http://ocw.jhsph.edu/courses/hsre/PDFs/HSRE_lect13_frick.pdf
Cost-Benefit and Cost-Effectiveness Analysis
Kevin Frick, PhD
Johns Hopkins University
Friday, August 23, 2013
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.
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.
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.
Saturday, August 3, 2013
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.
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..
.
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
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
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
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
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
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
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.
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.
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