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
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