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. Breast cancer screening tests, not only in Singapore but also in other parts of the world, reported more than 600,000 new breast cancer cases in 2012. This also accounts 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).
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.
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)
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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.
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