystic (or adenocystic) carcinoma
• Low-grade adenosquamous carcinoma (this is a type of metaplastic carcinoma)
• Medullary carcinoma
• Mucinous (or colloid) carcinoma
• Papillary carcinoma
• Tubular carcinoma

Some sub-types have the same or maybe worse prognosis than standard infiltrating ductal carcinoma. These include:

• Metaplastic carcinoma (most types, including spindle cell and squamous)
• Micropapillary carcinoma
• Mixed carcinoma (has features of both invasive ductal and lobular)

In general, all of these sub-types are still treated like standard infiltrating ductal carcinoma.

Last Medical Review: 08/23/2012
Last Revised: 02/26/2013

What is Breast Cancer?

from: http://www.breastcancer.org/symptoms/understand_bc/what_is_bc
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Breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop.

Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body.

The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.

Breast AnatomyLarger Version

Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes, small organs that filter out foreign substances in the body. If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body. The breast cancer’s stage refers to how far the cancer cells have spread beyond the original tumor (see the Stages of breast cancer tablefor more information).

Breast cancer is always caused by a genetic abnormality (a “mistake” in the genetic material). However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the “wear and tear” of life in general.

There are steps every person can take to help the body stay as healthy as possible and lower risk of breast cancer or a breast cancer recurrence (such as maintaining a healthy weight, not smoking, limiting alcohol, and exercising regularly). Learn what you can do to manage breast cancer risk factors.

Always remember, breast cancer is never anyone's fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is not productive.

Stages of breast cancer

Stage	Definition
Stage 0	Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue.
Stage IA	The tumor measures up to 2 cm  AND  the cancer has not spread outside the breast; no lymph nodes are involved
Stage IB	There is no tumor in the breast; instead, small groups of cancer cells -- larger than 0.2 millimeter but not larger than 2 millimeters – are found in the lymph nodes  OR  there is a tumor in the breast that is no larger than 2 centimeters, and there are small groups of cancer cells – larger than 0.2 millimeter but not larger than 2 millimeters – in the lymph nodes.
Stage IIA	No tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm)  OR  the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes  OR  the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes.
Stage IIB	The tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes  OR  the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.
Stage IIIA	No tumor is found in the breast. Cancer is found in axillary lymph nodes that are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone  OR  the tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone.
Stage IIIB	The tumor may be any size and has spread to the chest wall and/or skin of the breast  AND  may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone.  Inflammatory breast cancer is considered at least stage IIIB.
Stage IIIC	There may either be no sign of cancer in the breast or a tumor may be any size and may have spread to the chest wall and/or the skin of the breast  AND  the cancer has spread to lymph nodes either above or below the collarbone  AND  the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.
Stage IV	The cancer has spread — or metastasized — to other parts of the body.

For more information about staging, please visit the Stages of Breast Cancer page.

What is Breast Cancer? Definition, Types of Breast Cancer, Common Symptoms

from: http://breastcancer.about.com/od/definition/a/bc_definition.htm
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Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Cancer is a disease in which abnormal cells grow in an uncontrolled way. Breast cancer is the most common cancer in women, but it can also appear in men. In the U.S., it affects one in eight women.

The most common types of breast cancer are:

• ductal carcinoma (85 - 90% of all cases)
• lobular carcinoma (8% of all cases)

Invasive (Infiltrating) Breast Cancer
Invasive, or infiltrating, breast cancer has the potential to spread out of the original tumor site and invade other parts of your breast and body. There are several types and subtypes of invasive breast cancer.

Less common are:

• inflammatory breast cancer (occurs in the skin)
• Paget's disease of the nipple

Symptoms of Breast Cancer:

• a lump or a thickening in the breast or in the armpit
• a change of size or shape of the mature breast
• nipple fluid (not milk) leaking
• a change of size or shape of the nipple
• a change of color or texture of the nipple or theareola, or of the skin of the breast itself (dimples, puckers, rash)
• More details about symptoms of breast cancer.

If You Have Breast Pain

Early stages of breast cancer may not cause any pain or discomfort. Having a regularmammogram and a clinical breast exam by your health professional can help you understand changes in your breasts. Doing your breast self-exam can help you keep track of regular monthly changes.

Remember, many lumps and rashes are benign (not cancerous) and can respond well to proper treatment. If you experience any symptoms that cause you concern, see your doctor.

Treatments for breast cancer, as well as survival rates, are improving. Early detection and medical help is critical to improving the chances of living beyond a diagnosis of breast cancer.

Read about breast cancer symptoms and their explanations.

Cost-Benefit and Cost-Effectiveness Analysis

http://ocw.jhsph.edu/courses/hsre/PDFs/HSRE_lect13_frick.pdf

Cost-Benefit and Cost-Effectiveness Analysis
Kevin Frick, PhD
Johns Hopkins University

Using Cost-Effectiveness Analysis for Setting Health Priorities

http://www.dcp2.org/file/150/

Governments around the world face budget constraints that
compel them to make tough decisions about how best to invest
funds for public health. They need a way to evaluate which
investments will address the most pressing health problems and
bring the greatest health gains. Cost-effectiveness analysis is an
essential evaluation tool that allows policymakers and health
planners to compare the health gains that various interventions
can achieve with a given level of inputs. Getting the most value
for money has been a central thrust in the analysis presented in
Disease Control Priorities in Developing Countries, 2nd edition
(DCP2). The basic concepts underlying the analysis, as well as
needed improvements, are described here.

What Is Cost-Effectiveness Analysis?

Cost-effectiveness analysis is the primary tool for comparing
the cost of a health intervention with the expected health gains.
An intervention can be understood to be any activity, using
human, financial, and other inputs, that aims to improve health.
The health gain might be reducing the risk of a health problem,
reducing the severity or duration of an illness or disability, or
preventing death.

If the health outcome is the same, say preventing death from
measles either by immunizing a child or by treating the
disease, then analysts need only compare the costs of different
interventions that can achieve that outcome. The result is a costeffectiveness ratio, expressed as cost per outcome, which can
be compared across various types of services or various service
locations that perform the same function. The ratio is always
discussed in relative terms, as there is no “best” or absolute level
of cost-effectiveness.

The cost-effectiveness of an intervention can vary greatly
depending on a program’s size and scope. Typically, as program
coverage expands and more people are served, the cost per
outcome drops. For example, if more children can be immunized
with the same fixed costs like nurses and clinics, then each
additional immunization will be cheaper until the service
approaches full capacity.

On the other hand, costs can rise as coverage expands if
it becomes harder to reach additional patients. Therefore,
depending on the comparison undertaken, an analyst might
look at the average cost-effectiveness ratio or the incremental
cost-effectiveness ratio. The average cost-effectiveness ratio
looks at total costs and total results, starting from zero, while
the incremental ratio compares additional costs and additional
results, starting from the current level of coverage or services.
Using child immunizations as an example, the incremental
cost of adding mobile vaccination teams might be lower than
expanding fixed clinic services, particularly if the unvaccinated
children are dispersed and hard to reach.

In Figure 1, several alternatives might be available for expanding
the coverage of a current intervention (the status quo shown
at point “X”). If an alternative is more effective and less costly,
decisionmakers should usually opt in favor of adopting it, while
they should abandon options that are more costly and less
effective. The trade-offs are less clear in the unmarked quadrants,
requiring decisionmakers to weigh whether the benefits that
might be gained merit a change in strategy.

Guide to Analyzing the Cost-Effectiveness of Community Public Health Prevention Approaches

http://aspe.hhs.gov/health/reports/06/cphpa/report.pdf

INTRODUCTION
This guide provides practical advice to help program managers and evaluators understand,
design, and perform cost-effectiveness (CE) evaluations of community public health
prevention programs. Each chapter of the guide provides advice for addressing specific
components of a CE analysis. For example, Chapter 2 describes the planning process for CE
analysis and decisions about study design that must be made up front—prior to collecting or
analyzing cost or effectiveness data. Chapter 3 discusses issues that need to be considered
when selecting from among possible outcome measures for the prevention program.
Chapter 4 contains advice and tools for measuring program costs. Chapter 5 contains
instructions for performing a CE analysis and provides examples, and Chapter 6 answers the
question of how results from CE studies can be used by decision makers.
Throughout the guide, we have attempted to provide easy-to-follow instructions, advice,
and relevant examples to lead community program managers and evaluators through the
design and implementation of CE analysis. In the interest of brevity, the guide focuses on
common concerns about how best to design and perform CE analysis in a community
prevention setting that focuses on health promotion. For a more complete treatment of
issues surrounding CE analysis and related economic studies (e.g., cost-benefit, business
case analysis) in both clinical and community settings, we encourage readers to consult one
of the many texts available on economic evaluation as applied to public health or health
care. A list of such texts is provided in Appendix A. These texts are geared primarily toward
researchers and provide additional methodological details for conducting economic
evaluations of clinical or community prevention efforts. Examples of CE studies from the
literature are summarized in Appendix B.

Community Based Breast Cancer Screening in Klang: A Pilot Study – Collaboration with MOH

●Breast cancer is the most common cancer in  women in Malaysia

●The age-standardized incidence rate (ASR) is  46.2 per 100, 000 women in Malaysia (NCR 2003)

●About 64.1% breast cancer occurred in women  aged 40-59 years

●The Ministry of Health has been promoting Breast Self  Examination (BSE) and annual clinical breast examination (CBE) as part of breast cancer awareness  campaign since 1995.

●Mammography is available in the major hospitals in the  Ministry of Health and are mainly for diagnostic purposes or  limited for screening of high risk women with past history of  breast disease or positive family history.

Cancer screening in Singapore, with particular reference to breast, cervical and colorectal cancer screening

source: http://msc.sagepub.com/content/13/suppl_1/14.full.pdf
cache: https://docs.google.com/file/d/0B86b-ALn-1MGNHJTTzdwNFZRR3M/edit?usp=sharing

Cancer is the leading cause of mortality in Singapore, accounting for 27.1% of deaths in 2004. The
most common cancers are those of the lung, colon and rectum, liver, stomach, and prostate in men;
and breast, colon and rectum, lung, ovary and cervix in women. Singapore has the highest ageadjusted breast cancer incidence in Asia. National population screening programmes have been
implemented for breast and cervical cancer. BreastScreen Singapore (BSS), the first population-based
nationwide mammographic breast-screening programme in Asia, was launched in 2002, incorporating international standards and practice guidelines. For improved quality assurance, two-view
screening mammography is carried out. From January 2002 until March 2004, BSS conducted over
84,000 screens, with an overall recall rate of 9.5%, and an overall invasive cancer detection rate of
4.48 per 1000 screened. Close to 30% of the cancers diagnosed was ductal carcinoma in situ.
Papanicolaou (Pap) smear screening for cervical cancer has been available opportunistically since
1964. The national CervicalScreen Singapore programme was launched in 2004, aiming to achieve
coverage of 80% of targeted women by 2010. Colorectal cancer currently has the highest incidence
of all cancers in Singapore. The health authorities advocate colorectal cancer screening for the
average risk population, starting from age 50 years, but in the absence of a national screening
programme, the reliance is on opportunistic screening.

Cancer Incidence in Peninsular Malaysia, 2003-2005 The Third Report of the National Cancer Registry, Malaysia

source: http://www.radiologymalaysia.org/Archive/NCR/NCR2003-2005Bk.pdf
cache: https://docs.google.com/file/d/0B86b-ALn-1MGSHU1R0hoc1NvX1E/edit?usp=sharing

The.Malaysian.National.Cancer.Registry.(NCR).is.a.service.supported.by.Ministry.of.Health,.Malaysia.
(MOH).to.collect.information.about.cancer.incidence.in.Malaysia..This.information.is.vital.in.planning.
and.evaluation.of.cancer.services.by.the.governemental.agencies,.Non.Governemental.Organizations.
(NGO),.private.providers.and.the.industry..
.
In.November.2001,.the.Honorable.Minister.of.Health.Malaysia.directed.the.Clinical.Research.Centre.
(CRC).to.establish.a.National.Cancer.Registry.(NCR)..Following.this.directive,.the.NCR’s.Sponsor.
Group.was.formed..The.membership.comprised.of.Oncologist,.Pathologist,.Haematologist,.Paediatric.
Oncologist,.Head.of.the.Cancer.Research.Centre.in.the.Institute.of.Medical.Research,.Director.of.the.
Disease.Control.Division.and.the.Director.of.the.Medical.Development.Division...In.April.2002,.the.
NCR.obtained.approval.from.the.Director.General.of.Health.to.setup.its.operations.and.was.
subsequently.awarded.a.Medical.Research.Grant.grant.in.June.2002.by.the.Deputy.Director.General.
of.Health.(Research.&.Tech.Support)...
.
Administratively,.the.NCR.began.as.one.of.the.seven.clinical.registries.under.the.umbrella.of.the.
Clinical.Research.Centre,.Ministry.of.Health..In.2005,.as.the.registry.‘matured’.the.administration.of.
the.registry.was.handed.over.to.the.Department.of.Radiotherapy.and.Oncology,.Hospital.Kuala.
Lumpur..In.response.to.the.call.by.the.Director.General.of.Health.for.a.single.Cancer.Registry.in.
Malaysia,.the.Division.of.Public.Health.(DPH).has.taken.over.the.management.of.the.NCR.from.2007.
onwards..This.is.timely.as.the.DPH.is.in.the.midst.of.expanding.its.cancer.registration.system.at.a.
national.level..It.is.hoped.that.with.a.single.management.system,.the.regional.registries.alongwith.the.
national.registry.would.be.able.to.produce.national.data.more.effectively.and.efficiently..This.will.
provide.the.much.needed.impetus.for.further.development.of.cancer.programmes.and.initiatives...
.
.
The.objectives.of.National.Cancer.Registry.are.to:.
1..Determine.the.disease.burden.attributable.to.cancer.by.quantifying.the.magnitude.of.cancer.
.morbidity.and.mortality,.and.its.geographic.and.temporal.trends.in.Malaysia..
2..Identify.subgroups.in.the.population.at.high.risk.of.cancer.to.whom.cancer.prevention.effort.
.should.be.targeted..
3..Stimulate.and.facilitate.epidemiological.research.on.cancer.with.respect.to.cancer.etiology,.
.diagnosis.and.prognosis..
4..Evaluate.cancer.treatment,.control.and.prevention.programme..
.
The.NCR.received.data.voluntarily.on.cancer.incidence.mainly.from.individual.doctors.who.provided.
cancer.diagnostic.services.or.who.cared.for.cancer.patients..Information.on.cancer.incidence.was.
also.extracted.using.the.the.Ministry.of.Health’s.Hospital.Information.System..
.
NATIONAL CANCER REGISTRY
.
The.day.to.day.operations.of.the.NCR.can.be.categorized.as.two.essential.components:.
a.......................These.are.the.day.to.day.administration,.site.and.data.management.
.operations.of.a.Registry..It.entails.general.administration.of.the.registry,.initiating.and.maintaining.
.site.participation.in.the.registry,.data.acquisition,.data.storage,.data.processing.(data.transmittal,.
.review,.coding,.cleaning,.query,.reconciling,.transferring.and.archiving),.data.quality.assurance,.
.and.periodic.site.monitoring.and.retraining..
...
b..................................An.electronic.database.server.was.used.to.store.the.data.and.
.a.database.application.was.used.to.automate.most.of.the.work.processes.involved.in.data.
.management..The.database.management.system.required.routine.administration,.maintenance.
.and.continuing.development.and.enhancement.to.meet.the.dynamic.needs.of.this.registry..
..
........................
.
Oncology,.Haematology.and.Pathology.services,.MOH.
Division.of.Disease.Control,.Public.Health.Department,.MOH.
Medical.Development.Division,.MOH.
Cancer.Research.Centre,.Institute.for.Medical.Research,.MOH.
Clinical.Research.Centre,.Hospital.Kuala.Lumpur,.MOH.
....................................
NATIONAL CANCER REGISTRY
.
Malaysia.is.located.in.the.South.East.Asian.region.and.covers.an.area.of.329,.961.km2..It.shares.its.
borders.with.Singapore,.Thailand,.Indonesia.and.Brunei..The.South.China.Sea.separates.West.and.
East.Malaysia;.West.Malaysia.being.a.peninsular.region.of.the.Asian.Continent.whereas.East.
Malaysia.is.located.on.the.Island.of.Borneo..There.are.a.total.of.13.states.and.three.Federal.
Territories.as.follows:.
.
..Peninsular.Malaysia.
..Northern.Region:.Perlis,.Kedah,.Penang,.Perak..
..East.Coast.Region:.Kelantan,.Terengganu,.Pahang..
..Central.Region:.Selangor,.Federal.Territory.of.Kuala.Lumpur.and.Federal.Territory.of.
Putrajaya..
..Southern.Region:.Negeri.Sembilan,.Malacca,.Johor..
.
..East.Malaysia.
..Sarawak.
..Sabah.
..Federal.Territory.of.Labuan.
.
Malaysia.enjoys.an.equatorial.climate..It.is.hot.and.humid.throughout.the.year.with.an.average.
temperature.of.27oC.and.an.annual.rainfall.that.exceeds.2000.mm..The.rainy.seasons.are.influenced.
by.the.monsoon.trade.winds..
.

Breast Cancer in Sabah, Malaysia: A Two Year Prospective Study

source: http://apocp.org/cancer_download/Volume8_No4/c%20525-529%20Leong%205.pdf
cache: https://docs.google.com/file/d/0B86b-ALn-1MGa2dod0F5MFBPR28/edit?usp=sharing

Abstract
Introduction: Malaysian women have a 1 in 20 chance of developing breast cancer in their lifetime. Sabah, formerly known as North Borneo, is part of East Malaysia with a population of 3.39 million and more than 30 ethnic groups. We conducted a 2 year prospective epidemiological study to provide unreported data of breast cancer from this part of the world and to recognise which particular group of patients are more likely to present with advanced disease. Methods: All newly diagnosed breast cancers seen at the Queen Elizabeth Hospital, Kota Kinabalu, from January 2005 to December 2006 were included in the study. Patient and tumour characteristics, including age, race, education, socioeconomic background, parity, practice of breast feeding, hormonal medication intake, menopausal status, family history, mode of presentation, histology, grade, stage of disease and hormonal receptors status were collected and analysed. Results: A total of 186 patients were seen.


The commonest age group was 40 to 49 years old (32.3%). Chinese was the commonest race (30.6%) followed by Kadazan-Dusun (24.2%). The commonest histology was invasive ductal carcinoma (88.4%). Stages at presentation were Stage 0- 4.8%, Stage I- 12.9%, Stage II- 30.1%, Stage III- 36.6% and Stage IV- 15.6%. The estrogen and progesterone receptor status was positive in 59.1% and 54.8% of cases, respectively. 73.7% of Chinese patients presented with early cancer compared to 36.4% of the other races. Patients who presented with advanced disease were also poor, non-educated and from rural areas. 20.4% of patients defaulted treatment; most of them opted for traditional alternatives. Conclusions: Sabahan women with breast cancer present late. Great efforts are needed to improve public awareness of breast cancer, especially among those who have higher risk of presenting with advanced disease.

Key Words: Breast cancer, late presentation, advanced stage, poor, rural, ethnic groups

Breast Cancer in Malaysia : Are Our Women Getting The Right Message? 10 Year-Experience in A Single Institution In Malaysia

source: http://www.apocp.org/cancer_download/Volume8_No1/Aishah%20141-145.pdf

cache: https://docs.google.com/file/d/0B86b-ALn-1MGcmZLMjk3blkta00/edit?usp=sharing

Abstract

The message that health care providers caring for patients with breast cancer would like to put forth, is that, not only early detection is crucial but early treatment too is important in ensuring survival. This paper examines the pattern of presentation at a single institution over a 10-year period from 1995 to 2005. In Malaysia, education outreach programmes are ongoing, with contributions not only from the public sector, but also private enterprise.

Articles on breast cancer in local newspapers and women magazines and television are quite commonplace. However are our women getting the right message? Now is an appropriate time to bring the stakeholders together to formulate a way to reach all women in Malaysia, not excluding the fact that we are from different races, different education levels and backgrounds requiring differing ways of delivering health promotion messages.

To answer the question of why women present late, we prospectively studied 25 women who presented with locally advanced disease. A quantitative, quasi-qualitative study was embarked upon, as a prelude to a more detailed study. Reasons for presenting late were recorded. We also looked at the pattern of presentation of

breast lumps in women to our breast clinic in UMMC and in the surgical clinic in Hospital Kota Bharu, in the smaller capital of the state of Kelantan, in 2003. There is hope for the future, the government being a socially responsible one is currently making efforts towards mammographic screening in Malaysia. However understanding of the disease, acceptance of medical treatment and providing resources is imperative to ensure that health behaviour exhibited by our women is not self-destructive but self-preserving. Women are an integral part of not only the nation’s workforce but the lifeline of the family - hopefully in the next decade we will see great improvement in the survival of Malaysian women with breast cancer.

Key Words: Breast cancer survival, early detection, late presentation, health messages

Breast Cancer in Limited-Resource Countries: Early Detection and Access to Care

source: http://screening.iarc.fr/doc/Breast%20Cancer%20in%20LimitedResource%20Countries%20Early.pdf
cache: https://docs.google.com/file/d/0B86b-ALn-1MGSC1MVUFOWVJfRWc/edit?usp=sharing


Abstract:
Although incidence, mortality, and survival rates vary fourfold in the world’s regions, in the world as a whole, the incidence of breast cancer is increasing, and in regions without early detection programs, mortality is also increasing. The growing burden of breast cancer in low-resource countries demands adaptive strategies that can improve on the too common pattern of disease presentation at a stage when prognosis is very poor. In January 2005, the Breast Health Global Initiative (BHGI) held its second summit in Bethesda, MD. The Early Detection and Access to Care Panel reaffirmed the core principle that a requirement at all resource levels is that women should be supported in seeking care and should have access to appropriate, affordable diagnostic tests and treatment. In terms of earlier diagnosis, the panel recommended that breast health awareness should be promoted to all women. Enhancements to basic facilities might include the following, in order of resources: effective training of relevant staff in clinical breast examination (CBE) both for symptomatic and asymptomatic women; opportunistic screening with CBE; demonstration projects or trials of organized screening using CBE or breast self-examination; and finally, feasibility studies of mammographic screening. Ideally, for complete evaluation, such projects require notification of deaths among breast cancer cases and staging of diagnosed tumors.



Key Words:
breast awareness, breast cancer, clinical breast examination, developing countries, diagnosis, imaging, mammography, screening

Breast Cancer in Limited-Resource Countries: An Overview of the Breast Health Global Initiative 2005 Guidelines

source: http://screening.iarc.fr/doc/Breast%20Cancer%20in%20Limited-Resource%20Countries%20-%20An%20Overview.pdf
cache: https://docs.google.com/file/d/0B86b-ALn-1MGY2NQaGdEWHBsb3M/edit?usp=sharing


Abstract:

Breast cancer is the most common cause of cancer-related death among women worldwide, with case fatality rates highest in low-resource countries. Despite significant scientific advances in its management, most of the world faces resource constraints that limit the capacity to improve early detection, diagnosis, and treatment of the disease. The Breast Health Global Initiative (BHGI) strives to develop evidence-based, economically feasible, and culturally appropriate guidelines that can be used in nations with limited health care resources to improve breast cancer outcomes. Using an evidence-based consensus panel process, four BHGI expert panels addressed the areas of early detection and access to care, diagnosis and pathology, treatment and resource allocation, and health care systems and public policy as they relate to breast health care in limited-resource settings. To update and expand on the BHGI Guidelines published in 2003, the 2005 BHGI panels outlined a stepwise, systematic approach to health care improvement using a tiered system of resource allotment into four levels—basic, limited, enhanced, and maximal— based on the contribution of each resource toward improving clinical outcomes. Early breast cancer detection improves outcome in a cost-effective fashion assuming treatment is available, but requires public education to foster active patient participation in diagnosis and treatment. Clinical breast examination combined with diagnostic breast imaging (ultrasound ± diagnostic mammography) can facilitate cost-effective tissue sampling techniques for cytologic or histologic diagnosis. Breast-conserving treatment with partial mastectomy and radiation therapy requires more health care resources and infrastructure than mastectomy, but
can be provided in a thoughtfully designed limited-resource setting. The availability and administration of systemic therapies are critical to improving breast cancer survival. Estrogen receptor testing allows patient selection for hormonal treatments (tamoxifen, oophorectomy). Chemotherapy, which requires some allocation of resources and infrastructure, is needed to treat node-positive, locally advanced breast cancers, which represent the most common clinical presentation of disease in low-resource countries.
When chemotherapy is not available, patients with locally advanced, hormone receptor-negative cancers can only receive palliative therapy. Future research is needed to better determine how these guidelines can best be implemented in limited-resource settings.


Key Words: breast cancer, diagnosis, early detection, guideline, health care systems, health planning, international health problems, low-resource countries, pathology, public policy, recommendations, resource allocation, screening, treatment

Breast Cancer Prevention and Control Programs in Malaysia

source: http://eprints.um.edu.my/3063/1/Breast_cancer_prevention_and_control_programs_in_malaysia.pdf
cache: https://docs.google.com/file/d/0B86b-ALn-1MGOVhHd1pXRnBua1k/edit?usp=sharing

Abstract
Breast cancer is the most common cancer in Malaysian females. The National Cancer Registry in 2003 and
2006 reported that the age standardized incidence of breast cancer was 46.2 and 39.3 per 100,000 populations, respectively. With the cumulative risk at 5.0; a woman in Malaysia had a 1 in 20 chance of developing breast cancer in her lifetime. The incidence of cancer in general, and for breast cancer specifically was highest in the Chinese, followed by Indians and Malays. Most of the patients with breast cancers presented at late stages (stage I: 15.45%, stage II: 46.9%, stage III: 22.2% and stage IV: 15.5%). The Healthy Lifestyles Campaign which started in the early nineties had created awareness on breast cancer and after a decade the effort was enhanced with the Breast Health Awareness program to promote breast self examination (BSE) to all women, to perform annual clinical breast examination (CBE) on women above 40 and mammogram on women above 50. The National Health Morbidity Survey in 2006 showed that the prevalence rate of 70.35% by any of three methods of breast screening; 57.1% by BSE, 51.8% by CBE and 7.6% by mammogram. The current screening policy for breast cancer focuses on CBE whereby all women at the age of 20 years and above must undergo breast examination by trained health care providers every 3 years for age between 20-39 years, and annually for age 40 and above. Several breast cancer preventive programs had been developed by various ministries in Malaysia; among which are the RM50 subsidy for mammogram by the Ministry of Women, Family and Community Development and the SIPPS program (a call-recall system for women to do PAP smear and CBE) by the Ministry of Health. Measures to increase uptake of breast cancer screening and factors as to why women with breast cancer present late should be studied to assist in more development of policy on the prevention of breast cancer in Malaysia.

Keywords: Breast cancer - screening - prevention - Malaysia

Breast cancer screening programmes in 22 countries: current policies, administration and guidelines

source: http://ije.oxfordjournals.org/content/27/5/735.full.pdf
cache: https://docs.google.com/file/d/0B86b-ALn-1MGdlBybU0tUWVnOWM/edit?usp=sharing

Background

Currently there are at least 22 countries worldwide where national, regional or
pilot population-based breast cancer screening programmes have been established. A collaborative effort has been undertaken by the International Breast
Cancer Screening Network (IBSN), an international voluntary collaborative
effort administered from the National Cancer Institute in the US for the purposes
of producing international data on the policies, funding and administration, and
results of population-based breast cancer screening.


Methods

Two surveys conducted by the IBSN in 1990 and 1995 describe the status of
population-based breast cancer screening in countries which had or planned to
establish breast cancer screening programmes in their countries. The 1990 survey
was sent to ten countries in the IBSN and was completed by nine countries. The
1995 survey was sent to and completed by the 13 countries in the organization
at that time and an additional nine countries in the European Network.


Results

The programmes vary in how they have been organized and have changed from
1990 to 1995. The most notable change is the increase in the number of countries
that have established or plan to establish organized breast cancer screening
programmes. A second major change is in guidelines for the lower age limit for
mammography screening and the use of the clinical breast examination and
breast self-examination as additional detection methods.


Conclusion

As high quality population-based breast cancer screening programmes are implemented in more countries, they will offer an unprecedented opportunity to assess
the level of coverage of the population for initial and repeat screening, evaluation
of performance, and, in the longer term, outcome of screening in terms of
reduction in the incidence of late-stage disease and in mortality.


Keywords

Breast cancer, screening, population-based, database, guidelines, policies

Accepted 4 January 1998

SECOND REPORT OF THE NATIONAL CANCER REGISTRY CANCER INCIDENCE IN MALAYSIA 2003

Source: http://www.crc.gov.my/documents/report/2nd%20National%20Cancer%20Registry.pdf
Cache : https://docs.google.com/file/d/0B86b-ALn-1MGM3Y2R1l1QzR5VTg/edit?usp=sharing

ABOUT THE NATIONAL CANCER REGISTRY 
The National Cancer Registry (NCR) is a service supported by the Ministry of Health
(MOH) to collect information about cancers in Malaysia. The information allows us to
estimate the incidence of cancer, and to evaluate its risk factors, treatment and outcomes.
Such information is useful for assisting the MOH, Non-Governmental Organizations,
private providers and industry in program planning and evaluation, leading to cancer
prevention and control.

The NCR receives data on cancer from 3 main sources:
1. The Ministry of Health hospital information system
2. The National Registration Department (Jabatan Pendaftaran Negara)
3. And most important of all, the individual doctors who provide cancer diagnostic
services or who care for cancer patients, and voluntarily report data to the NCR.

The objectives of NCR are to:
1. Determine the disease burden attributable to cancer by quantifying the magnitude of
cancer morbidity and mortality, and its geographic and temporal trends in Malaysia.
2. Identify subgroups in the population at high risk of cancer to whom cancer prevention
effort should be targeted.
3. Identify potential risk factors involved in cancer.
4. Evaluate cancer treatment, control and prevention programme.
5. Stimulate and facilitate epidemiological research on cancer, e.g. generating hypotheses
on cancer aetiology.

REPORT SUMMARY

1. OVERALL CANCER INCIDENCE
A total of 21,464 cancer cases were diagnosed among Malaysians in Peninsular Malaysia
in the year 2003, comprising 9,400 males and 12,064 females. The corresponding figures
for Sabah and Sarawak are shown in Table 1.1.1. As the ASR were considerably lower
than that of Peninsular Malaysia, there is serious doubt about the completeness of cancer
registration from these two East Malaysian States. Hence, they were omitted from
further analysis in this report. On the other hand, case ascertainment for Peninsular
Malaysia was likely to be as good as for year 2002 if not better in terms of lower
inclusion of prevalent cases. Certainly, as can be seen from the ethnic specific ASR, case
ascertainment for the NCR is comparable with that of the Penang Cancer Registry.
The National Cancer Registry received 42,985 cancer notifications of Malaysian
residents in 2003 of which 23,746 were unique incident cancer cases. Thus there were 1.8
notifications per case. Of the 23746 cases, 22622 cases had histological verification thus
95.3 % of the cases had histological verification. There were 511 cases coded as Primary
Site Uncertain representing 2.2% of the total cases. There were no missing data for race
and age variable whereas there was only 1 case with missing sex.
The 2003 cancer incidence results presented in the rest of this report refer only to
Peninsular Malaysia.


2. CANCER BURDEN
The crude rate for males was 97.4 per 100,000 population and 127.6 per 100,000
population for females. The age standardized incidence rate for all cancers in the year
2003 was 134.3 per 100,000 males and 154.2 per 100,000 females.
Generally the cancer incidence rates were lower than in 2002 suggesting we have been
more successful in eliminating prevalent cases (rather than the alternative possibility of
deteriorating ascertainment, as explained above). This was to be expected of a maturing
registry. There appears to be a continuing problem with differential under-ascertainment
in the 2003 data especially affecting lung cancers.
On the other hand, the fact that unusual findings that were noted in the first report are
convincingly repeated in the second report deserve special attention and study, such as
the ranking of leukaemia among the top 5 cancers in males and top 10 cancers in females.
While the cancer rates for 2003 were generally lower, they are not that far off from 2002
results (which had included more prevalent cases), relative ranking of cancer incidence
was largely consistent, and most statements still held true. For example, incidence of
nasopharyngeal cancer among Chinese was still very high, and comparable to Singapore 35
To overcome the problem of under-ascertainment in some of the tumour sites mentioned
above, the reporting of cases to the National Cancer Registry had been extended to
include the chest physicians, gastroenterologist, hepatobiliary surgeons, neurosurgeons
and radiologists in addition to the pathologists, oncologists and palliative care personnel.
However, this would only show an effect on cancer trends from the middle of 2003
onwards.


3. VARIATION IN CANCER INCIDENCE BY AGE, SEX AND ETHNICITY
Cancer occurred at all ages. The median age at diagnosis for cancer in Malaysian males
was 59 years and 53 years for Malaysian females. The 5 most frequent cancers in
children (0-14 years old) were leukaemia, cancers of the brain, lymphoma, cancers of the
connective tissue and kidney. In the group of young adults (15-49 years old), the common
cancers were nasopharynx, leukaemia, lymphoma, lung, colon and rectum in men, and
cancers of the breast, cervix, ovary, uterus, thyroid gland and leukaemia in women. In
older subjects (50 years old and above), cancers of the lung, colon, rectum, nasopharynx,
prostate and stomach were predominant among men, while cancers of the breast, cervix,
colon, uterus, lung and rectum occurred commonly in women.
The crude incidence rate of age groups by sex, showed an increasing trend of incidence
with age. The crude incidence rate for males aged 0-19 years was 18.0 per 100,000
population; aged 20-39 years was 33.0 per 100,000; aged 40-59 years was 168.6 per
100,000 population and aged 60+ years was 731.8 per 100,000 population.
The crude incidence rate for females aged 0-19 years was 14.0 per 100,000 population;
aged 20-39 years was 54.8 per 100,000; aged 40-59 years was 318.2 per 100,000
population and aged 60+ years was 591.1 per 100,000 population.
The overall male crude incidence rate of 97.4 per 100,000 population was lower than the
female crude incidence rate of 127.6 per 100,000 population. The male to female ratio of
cancer incidence is 1:1.3. The most common cancer in males in the year 2003 was cancer
of the lung (13.8% of all male cancers). Whereas among females, the most frequent
cancer was cancer of the breast (31.0% of all female cancers).
There is variation of cancer incidence rate between the different ethnic groups. The crude
incidence rate for cancers in Malay male and females were 60.6 and 79 per 100,000
population respectively; for Chinese male and females 169.2 and 217.7 per 100,000
population respectively; and for the Indian male and females 85.7 and 147.2 per 100,000
population respectively. 36


4. INDIVIDUAL CANCERS
4.1 FEMALE BREAST CANCER
In 2003, there were 3738 female breast cancer cases that were reported, making it the
most commonly diagnosed cancer in women. It accounted for 31.0 % of newly diagnosed
female cases. Breast cancer was the commonest cancer in all ethnic groups and all age
groups in females from the age of 15 years. The overall ASR was 46.2 per 100,000
population.
The age pattern in 2003 showed a peak age specific incidence rate at the 50-59 age group
in Malays, Chinese, and Indians, and the rates then declined in the older age groups. Of
the cases diagnosed in 2003, 64.1 % were in women between 40 and 60 years of age.
Chinese had the highest incidence with an ASR of 59.7 per 100,000 population followed
by Indian women with an ASR of 55.8 per 100,000 population and Malay women with an
ASR of 33.9 per 100,000 population. Compared to 2002 data, the ASR is lower for all
races, but the age-specific incidence patterns are very similar.


4.2 LUNG CANCER
A total of 1758 incident cases of lung cancer were reported, comprising 13.8% of male
cancers and 3.8% of female cancers. The male: female ratio in terms of incidence for
Peninsular Malaysia was 2.8 : 1. Rates of lung cancer rose progressively with age for
both males and females. There was a steeper rise in incidence after the age of 40 years for
both sexes, with a progressive divergence of the curves for the two sexes.
The incidence of lung cancer among the Chinese was higher than the other ethnic groups.
The age-standardized incidence rate (ASR), for Chinese was more than twice that of
Malays and Indians for both sexes.
Even though lung cancer was in second place when colon and rectum were added
together, caution has to be exercised in its interpretation. This is because of : a) the
ascertainment rate calculated at 68% for 2002 data, and b) comparing the age incidence
rate with reports from Singapore and Penang.
We remind the reader that for this cancer, the registration was almost certainly
incomplete. The specific recruitment of radiologists and chest physicians to report
cancers to the NCR from the middle of 2003 onwards, it is hoped that more complete
results will be available in the future. 37


4.3 COLON AND RECTUM CANCER
Cancers of the colon and rectum were recorded separately in this report. On their own
each of them ranked among the top ten most common cancers in Malaysia. When taken
together, colorectal cancers would account for 14.2% of male cancers making it the
commonest cancer among men and the third most common cancer among women (10.1%
of female cancers).
The male to female ratio for colon cancer was nearly equal (0.98:1), with the frequency
in males rising more rapidly after the age of 60 years. In rectal cancer, the preponderance
of males was more noticeable (1.26:1), with a steeper rise in age specific incidence of
males occurring at age of 50 years onwards.
The age specific incidence for both colon and rectal cancers increased exponentially with
age. Chinese had a higher incidence of colon cancers than the other races. Comparing the
crude rates between Chinese and Malays, Chinese had more than 5.1 times the incidence
of male colon cancer, and 4.6 times the incidence of female colon cancer. With regard to
rectal cancers, Chinese had the highest incidence rate of rectal cancers which was 2.8
times the Malay male incidence and 3.4 times the Malay females.


4.4 CERVICAL CANCER
Cancer of the cervix was the second most common cancer among women. It constituted
12.9% of total female cancers. There were a total of 1,557 cases of cancer cervix, with an
ASR of 19.7 per 100,000 population.
Cervical cancer incidence rate increased with age after 30 years. It has a peak incidence
rate at ages 60 -69 years, and declined thereafter. These features were very similar to
data in 2002.
Chinese women had the highest ASR of 28.8 per 100,000 population, followed by
Indians with ASR of 22.4 per 100,000 population and Malays with ASR of 10.5 per
100,000 population.


4.5 LEUKAEMIA
A total of 539 cases of myeloid leukaemia and 433 cases of lymphatic leukaemia were
reported comprising 4.5% of the total number of cancers. Males predominated at a ratio
of 1.7:1 for lymphatic leukaemia and 1.1:1 for myeloid leukaemia. Leukaemia was the
fourth commonest cancer in males and seventh in females.
Age specific incidence curves of lymphatic leukaemia demonstrated a bimodal pattern.
Leukaemia was the commonest cancer in children less than 15 years old. It was the
second highest cancer among the 15-49 year old males, and the sixth commonest among
the 15-49 year old females. Leukaemia was no longer among the top 10 list after age 50
years for both sexes. 38


4.6 NASOPHARYNGEAL CANCER
Nasopharyngeal cancer was the second most common cancer among men. It constituted
8.8% of total male cancers. There were a total of 1,125 cases of nasopharyngeal cancer,
with an age standardized incidence of 10.2 and 3.6 per 100,000 population for males and
females respectively. The male to female ratio is 2.75:1.
The age specific incidence increased after 30 years with a peak incidence rate at ages 60 -
69 years, and declined thereafter. These features are very similar to data in 2002.
Chinese men had the highest age standardized incidence rate (18.1 per 100,000
population) followed by Chinese women (7.4 per 100,000 population), Malay males (4.8
per 100,000 population) and Indian males (2.6 per 100,000 population).


4.7 PROSTATE CANCER
There was a total of 602 cases reported (6.4% ) making it the 6th most common cancer
among males overall. The age specific incidence rate rises sharply after the age of 60.
The overall age standardised incidence was 10.3per 100,000 population.