山西省肿瘤医院乳腺癌钼靶检查数据分析

目的分析乳腺钼靶X线检查数据,间接评估山西省乳腺癌发病趋势。方法回顾性分析2005年至2007年在山西省肿瘤医院放射科进行乳腺钼靶X线检查患者的资料。对乳腺癌及良性乳腺疾病的诊断数目、比例、年龄分布、两侧乳腺癌分布和乳腺癌病理组织类型进行总结。结果2005年至2007年,行乳腺钼靶X线检查的患者从533例增加到1975例。诊断为乳腺癌的患者由62例快速增长至400例。乳腺癌患者占所有行乳腺钼靶X线检查的患者人数的比例有增长趋势（2005年、2006年、2007年分别为11．6％、17．8％、20．3％,P〈0．001）。乳腺癌患者的平均年龄显著大于良性患者（49．98岁和42．8岁,P〈0．001）。乳腺癌阳性率最高人群为45岁至54岁年龄组（37．6％）。左侧乳腺发病率大于右侧（53．42％和45．98％）。大多数病理组织类型为浸润性导管癌（78．95％）;浸润性小叶癌和导管原位癌分别为8．7％和5．39％。结论乳腺癌发病率呈增长趋势,其流行病学特点与先前有关中国女性乳腺癌发病情况的研究相一致。建立乳腺癌注册制度和系统完整的乳腺疾病数据库,将为推测未来乳腺癌发病率、癌谱变化规律以及评估乳腺癌的防治效果提供科学的依据。     

Metastatic relapse of stage I–III breast cancer in New Zealand

Purpose

This study aims to investigate the factors that influence the risk of metastatic relapse in women presenting with stage I-III breast cancer in New Zealand.

Methods

The study included women diagnosed with stage I–III breast cancer. Cumulative incidence of distant metastatic relapse was examined with the Kaplan–Meier method by cancer stage and subtype. Cox proportional hazards models were used to estimate the adjusted hazard ratio of developing recurrent metastatic breast cancer by cancer stage and biomarker subtype after adjustment for other factors.

Results

A total of 17,543 eligible women were identified. The 5-year cumulative incidence of metastatic recurrence was 3.7% for stage I, 13.3% for stage II and 30.9% for stage III disease. The adjusted hazard ratios (HR) of stage II and stage III breast cancer developing metastatic disease were 2.07 and 4.82 compared to stage I. The adjusted risk of distant metastatic relapse was highest for luminal B HER2- cancers (adjusted HR: 1.59 compared to luminal A disease). Higher grade cancers were associated with a higher risk of metastases. After adjustment, women aged 60–69 years and Asian women had the lowest risk of distant metastatic relapse.

Conclusions

The prognosis of women with locally invasive breast cancer differs greatly with the chance of developing metastatic disease depending on the stage of disease at diagnosis and the subtype. Grade of disease at diagnosis was also important. Māori or Pacific ethnicity did not influence the risk of developing metastatic disease, although Asian women seemed less likely to develop metastases.

     

Management of breast cancer after Hodgkin's disease.

PURPOSE: To evaluate the incidence, detection, pathology, management, and prognosis of breast cancer occurring after Hodgkin's disease. PATIENTS AND METHODS: Seventy-one cases of breast cancer in 65 survivors of Hodgkin's disease were analyzed. RESULTS: The median age at diagnosis was 24.6 years for Hodgkin's disease and 42.6 years for breast cancer. The relative risk for invasive breast cancer after Hodgkin's disease was 4.7 (95% confidence interval, 3.4 to 6. 0) compared with an age-matched cohort. Cancers were detected by self-examination (63%), mammography (30%), and physician exam (7%). The histologic distribution paralleled that reported in the general population (85% ductal histology) as did other features (27% positive axillary lymph nodes, 63% positive estrogen receptors, and 25% family history). Although 87% of tumors were less than 4 cm, 95% were managed with mastectomy because of prior radiation. Two women underwent lumpectomy with breast irradiation. One of these patients developed tissue necrosis in the region of overlap with the prior mantle field. The incidence of bilateral breast cancer was 10%. Adjuvant systemic therapy was well tolerated; doxorubicin was used infrequently. Ten-year disease-specific survival was as follows: in-situ disease, 100%; stage I, 88%; stage II, 55%; stage III, 60%; and stage IV, zero. CONCLUSION: The risk of breast cancer is increased after Hodgkin's disease. Screening has been successful in detecting early-stage cancers. Pathologic features and prognosis are similar to that reported in the general population. Repeat irradiation of the breast can lead to tissue necrosis, and thus, mastectomy remains the standard of care in most cases.     

Is the incidence of advanced‐stage breast cancer affected by whether women attend a steady‐state screening program?

In this cross‐sectional population‐based study, we assessed the incidence of advanced breast cancer based on screening attendance. Women from the Netherlands Cancer Registry were included if aged ≥49 years and diagnosed with breast cancer between 2006 and 2011, and data were linked with the screening program. Cancers were defined as screen‐related (diagnosed <24 months after screening) or nonscreened (all other breast cancers). Two cut‐offs were used to define advanced breast cancer: TNM‐stage (III–IV vs 0–I–II) and T‐stage alone (≥15 mm vs <15 mm or DCIS). The incidence rates were adjusted for age and logistic regression was used to compare groups. Of the 72,612 included women diagnosed with breast cancer, 44,246 (61%) had screen‐related breast cancer. By TNM stage, advanced cancer was almost three times as likely to be at an advanced TNM stage in the nonscreened group compared with the screen‐related group (38 and 94 per 100,000, respectively; OR: 2.86, 95%CI: 2.72–3.00). By T‐stage, the incidence of advanced cancer was higher overall, and in nonscreened women was significantly higher than in screened women (210 and 169 per 100,000; OR: 1.85, 95%CI: 1.78–1.93). Data on actual screening attendance showed that the incidence of advanced breast cancer was significantly higher in nonscreened women than in screened women, supporting the expectation that screening would cause a stage shift to early detection. Despite critical evaluations of breast cancer screening programs, our data show that breast cancer screening is a valuable tool that can reduce the disease burden in women.     

Distinguishing features of primary hyperparathyroidism in patients with breast cancer

Thirty-five women with breast cancer and primary hyperparathyroidism (1 degree HPT) were admitted to Memorial Hospital during a 25-year period. The incidence of primary hyperparathyroidism in the breast cancer patients was similar to the incidence in the total patient population at Memorial Sloan-Kettering Cancer Center (0.15% and 0.14%, respectively). The patients with 1 degree HPT disease had clinical findings which distinguished them from those patients with cancer-related hypercalcemia. Eighty percent of the breast cancer patients with primary hyperparathyroidism had earlier stage disease (Stage 0, Stage 1, Stage 2); whereas 97% of the patients with breast cancer and hypercalcemia (not due to 1 degree HPT) had advanced disease. There appeared to be a trend towards improved survival in the breast cancer patients with primary hyperparathyroidism when compared to patients of similar stage of disease who did not have parathyroid disease.     

Elevated serum acute phase protein levels as predictors of disseminated breast cancer

Serum levels of four acute phase proteins, alpha 1-acid glycoprotein (AAGP), alpha 1-antitrypsin (AAT), haptoglobin (Hpt), and C3, were measured prior to biopsy in 38 women subsequently shown to have Stage I and II breast cancer and prior to treatment in 16 women with Stage IV disease. Sixty-one women with benign and 28 women with no breast disease served as controls. Mean serum levels of all four proteins were significantly elevated in women with stage IV disease as compared to women with Stage I or II disease or controls. Normal versus elevated levels for each protein were defined and AAGP was found to be the single most sensitive predictor of disseminated disease among the four. AAGP was elevated in 81.3% of Stage IV, 25% of Stage II, 14.3% of Stage I, and 12.4% of controls. Women with multiple proteins elevated were most likely to have advanced stage disease. Composite analysis of all four proteins using number of proteins abnormal or logistic regression analysis gave results similar to AAGP, both showing increasing numbers of proteins abnormal with increasing stage of breast cancer. These results indicate that measurement of serum acute phase proteins may be useful in initial staging of breast cancer patients and in following patients for indications of disseminated disease.     

Breast cancer prevention and control programs in Malaysia

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.     

Trends in cervical cancer incidence--Indian scenario.

Cancer of the uterine cervix is the second most common cancer among women in the world after breast cancer. It is the most common cancer among Indian women. The present communication reports the trends in the incidence rate of cervical cancer for the Indian population. The data published in Cancer Incidence in Five Continents for various Indian registries for different periods and/or publication by the individual registry served as the source material. During the years 1990-1997, the age-adjusted incidence rates (AAR) for cervical cancer varied from 10.9 to 65.4 amongst various registries. The highest incidence was noted in the Ambillikai registry. The age-specific incidence rates (ASIR) for cervical cancer revealed that the disease increases from 35 years and reaches a peak between the ages 55 to 64 years. The trend analysis by period showed a decreasing trend in the incidence rate of cervical cancer in all the registries. However, the decrease was very small. The mean annual percentage decrease in the AAR ranged from 0.9 to 2.6% amongst various registries. Analysis of the data by ASIR revealed that the mean annual percentage decrease was higher for women in earlier age groups in most of the registries. For women beyond 64 years, the disease incidence showed an increasing trend or minimal decrease. It was also noted that most of the cervical cancer cases were detected with regional spread of the disease and a very small proportion were diagnosed at a localized stage. In India, an organized mass-screening programme with Pap smear for early detection of cervical cancer is not in practice. The data suggest an urgent need for initiation of community screening and educational programmes for the control and prevention of cervical cancer.     

Oral contraceptives as related to cancer and benign lesions of the breast.

We conducted a case-control study to search for any relationship between use of oral contraceptives and development of breast cancer or benign breast disease. Women less than 50 years old with these diseases were matched with 2 controls by age, race, religion, and hospital. Home interviews elicited information on oral contraceptive use and other host and environmental factors. The study population comprised 1,770 women, including 452 with breast cancer and 446 with benign breast disease. The relative risk of developing cancer or benign disease was measured by matched set and summary chi-square analyses. Although the relative risk of developing breast cancer among "ever-users" of oral contraceptives was 1.1, the risk among women using oral contraceptives for 2-4 years was 1.9 (significantly increased). This risk estimate reached 2.5 for the 2- to 4-year users if they were still taking oral contraceptives when entered into study. Moreover, prior biopsy for benign breast disease increased the cancer risk among long-term users by as much as 11-fold. The relative risk of breast cancer did not vary by age, interval since first use, earliest year of use, or interval since last use. These results could be interpreted to indicate that oral contraceptives did not induce breast cancer but may have accelerated the growth rate of preexisting breast cancer. The relative risk of developing benign breast disease among ever-users of oral contraceptives was 0.8 (significantly reduced); it decreased with longer duration of use until it reached 0.2 for women who took these hormones 8 years or more. The relative risk of benign breast was not affected by earliest year of use or interval since last use. We concluded that oral contraceptives reduced the incidence of benign breast disease, but that use of steroid hormones is ill-advised for women with already established benign breast disease.     

Effects of pregnancy after treatment for breast carcinoma on survival and risk of recurrence

BACKGROUND: The goal of the current study was to assess the effect of pregnancy on the subsequent risk of recurrence after treatment for breast carcinoma, adjusting for established prognostic factors. METHODS: Between 1974 and 1998, 383 patients age < or =35 years were treated for breast carcinoma with adjuvant chemotherapy at The University of Texas M. D. Anderson Cancer Center (Houston, TX). The median follow-up period was 13 years. Of these, 13 patients were excluded from analysis, as no history was available regarding pregnancy; 240 (65%) were >30 years old; 47 (13%) had at least 1 pregnancy after therapy; 32 had full-term pregnancies; 10 had spontaneous or elective abortions; 4 had miscarriages; and 1 had a premature delivery. Estrogen receptor (ER) status, lymph node involvement, and disease stage were evaluated as potential risk factors for recurrence. Information on ER status was unavailable for 123 (33%) patients. RESULTS: Patients who experienced a pregnancy tended to have earlier-stage disease (Stage I/II: 80% vs. 73%), fewer positive lymph nodes (<4: 87% vs. 52%), more ER negativity (68% vs. 58%), and younger age (<30 years: 57% vs. 32%) than patients who did not. The incidence of disease recurrence was 23% for women who experienced a pregnancy and 54% for women who did not. The hazard ratio (using the multivariate Cox proportional hazards model) for disease recurrence in patients with posttreatment pregnancy was 0.71 (P=0.4). CONCLUSIONS: In the current study population, pregnancy was not associated with an increased risk of disease recurrence or poorer survival in patients previously treated for breast carcinoma.     

A comparison of trends in incidence and mortality rates of breast cancer, incidence to mortality ratio and stage at diagnosis between Arab and Jewish women in Israel, 1979-2002.

In Israel, breast cancer is the most common malignancy in women, but there are large intra-population differences. The aim of this study was to compare the incidence and mortality, incidence to mortality rate ratio and stage at diagnosis of breast cancer between Arab and Jewish women in Israel. Data on all cases of breast cancer, stage at diagnosis and mortality were obtained from the National Cancer Registry and the Central Bureau of Statistics. Trends in age-specific and age-adjusted incidence and mortality rates, rate ratios and stage at diagnosis were examined for Arab and Jewish women during 1979-2002. Five-year survival rates for 1995-1999 were compared by stage. Among Arab women, age-adjusted incidence rates increased by 202.1%, from 14.1 per 100,000 in 1979-1981 to 42.6 in 2000-2002. Among Jewish women, the rates increased by 45.7%, from 71.1 per 100,000 women in 1979-1981 to 103.6 in 2000-2002. Incidence to mortality rate ratio increased for both population groups, but it is still lower among Arab women. In every age group, Arab women were more likely to be diagnosed at a more advanced stage of the disease. The rise in breast cancer incidence and mortality rates and the later stage of diagnosis among Arab women emphasize the urgent need for increasing early detection of breast cancer in the Arab population by improving rates of compliance with screening mammography.     

Alarming Burden of Triple-Negative Breast Cancer in India

Breast cancer is the most prevalent cancer among women worldwide. Among the different breast cancer subtypes, triple-negative breast cancer (TNBC), which is more prevalent among younger age women, is the most aggressive form. Numerous clinicopathologic studies performed throughout the world strongly support the utterly poor prognoses and high recurrence rate of TNBC. The present report details a thorough data survey from Google and PubMed on the burden of TNBC worldwide and other associated factors, with special emphasis on its ever increasing incidence among Indian women. Our analysis revealed that the proportion of TNBC ranges from 6.7% to 27.9% in different countries, with the highest reported percentage in India among all, followed by Indonesia, Algeria, and Pakistan. Most of the other countries (Netherlands, Italy, London, Germany) had a TNBC incidence less than the mean level (ie, 15%). The high incidence of TNBC in the Indian population is associated with vivid risk factors, which primarily include lifestyle, deprivation status, obesity, family history, high mitotic indexes, and BRCA1 mutations. The treatment of TNBC is greatly hampered due to the lack of targeted therapies. Hence, it requires earnest attention towards extensive research for the prevention and development of treatment modalities with high efficacy.     

Second events following ductal carcinoma in situ of the breast: a register-based cohort study

The incidence of ductal carcinoma in situ (DCIS) of the breast has increased in recent decades, particularly, in counties offering mammography screening. The aims of the present study are to examine factors that may predict subsequent breast malignancy amongst patients with DCIS, and to compare the incidence of the subsequent malignancy and mortality with that of the general population. This population-based study includes all primary cases of pure DCIS diagnosed in Norway in the period 1993 to 2007 (N = 3167). The patients were followed to subsequent malignancy (DCIS or invasive cancer) or death. Risk estimates within 10 years of follow-up were calculated using Kaplan–Meier methods adjusting for competing risks, Cox regression models and Standard Incidence and Mortality Ratios. Patients with DCIS had a 11.2% risk of being diagnosed with a subsequent breast malignancy within 10 years (9.4% for invasive cancer), implying that they were five times as likely to be diagnosed with breast malignancy as the general female population in Norway. The risk was dependent on the treatment of the DCIS; patients treated with mastectomy and breast-conserving treatment had a 3.8 and 9.8% risk of ipsilateral invasive cancer within 10 years, respectively. Breast cancer mortality was 2.5% within 10 years of follow-up, a fourfold risk compared with the general population. Patients with DCIS have an increased risk of both subsequent breast malignancy and breast cancer death compared with women in the general population. Our results support previous knowledge of DCIS as a heterogeneous disease.     

Patterns of recurrence and survival in breast cancer

Breast cancer is the leading cause of death affecting women worldwide, according to mortality estimation and incidence. In Chile, breast cancer ranks third among cancer mortality rates. Two-hundred and eighty-three breast cancer patients registered at the Gustavo Fricke Hospital of Vi?a del Mar, Chile, were studied to assess the influence of several factors on the recurrence and survival of breast cancer patients. Patients selected had 5-year post-surgery recurrences of breast cancer and had an average of 58.5 years of age. The variables considered in these patients were the quadrants involved, stage of the tumor, type of recurrence, type of exams, type of surgery, the grade of tumor in relation to Broder's classification and pathology of tumor. The results indicated that the superior external right and left quadrants, Stage IIA, loco-regional recurrences, lumpectomies with axillar lymph node removal and after 5 years, Grade II were prevalent in this population. Among the pathologies analyzed, the ductal carcinomas were the most commonly found and were positive for PCNA, beta-catenin, cytokeratin 18 and ErbB2 protein expression. A median follow-up of 60 months of survival was achieved in 95% of patients. However, those cases with a recurrence of breast cancer had only 40% survival. The risk of mortality was significantly greater when recurrence was present (P<0.0001). The global probability of survival of the patients reached 72% after 5 years. It can be concluded that early detection of breast cancer allows for control of the disease and avoids remissions, or at least extends survival.     

湖北省襄阳市30~64岁妇女宫颈癌和乳腺癌筛查结果分析

目的 了解现阶段湖北省襄阳市妇女宫颈癌和乳腺癌（“两癌”）流行情况及其发病的影响因素。方法 对襄阳市辖区内30~64岁已婚妇女进行问卷调查,收集一般人口学信息、疾病既往史、家族肿瘤史、月经生育史及妇科疾病患病情况等资料。宫颈癌筛查采用高危型HPV初筛,结合液基薄层细胞学检查、阴道镜和病理学检查的逐级筛查手段开展。乳腺癌筛查采用视诊、触诊和彩色多普勒超声进行初筛,结合乳腺钼靶X线及病理学检查的逐级筛查手段开展。结果 2017年全市共有318 067名30~64岁妇女参与了“两癌”筛查,检出非HPV生殖道感染91 143例（28.66%）;子宫良性疾病44 736例（14.06%）;宫颈癌前病变826例（259.69/10万）,其中CINⅡ 385例,CINⅢ 425例,原位腺癌16例;检出宫颈癌79例（24.84/10万）,其中微小浸润癌18例,浸润癌61例;检出良性乳腺疾病44 097例（13.86%）;检出乳腺癌80例（25.27/10万）。影响因素分析提示：年龄、宫颈癌家族史、多孕、绝经年龄较晚和生殖道感染可能为宫颈癌的危险因素,而年龄、较高文化程度和乳腺癌家族史则可能为乳腺癌的危险因素。结论 襄阳市妇女 “两癌”发病处于中等水平,定期的筛查和积极控制高危因素,对“两癌”的防治意义重大。     

Breast cancer in women with human immunodeficiency virus infection: implications for diagnosis and therapy

The rising incidence of the human immunodeficiency virus (HIV) infection in women and the prolonged survival increases the risk of development of breast cancer in this population. Through December 2001, 38 cases of breast cancer, two occurring in men, have been reported in persons infected with HIV. Between 1995 and 2001, five HIV infected premenopausal women presented with breast cancer to the Karmanos Cancer Institute. Three patients presented 3–5 years after the diagnosis of HIV infection. One patient presented with stage IV breast cancer, three with stage III, and one with stage II disease. Chemotherapy-induced myelosuppression was pronounced in all patients. Two patients had progression of HIV on treatment manifested by a rise in HIV-I RNA or development of opportunistic infections. In general, the outcome of breast cancer in our small series of patients was worse than in a non-HIV population. HIV infection may influence the natural history and treatment of breast cancer.     

2015年重庆市城乡女性乳腺癌发病及死亡现状分析

目的:了解重庆市女性乳腺癌发病与死亡现状,为开展乳腺癌防治提供建议.方法:收集整理2015年重庆市11个肿瘤登记点报告的乳腺癌(ICD-10编码为C50).采用SPSS 19.0统计分析发病率、死亡率、标化发病率、标化死亡率、构成比、顺位.不同地区间乳腺癌发病率与死亡率的比较采用χ2检验,年龄别发病率与死亡率趋势分析采用趋势χ2检验.结果:2015年11个肿瘤登记点女性乳腺癌粗发病率为31.48/10万,城市发病率(42.07/10万)高于农村(26.32/10万),差异有统计学意义(P=0.002),乳腺癌标化发病率为24.20/10万,在女性恶性肿瘤中顺位居第2位,占6.00%.女性乳腺癌粗死亡率为7.33/10万,城市(8.77/10万)与农村乳腺癌死亡率(6.62/10万)差异无统计学意义(P=0.099),乳腺癌标化死亡率为4.96/10万,在恶性肿瘤死亡顺位中居第6位,占2.10%.女性乳腺癌发病率25岁前低于5/10万,25岁后快速上升,50岁~年龄组达到高峰,随后下降.女性乳腺癌死亡率在40岁前低于5/10万,40岁后呈上升趋势,80岁~年龄组达到高峰.女性乳腺癌截缩发病率为56.01/10万,城市(67.91/10万)高于农村(50.55/10万),差异有统计学意义(P=0.001).截缩死亡率为10.75/10万,乳腺癌截缩死亡率城市(11.96/10万)与农村(10.42/10万)比较差异无统计学意义(P=0.136).发病累积危险度为2.27%,城市(3.07%)高于农村(1.93%),差异有统计学意义(P=0.039).死亡累积危险度为0.51%.结论:重庆市女性乳腺癌发病率与死亡率较高,应针对城乡女性乳腺癌发病死亡特点开展三级预防.     

What affects the public healthcare costs of breast cancer in New Zealand?

Backgrounds

The pressure to the healthcare system for providing ongoing monitoring and treatment for breast cancer survivors is increasing. This study aims to identify the factors that affect the public healthcare costs of stage I–III breast cancer and stage IV cancer in New Zealand.

Methods

We identified women diagnosed with invasive breast cancer between July 1, 2010 and June 30, 2018 and who received services in a public hospital. Patients were identified from the National Breast Cancer Register and/or New Zealand Cancer Registry and were linked to the national administrative datasets. A two-part model was used to identify the factors that affect the public healthcare costs of stage I–III breast cancer and stage IV cancer.

Results

We identified 16,977 stage I–III and 1,093 stage IV breast cancer patients eligible for this study. The costs of stage I–III cancer in the second to fifth year post diagnosis decreased over time, and the costs of stage IV cancer in the first year post diagnosis increased over time. After adjustment for other factors, the costs of stage I–IV cancer decreased with age but increased with cancer stage. HER2+ cancers had the highest costs, followed by triple negative cancers. After adjustment for other factors, Pacific and Asian women had lower costs, and Māori had similar costs compared to others. For stage I–III cancers, women living in nonmajor urban areas had a higher chance of incurring costs in follow-up years, and screen detected patients and patients having any services in a private hospital had a decreased probability of receiving any public healthcare services.

Conclusions

Pacific women had higher costs than others, but after adjustment for cancer stage, subtype, and other factors, they had lower costs than others. The early detection and better management of stage I–III breast cancer can lead to better outcome and lower costs in follow-up years.