Lung Cancer in Asia

Incidence & Mortality

           Lung cancer is the leading cause of cancer death for both men and women worldwide. In 2012, there were more than 1.8 million lung cancer diagnoses causing 1.6 million deaths worldwide (Goldstraw et al., 2011). With the current high and ever-increasing rate of smoking in many Asian and developing countries, the incidence of lung cancer and consequent deaths from this disease is anticipated to increase over the next decades. In Asia, it is noteworthy that a significant proportion of people who develop lung cancer are lifelong non-smokers (Thun et al., 2008; Toh et al., 2006). The mortality rate of lung cancer is high compared with other cancers because only about 15% of lung cancer cases are diagnosed at an early stage allowing curative treatment (Liam, Pang, Leow, Poosparajah, & Menon, 2006; Wang et al., 2013).

           In the United States, 5-year survival figures range from 52% to 24% to 4% for local, loco-regional and distant disease, respectively (Howlader et al., 2015). However, meta-analytic studies suggest that the survival of Asian lung cancer patients is better than that of their Caucasian counterparts (Soo et al., 2011). The reasons behind a more favourable prognosis of Asian lung cancer patients might be explained by the relatively high prevalence of epidermal growth factor receptor (EGFR) mutations predicting altered biology and more favourable response to EGFR tyrosine kinase inhibitors (Liam, Wahid, Rajadurai, Cheah, & Ng, 2013; Zhou & Christiani, 2011).

Lung Cancer Screening & Treatment 

           Over the last decades, lung cancer has been the leading cause of cancer-related mortality in the world, with almost 1 in 5 deaths attributable to it (Cancer, 2014).  Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers, with this encompassing the pathologically distinct adenocarcinoma, squamous cell carcinoma and large cell carcinoma sub-types. NSCLC is associated with good prognosis if diagnosed at an early stage, when surgery is most effective (Ettinger et al., 2010); however, for advanced disease, 5 year survival rates remain low, despite developments in chemotherapy (Klastersky & Paesmans, 2001) This highlights the need for alternative treatment approaches for patients with unresectable or metastatic tumours.

           Targeted therapies are systemic treatments that work by specifically blocking certain aspects of signaling pathways associated with tumour growth and suppression. The first of these to be put into clinical practice were small molecule inhibitors of the epidermal growth factor receptor (EGFR). This is expressed in a high proportion of tumours, and is involved in cell proliferation and apoptosis signaling. The identification of the echinoderm microtubule-associated protein-like 4 (EML-4)–anaplastic lymphoma kinase (ALK) fusion oncogene in 2007 provided a further target for molecular therapy (Soda et al., 2007).

           Advances in our knowledge of cancer biology, in particular in its genetic basis, are continually providing further targets for systemic therapies. Furthermore, increasingly, genetic screening of patients is allowing for identification of subgroups that will benefit most from a particular drug (Cagle & Allen, 2012). Over the last decade there have been significant advances in the treatment of advanced NSCLC. There is now a variety of drugs available on the market that has been demonstrated to improve survival when administered as first-line, second-line or combination therapies. The identification of genetic alterations that predict response to some drugs has provided an effective means of selecting the most appropriate treatment for individual patients.

At International Cancer Specialists (ICS), we relentlessly strive to provide our patients compassionate and competent care. Led by qualified and experienced oncology clinicians and healthcare managers, as well as a multidisciplinary team of medical specialist partners (all of whom are UK or/and US Board-Certified), ICS stands ready to deliver cutting-edge patient-centered care in a welcoming environment. Feel free to contact us anytime @

HOTLINE: +65-6235-9005 WHATSAPP: +65-8168-6908 EMAIL: enquiries@icscancer.com

  1. Cagle, P. T., & Allen, T. C. (2012). Lung cancer genotype-based therapy and predictive biomarkers: present and future. Archives of pathology & laboratory medicine, 136(12), 1482-1491.
  2. Cancer, I. A. f. R. o. (2014). World Health Organisation. Globocan 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. In.
  3. Ettinger, D. S., Akerley, W., Bepler, G., Blum, M. G., Chang, A., Cheney, R. T., . . . Ganti, A. K. P. (2010). Non–small cell lung cancer. Journal of the national comprehensive cancer network, 8(7), 740-801.
  4. Goldstraw, P., Ball, D., Jett, J. R., Le Chevalier, T., Lim, E., Nicholson, A. G., & Shepherd, F. A. (2011). Non-small-cell lung cancer. The Lancet, 378(9804), 1727-1740.
  5. Howlader, N., Noone, A., Krapcho, M., Neyman, N., Aminou, R., Waldron, W., . . . Tatalovich, Z. (2015). SEER Cancer Statistics Review, 1975–2008, National Cancer Institute. Bethesda, MD. Based on November 2010 SEER data submission, posted to the SEER website, 2011. Google Scholar.
  6. Klastersky, J., & Paesmans, M. (2001). Response to chemotherapy, quality of life benefits and survival in advanced non-small cell lung cancer: review of literature results. Lung Cancer, 34, 95-101.
  7. Liam, C.-K., Pang, Y.-K., Leow, C.-H., Poosparajah, S., & Menon, A. (2006). Changes in the distribution of lung cancer cell types and patient demography in a developing multiracial Asian country: experience of a university teaching hospital. Lung Cancer, 53(1), 23-30.
  8. Liam, C.-K., Wahid, M. I. A., Rajadurai, P., Cheah, Y.-K., & Ng, T. S.-Y. (2013). Epidermal growth factor receptor mutations in lung adenocarcinoma in Malaysian patients. Journal of Thoracic Oncology, 8(6), 766-772.
  9. Soda, M., Choi, Y. L., Enomoto, M., Takada, S., Yamashita, Y., Ishikawa, S., . . . Hatanaka, H. (2007). Identification of the transforming EML4–ALK fusion gene in non-small-cell lung cancer. Nature, 448(7153), 561.
  10. Soo, R. A., Loh, M., Mok, T. S., Ou, S.-H. I., Cho, B.-C., Yeo, W.-L., . . . Soong, R. (2011). Ethnic differences in survival outcome in patients with advanced stage non-small cell lung cancer: results of a meta-analysis of randomized controlled trials. Journal of Thoracic Oncology, 6(6), 1030-1038.
  11. Thun, M. J., Hannan, L. M., Adams-Campbell, L. L., Boffetta, P., Buring, J. E., Feskanich, D., . . . Kolonel, L. N. (2008). Lung cancer occurrence in never-smokers: an analysis of 13 cohorts and 22 cancer registry studies. PLoS medicine, 5(9), e185.
  12. Toh, C.-K., Gao, F., Lim, W.-T., Leong, S.-S., Fong, K.-W., Yap, S.-P., . . . Thirugnanam, A. (2006). Never-smokers with lung cancer: epidemiologic evidence of a distinct disease entity. Journal of Clinical Oncology, 24(15), 2245-2251.
  13. Wang, B.-Y., Huang, J.-Y., Cheng, C.-Y., Lin, C.-H., Ko, J.-L., & Liaw, Y.-P. (2013). Lung cancer and prognosis in Taiwan: a population-based cancer registry. Journal of Thoracic Oncology, 8(9), 1128-1135.
  14. Zhou, W., & Christiani, D. C. (2011). East meets West: ethnic differences in epidemiology and clinical behaviors of lung cancer between East Asians and Caucasians. Chinese journal of cancer, 30(5), 287.

Breast Cancer in Asia

Incidence & Mortality

           Breast cancer is the most common type of cancer and the second leading cause of cancer-related deaths among women in Asia, accounting for 39% of all breast cancers diagnosed worldwide. In 2012, > 600,000 new breast cancer cases were reported in Asia, accounting for 39% of all breast cancers diagnosed worldwide (Chen et al., 2013). Based on these estimated numbers, breast cancer is certainly the most common cancer among women in Asia, accounting for 21.2% of all cancer cases in women

            In 2012, an estimated 231,013 women in Asia died from breast cancer, accounting for 7% of all deaths, and 40.8% of the cancer deaths, ranking second behind lung cancer in women. The most suitable measure to compare outcomes for patients across countries is the age-standardized mortality-to-incidence rate (M/I) ratio. For breast cancer in Asia, it is 0.35, which is higher than the world average of 0.30, and also higher than expected from Asia’s human development index (Cancer, 2014).

Risk Factors

            In Asian populations, breast cancer is associated with some of the risk factors known from Western populations, including early menarche, late menopause, older age at first full-term pregnancy, and no breast-feeding, regardless of the region (Lertkhachonsuk et al., 2013).

            Following socio-cultural changes towards Westernized lifestyles, Asian women are now characterized by delayed childbearing and fewer children, less breast-feeding, a more sedentary workforce, and other Westernized dietary and lifestyle patterns. These changes increase the relevance of ‘Western’ breast cancer risk factors. Modifiable health behaviors in Asian populations thus include the maintenance of a traditional dietary pattern (high in rice, fresh vegetables, and soy) thought to be protective, in addition to enhanced physical activity and maintaining body weight (Fan et al., 2009; Porter, 2008; Shu et al., 2009).

            Presenting with more advanced stages of breast cancer is related to poor prognosis and higher treatment cost (Anderson et al., 2003) . The stage at presentation of breast cancer varies widely throughout Asian countries and within these countries. In less developed regions and countries, late stage at presentation is very common. Besides delays in diagnosis in less developed regions, long waiting times before initiation of treatment for newly diagnosed breast cancer are common in Asia. These numbers are causing concern, as any effort to increase awareness and early diagnosis of breast cancer becomes irrelevant if timely treatment cannot be offered to patients.

Treatment

           Because of its cost and the need for specialized multi-modality infrastructure and human resources, the variability in treatment standards offered to breast cancer patients in Asia is even greater than that of screening options. Of a total of 51 Asian countries, only 20 have some form of national cancer center, with research capacities in only a minority of these (Yoo, 2010).

           Japan, Korea, Singapore, and Taiwan belong to the group of high-resource Asian countries, with high breast cancer incidences and relatively favorable breast cancer survival rates. These countries have well-established cancer control and cancer care systems with sufficient financial resources at the national level. The clinical characteristics and outcomes of breast cancer in these countries are quite similar to those in Western countries and treatment is standardized to a large extent (Son et al., 2006)

At International Cancer Specialists (ICS), we relentlessly strive to provide our patients compassionate and competent care. Led by qualified and experienced oncology clinicians and healthcare managers, as well as a multidisciplinary team of medical specialist partners (all of whom are UK or/and US Board-Certified), ICS stands ready to deliver cutting-edge patient-centered care in a welcoming environment. Feel free to contact us anytime @

HOTLINE: +65-6235-9005 WHATSAPP: +65-8168-6908 EMAIL: enquiries@icscancer.com

  1. Anderson, B. O., Braun, S., Carlson, R. W., Gralow, J. R., Lagios, M. D., Lehman, C., . . . Vargas, H. I. (2003). Overview of breast health care guidelines for countries with limited resources. The breast journal, 9(s2).
  2. Cancer, I. A. f. R. o. (2014). World Health Organisation. Globocan 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. In.
  3. Chen, W., Zheng, R., Zhang, S., Zhao, P., Li, G., Wu, L., & He, J. (2013). Report of incidence and mortality in China cancer registries, 2009. Chinese Journal of Cancer Research, 25(1), 10
  4. Fan, L., Zheng, Y., Yu, K.-D., Liu, G.-Y., Wu, J., Lu, J.-S., . . . Shao, Z.-M. (2009). Breast cancer in a transitional society over 18 years: trends and present status in Shanghai, China. Breast cancer research and treatment, 117(2), 409-416.
  5. Lertkhachonsuk, A.-a., Yip, C. H., Khuhaprema, T., Chen, D.-S., Plummer, M., Jee, S. H., . . . Wilailak, S. (2013). Cancer prevention in Asia: resource-stratified guidelines from the Asian Oncology Summit 2013. The lancet oncology, 14(12), e497-e507.
  6. Porter, P. (2008). “Westernizing” women’s risks? Breast cancer in lower-income countries. New England Journal of Medicine, 358(3), 213-216.
  7. Shu, X. O., Zheng, Y., Cai, H., Gu, K., Chen, Z., Zheng, W., & Lu, W. (2009). Soy food intake and breast cancer survival. JAMA, 302(22), 2437-2443.
  8. Son, B. H., Kwak, B. S., Kim, J. K., Kim, H. J., Hong, S. J., Lee, J. S., . . . Ahn, S. H. (2006). Changing patterns in the clinical characteristics of Korean patients with breast cancer during the last 15 years. Archives of Surgery, 141(2), 155-160.
  9. Yoo, K.-Y. (2010). Cancer prevention in the Asia Pacific region. Asian Pac J Cancer Prev, 11(4), 839-844.