Survival Rate of Breast Cancer Patients In Malaysia: A Population-based Study

Breast cancer is the most common cancer among Malaysian women. Other than hospital-based results, thereare no documented population-based survival rates of Malaysian women for breast cancers. This populationbasedretrospective cohort study was therefore conducted. Data were obtained from Health Informatics Centre,Ministry of Health Malaysia, National Cancer Registry and National Registration Department for the periodfrom 1st January 2000 to 31st December 2005. Cases were captured by ICD-10 and linked to death certificates toidentify the status. Only complete data were analysed. Survival time was calculated from the estimated date ofdiagnosis to the date of death or date of loss to follow-up. Observed survival rates were estimated by Kaplan-Meier method using SPSS Statistical Software version 17. A total of 10,230 complete data sets were analysed.The mean age at diagnosis was 50.6 years old. The overall 5-year survival rate was 49% with median survivaltime of 68.1 months. Indian women had a higher survival rate of 54% compared to Chinese women (49%) andMalays (45%). The overall 5-year survival rate of breast cancer patient among Malaysian women was still lowfor the cohort of 2000 to 2005 as compared to survival rates in developed nations. Therefore, it is necessary toenhance the strategies for early detection and intervention.     

Predictive Factors of Survival Time of Breast Cancer in Kurdistan Province of Iran between 2006-2014: A Cox Regression Approach

Background: Breast cancer is the most common cancer and the second most common cause of cancer-inducedmortalities in Iranian women, following gastric carcinoma. The survival of these patients depends on severalfactors, which are very important to identify in order to understand the natural history of the disease. Materialsand Methods: In this retrospective study, 313 consecutive women with pathologically-proven diagnosis of breastcancer who had been treated during a seven-year period (January 2006 until March 2014) at Towhid hospital,Sanandaj city, Kurdistan province of Iran, were recruited. The Kaplan-Meier method was used for data analysis,and finally those factors that showed significant association on univariate analysis were entered in a Cox regressionmodel. Results: the mean age of patients was 46.10±10.81 years. Based on Kaplan-Meier method median ofsurvival time was 81 months and 5 year survival rate was 75%±0.43. Tumor metastasis (HR=9.06, p=0.0001),relapse (HR=3.20, p=0.001), clinical stage of cancer (HR=2.30, p=0.03) and place of metastasis (p=0.0001) hadsignificant associations with the survival rate variation. Patients with tumor metastasis had the lowest five-yearsurvival rate (37%)and among them patients who had brain metastasis were in the worst condition (5 year survivalrate= 11%±0.10). Conclusions: Our findings support the observation that those women with higher stages ofbreast malignancies (especially with metastatic cancer) have less chance of surviving the disease. Furthermore,screening programs and early detection of breast cancer may help to increase the survival of those women whoare at risk of breast cancer.     

Survival Rate and Prognostic Factors for Colorectal Cancer in Sabah,Borneo, Malaysia: A Retrospective Cohort of a Population-Based Study

Background: Colorectal cancer is a major public health problem with significant number of cases and death in the population. This study aimed to determine the 5-year overall survival rate and the prognostic factors for colorectal cancer patients in Sabah. Methods: This was a retrospective cohort study conducted using secondary data from Malaysian National Cancer Registry (MNCR) database. A 5-year overall survival and the median survival time were determined with Kaplan-Meier survival curve. Cox regression analysis was done to determine the prognostic factors on survival. Results: A total of 1,152 patients were included in this study. The majority of the patients had colon cancer and presented at late stage (stage III and IV) as compared to early stage (stage I and II). From the analysis, the 5-year overall survival for colorectal cancer was 23.2% (95% CI: 21.8, 24.6) and the median survival time was 16 months (95% CI: 14.3, 17.7).  Higher survivals are seen in males (23.6%, 95% CI: 20.4, 24.7), aged 50-74 years old (24.2%, 95% CI: 22.4, 26.0), Chinese (25.5%, 95% CI: 23.0, 28.0), lived in Keningau (25.6%, 95% CI: 20.8, 30.4), colon as primary tumor site (24.5%, 95% CI: 22.5, 26.4), diagnosed with stage I (55.6%, 95% CI: 48.7, 62.5) and received surgery with chemotherapy or radiotherapy (31.3%, 95% CI: 27.8, 34.8). The significant prognostic factor was the stage at diagnosis. Patients with stage IV colorectal cancer (HR: 11.18; 95% CI: 3.48, 35.93) had eleven times risk of dying as compared to stage I. Conclusion: The survival rate for colorectal cancer patients in Sabah was comparatively lower than other states in Malaysia and in some Asian countries. Those patients who presented at later stage had poorer survival. Health promotion and community-based screening program should be emphasized in addition to encouraging early diagnosis to improve survival.     

Overall Survival and Local Recurrence Among Breast Cancer Patients in Hospital Sultanah Nora Ismail Batu Pahat, 2007-2013

Objective: To gauge surgical outcome in breast cancer patients with particular reference to overall survival andrecurrence free survival among breast cancer patients in Hospital Sultanah Nora Ismail Batu Pahat, Johor, Malaysia.Methods: Patients undergoing ablative breast cancer surgery were identified and clinical records were assessed.Inclusion criteria for enrolment were stage I-IV breast malignancy necessitating resection with or without radiotherapy/chemotherapy from 2007 to 2013. All individuals had a pre-operative assessment. The post operative assessment periodranged from 1 year to 5 years. Survival distributions were analyzed using Kaplan-Meier curves. Results: A total of121 patients were included in this study, with an age range of 28-78 years. Some 98% had undergone local excision/lumpectomy/ mastectomy with axillary clearance. While 81% of patients underwent chemotherapy, only 69% hadradiotherapy. Tumours were oestrogen receptor positive in 58% of cases and progesterone receptor positive in 62%.Local recurrence was detected in 10%. The mean age at diagnosis was 51.3 + 10.4 years. The overall survival analysiswas based on 22 deaths among the 121 patients (18.2%). Three-year and five-year survival rates were 87.6% and 78.4%,respectively. Analysis of recurrence-free-survival (RFS) was based on 12 events among 121 patients. The Kaplan-MeierRFS analysis revealed that in 90% of the patients with recurrence, it occurred within 45 months. The five year RFSrate was 84.5%. The median time taken from diagnosis to ablative surgery was 51 days (upper limit of 791 days).Only distant metastasis was a significant factor that impacted on both overall survival and recurrence-free survival(p<0.001). Conclusion: Overall survival among our breast cancer patients in our facility is comparable to other inother tertiary centres in the country. A trend for earlier detection was noted.     

Roles of Ethnicity in Survival of Hepatocellular Carcinoma Patients in Malaysia

The incidence of hepatocellular carcinoma (HCC) in Malaysia for the year 2001 was 2.8 per 100,000 people.The mortality rate is increasing. A retrospective cohort study measuring the survival of HCC patients who received treatment in Selayang Hospital was conducted from 1 January 2003 to 31 December 2006. The main objectivesof the study were to measure the survival of the patients and to understand the influencing factors, especially ethnicity. The subjects were newly diagnosed cases of HCC by CT scan and histopathological assessment who underwent futher investigations and treatments in Hospital Selayang (inception cohort). The survival time was measured from the date of diagnosis until the subjects died, or failed to follow-up at the end of the study period (31 December 2007). A total of 299 patients were selected with 95 patients dying, the majority among Chinese(39.1%). Subgroup analysis according to ethnicity proved significantly that Chinese patients who had smaller tumor, less number of nodules, low AFP level, Child Pugh Class A and received surgical treatment had a better median survival rate compared to other ethnic groups. Malay (cHR: 1.3, 95%CI; 0.89-1.85) and Indian (cHR: 1.3, 95%CI; 0.74-2.26) patients had a poor survival compared to Chinese patients, but not in the final model.Therefore ethnicity may play a role in survival of HCC patients, but not as a main hazard prognostic factor.     

Breast Cancer Survival at a Leading Cancer Centre in Malaysia

Background: GLOBOCAN12 recently reported high cancer mortality in Malaysia suggesting its cancer health services are under-performing. Cancer survival is a key index of the overall effectiveness of health services in the management of patients. This report focuses on Subang Jaya Medical Centre (SJMC) care performance as measured by patient survival outcome for up to 5 years. Materials and Methods: All women with breast cancer treated at SJMC between 2008 and 2012 were enrolled for this observational cohort study. Mortality outcome was ascertained through record linkage with national death register, linkage with hospital registration system and finally through direct contact by phone or home visits. Results: A total of 675 patients treated between 2008 and 2012 were included in the present survival analysis, 65% with early breast cancer, 20% with locally advanced breast cancer (LABC) and 4% with metastatic breast cancer (MBC). The overall relative survival (RS) at 5 years was 88%. RS for stage I was 100% and for stage II, III and IV disease was 95%, 69% and 36% respectively. Conclusions: SJMC is among the first hospitals in Malaysia to embark on routine measurement of the performance of its cancer care services and its results are comparable to any leading centers in developed countries.     

329例转移性乳腺癌的预后因素及生存分析

目的观察转移性乳腺癌患者的疗效及预后情况,分析影响转移性乳腺癌患者生存的预后因素。方法选取转移性乳腺癌患者329例进行回顾性研究。结果总生存率(OS)1年总生存率为62.9%,2年总生存率为41.9%,3年总生存率为25.8%及5年总生存率11.9%。接受治疗的患者中位生存时间为18.2个月,分别为:骨转移患者23.4个月,淋巴结转移患者31.3个月,肝转移患者17.6个月,肺转移患者15.3个月,脑转移患者7.2个月。通过单因素及多因素分析,获取了同生存获益相关的预后因素。结论对转移性乳腺癌生存有积极影响的独立因素包括:体力状况,年龄≤70岁以及没有内脏的转移。对于此类患者,在解救治疗中应采取较为积极的处理措施,争取更好的生存获益。     

Metastatic Axillary Lymph Node Ratio (LNR) is Prognostically Superior to pN Staging in Patients with Breast Cancer - Results for 804 Chinese Patients from a Single Institution

The number of axillary lymph nodes involved and retrieved are important prognostic factors in breast cancer.The purpose of our study was to investigate whether the lymph node ratio (LNR) is a better prognostic factor inpredicting disease-free survival (DFS) for breast cancer patients as compared with pN staging. The analysis wasbased on 804 breast cancer patients who had underwent axillary lymph node dissection between 1999 and 2008in Sun Yat-Sen University Cancer Center. Optimal cutoff points of LNR were calculated using X-tile softwareand validated by bootstrapping. Patients were then divided into three groups (low-, intermediate-, and high-risk)according to the cutoff points. Predicting risk factors for relapse were performed according to Cox proportionalhazards analysis. DFS was estimated using the Kaplan-Meier method and compared by the log-rank test. The5-year DFS rate decreased significantly with increasing LNRs and pN. Univariate analysis found that the pT ,pN, LNR, molecule type, HER2, pTNM stage and radiotherapy well classified patients with significantly differentprognosis. By multivariate analysis, only LNR classification was retained as an independent prognostic factor.Furthermore, there was a significant prognostic difference among different LNR categories for pN2 category,but no apparent prognostic difference was seen between different pN categories in any LNR category. Therefore,LNR rather than pN staging is preferable in predicting DFS in node positive breast cancer patients, and routineclinical decision-making should take the LNR into consideration.     

Survival Rates of Cervical Cancer Patients in Malaysia

Cervical cancer is the most common malignant cancer of the female reproductive organs worldwide. Currently,cervical cancer can be prevented by vaccination and detected at an early stage via various screening methods.Malaysia, as a developing country faces a heavy disease burden of cervical cancer as it is the second mostcommon cancer among Malaysian women. This population based study was carried out to fulfil the primary aimof determining the survival rates of Malaysian women with cervical cancer and associated factors. Data wereobtained from two different sources namely, the Malaysian National Cancer Registry (MNCR) and NationalHealth Informatics Centre (NHIC) from 1st January 2000 to 31st December 2005. Kaplan Meier analyses wereconducted to identify the overall survival rates and median survival time. Differences in survival among differentethnic and age group were compared using the log-rank test. A total of 5,859 patients were included. The mediansurvival time for cervical cancer in this study was 65.8 months and the 5-year survival rate was 71.1% . Theoverall observed survival rates at 1, 3 and 5 years were 94.1%, 79.3% and 71.1% respectively. The log-rank testfinding also showed that there were significant differences in the 5-year survival rate among different ethnicgroups. Malays had the lowest survival rate of 59.2% followed by Indians (69.5%) and Chinese (73.8%). Theoverall 5-year survival rate among patients with cervical cancer in Malaysia is relatively good. Age and ethnicgroups remain as significant determining factors for cervical cancer survival rate.     

Survival Time and Prognostic Factors for Breast Cancer among Women in North-East Peninsular Malaysia

Background: Breast cancer is the most common malignant disease and the leading cause of cancer death amongwomen globally. This study aimed to determine the median survival time and prognostic factors for breast cancerpatients in a North-East State of Malaysia. Methods: This retrospective cohort study was conducted from January tillApril 2017 using secondary data obtained from the state’s cancer registry. All 549 cases of breast cancer diagnosedfrom 1st January 2007 until 31st December 2011 were selected and retrospectively followed-up until 31st December2016. Sociodemographic and clinical information was collected to determine prognostic factors. Results: The average(SD) age at diagnosis was 50.4 (11.2) years, the majority of patients having Malay ethnicity (85.8%) and a histology ofductal carcinoma (81.5%). Median survival times for those presenting at stages III and IV were 50.8 (95% CI: 25.34,76.19) and 6.9 (95% CI: 3.21, 10.61) months, respectively. Ethnicity (Adj. HR for Malay vs non-Malay ethnicity=2.52;95% CI: 1.54, 4.13; p<0.001), stage at presentation (Adj. HR for Stage III vs Stage I=2.31; 95% CI: 1.57, 3.39; p<0.001and Adj. HR for Stage IV vs Stage I=6.20; 95% CI: 4.45, 8.65; p<0.001), and history of surgical treatment (Adj. HRfor patients with no surgical intervention=1.95; 95% CI: 1.52, 2.52; p<0.001) were observed to be the statisticallysignificant prognostic factors associated with death caused by breast cancer. Conclusion: The median survival timeamong breast cancer patients in North-East State of Malaysia was short as compared to other studies. Primary andsecondary prevention aimed at early diagnosis and surgical management of breast cancer, particularly among the Malayethnic group, could improve treatment outcome.     

Relative Survival of Breast Cancer Patients in Iran

Background: The survival rate reflecting prognosis of breast cancer patients is usually estimated based on crudesurvival methods such as observed and cause-specific. In situations where data are based on population-cancerregistries, this method may produce biased estimations. This study therefore aimed to estimate the net survival ofbreast cancer based on relative survival. Materials and Methods: Data for 622 breast cancer patients diagnosedat the Iran Cancer Institute during 1990-95 and tracked till the end of 2000 were analyzed. For estimation ofrelative survival, Ederer’s second method and SAS (9.1) and STATA (11) software were used. Results: Threeyearrelative survivals of 85%, 90%, 80% and 67% were observed for age groups 15-44, 55-59, 60-74, and 75+years-old, respectively. A relative survival of approximately one was observed for two subsequent years forage-group 45-59 years-old. A value greater than one for two subsequent years of follow-up was observed in theage-group 60-74 years-old. Conclusions: Tracking the diagnosis of breast cancer, the relative survival decreasesas we go to higher age-groups. It is also perceived that through follow-up, relative survival first decreased andthen increased a little. The statistical cure point is acceptable for age group 45-59 years-old while for age-groups15-44 and 60-74 years old is a sign of low quality data for some follow-up intervals.     

Survival analysis of malaysian women with breast cancer: results from the university of malaya medical centre

Background: Breast cancer is the commonest cancer amongst Malaysian women but local survival data are scarce. The present study was therefore conducted to assess overall survival and prognostic factors in Malaysian breast cancer patients. Methods: The research sample was a prospective cohort of 413 patients diagnosed with breast cancer in the University of Malaya Medical Centre between 1993 to 1997. Survival data were obtained from the National Registry of Birth and Deaths in December 2000. The clinico-pathological variables studied were age, ethnic group, stage, tumour size, lymph node status, oestrogen receptor status and grade. The data were analysed utilizing Splus statistical software. The important prognostic factors were identified by fitting the Cox's proportional hazard model to the data set. Survival probabilities were estimated using the Kaplan-Meier method and differences were compared by the log-rank test. Results: The overall 5-year survival was 59.1%. The Cox's proportional hazard model identified stage, lymph node status, size and grade as factors that correlated with prognosis. Age was not a significant prognostic factor. The Cox regression model by stepwise selection showed stage, nodal status and grade of tumour to be independent prognostic factors, whereas ethnicity, age and ER status were not. Interpretation: The overall survival in our centre was low. Recognizing factors that affect prognosis of breast cancer patients in Malaysia may improve delivery of health care to at-risk groups by strategizing interventions as survival depends on early detection and effective treatment.     

Epidemiology of Breast Cancer in Malaysia

Data from the National Cancer Registry of Malaysia for 2004 provide an age-standardised incidence rate (ASR)of 46.2 per 100,000 women. This means that approximately 1 in 20 women in the country develop breast cancer intheir lifetime. However, the rate differs between the three main races, the Malays, Chinese and Indians. The agestandardized incidence in Chinese is the highest, with 59.7 per 100,000, followed by the Indians at 55.8 per 100,000.The Malays have the lowest incidence of 33.9 per 100,000. This translates into 1 in 16 Chinese, 1 in 16 Indian and 1in 28 Malay women developing breast cancer at some stage in their lives. The commonest age at presentation isbetween 40-49 years, with just over 50% of the cases under the age of 50 years, 16.8% below 40, and 2% under 30.Some 55.7% of all cases were found to be ER positive. The commonest presenting symptom was a lump in the breastin over 90% of cases, generally felt by the woman herself. The mean size of the lump was 4.2 cm, and on average, thewomen waited 3 months before seeking medical attention. Over the 12-year period from 1993 to 2004, about 60-70%of women presented with early stage (Stages 1- 2) while 30-40% presented with late breast cancer (Stages 3-4).Especially Malays present at later stages and with larger tumours. Consequently their survival is worse than withChinese and Indian women. The challenge in Malaysia is to be able to provide a comprehensive service in the diagnosisand treatment of breast cancer, and this requires training of a team of health professionals dedicated to breasthealth, such as breast surgeons, radiologists specializing in breast imaging, breast pathologists, plastic surgeonsspecializing in breast reconstruction, medical and radiation oncologists, psycho-oncologists, counselors, and breastnurses. Advocacy can play a role here in galvanizing the political will to meet this challenge.     

Demographic Characteristics,Survival and Prognostic Factors of Early Breast Cancer Patients with Type 2 Diabetes Mellitus: A Hospital-Based Cohort Study

Objective: With increasing prevalence of type 2 diabetes mellitus and breast cancer in Iran, we aimed to search hospital registries of breast cancer patients to investigate type 2 diabetes mellitus association with survival outcomes of early breast cancer after adjustment of confounding factors. Methods: In a retrospective cohort study conducted from July 2003 to Feb 2014 and followed up until death or December 2016, female patients with early breast cancer who have been treated for the first time at the Cancer Institute of Iran, were divided to diabetic and non-diabetic groups. Primary and secondary outcomes were relapse free survival (RFS) and overall survival (OS). SPSS version 23 was used for analysis of data. Other variables included age, tumor stage, hormone receptor status, tumor subtype, and patient’s body mass index (BMI). Result: From a total of 1021 patients, 218 (21.4%) had type 2 diabetes mellitus. Diabetic patients had a higher mean age (53.31 vs 47.00), higher mean BMI (31.13 vs 29.15), lower HER2 expression (20.8% vs 32.1%) and higher frequency of luminal A subtype (61.1% vs 51.0). Overall, after adjustment of other variables, diabetes status did not affect RFS or OS independently. However, in luminal A subgroup, patients with diabetes mellitus had significantly lower survival outcomes of OS (135.277 vs 154.701) and RFS (114.107 vs 133.612) as well as OS higher hazard ratio of 1.830 and RFS hazard ratio of 1.663 compared to non-diabetic patients. BMI, hormone receptor status and tumor stage significantly affected the survival of the patients. Conclusion: In the present study, in addition to known breast cancer risk factors, BMI and type 2 diabetes mellitus had an independent impact on survival of the patients, highlighting the importance of health issues such as obesity and diabetes suboptimal performance in the treatment outcomes of early breast cancer patients in Iran.     

Factors Affecting Survival in Patients with Colorectal Cancer in Shiraz,Iran

Background: Colorectal cancer (CRC) is the third most common cancer in the world, and the fourth in Iran in both genders. The aim of this study was to find predictive factors for CRC survival. Materials and Methods: Medical records of 570 patients referred to the radiotherapy oncology department of Shiraz Namazi hospital from 2005 to 2010 were retrospectively analysed. Data were collected by reviewing medical records, and by telephone interviews with patients. Survival analysis was performed using the Cox’s regression model with survival probability estimated with Kaplan-Meier curve. The log-rank test was used to compare survival between strata. Data was analyzed with Stata 12. Results: The five-year survival rate and the mean survival time after cancer diagnosis were 58.5% and 67±1.4 months. On multivariate analysis, age of diagnosis, disease stage and primary tumor site‚ lymphovascular invasion and type of treatment (in colon cancer) were significant factors for survival. Conclusions: Age of diagnosis and type of treatment (adjuvant therapy in patients with colon cancer) were two modifiable factors related to survival of CRC patients. Therefore earlier diagnosis might help increase survival.     

Endometrial Cancer in Hospital Universiti Sains Malaysia

Background: Endometrial cancer is the most common gynecological malignancy among females worldwide, approximately 320,000 women being diagnosed with the disease each year and 76,000 dying. To date, there is limited knowledge of endometrial cancer in Malaysia. Objectives: To identify the epidemiological profile and prognostic factors of survival. Materials and Methods: A list of endometrial cancer patients in 2000-2011 was obtained from the hospital Record Department. Only cases confirmed by histopathology examination were included. We excluded those with incomplete medical records or referral cases. Simple and multiple Cox regression approaches were used for data analysis. Results: Only 108 cases were included with a mean (SD) age of 62.7 (12.3) years, with 87.0% Malay ethnicity. Grade of cancer was: 29.1% grade 1, 43.7% grade 2 and 27.2% grade 3. The majority of patients had non-endometrioid type (60.2%), with myometrial invasion (82.2%) and lymphovascular invasion (57.3%). The significant prognostic factors were age (HR 1.05; 95% CI: 1.02, 1.08, p=0.002) and having lymphovascular invasion (HR 2.15; 95% CI: 1.08, 4.29; p=0.030). Conclusions: Endometrial cancer patients should be diagnosed earlier to reduce the risk of mortality. The public should be given education on the signs and symptoms of the disease.     

Male Breast Cancer: a 24 Year Experience of a Tertiary Care Hospital in Pakistan

Background: Male breast cancer accounts for less than 1% of all cancers found in men. It usually presentsat a later age and stage as compared to female breast cancer. Treatment strategies are extrapolated from themanagement of female breast cancer. Our study here looked at 18 patients diagnosed with and treated for malebreast cancer at The Aga Khan University Hospital in Pakistan. We compared our findings with the existingdata from Asian and Western countries. Materials and Methods: A retrospective study was conducted looking atpatients with male breast cancer between January 1986 and December 2009. Patient and disease characteristicswere analyzed and 5 year overall survival was calculated using Microsoft Excel and SPSS. Results: The averageage at diagnosis was 52 years (38-67 years). Twelve (66.7%) patients had axillary lymphadenopathy. Stage IIdisease was the most common stage at presentation (9 patients, 50%). Infiltrating ductal carcinoma was seen in16 patients (88.8%). Seven lesions were positive for both estrogen and progesterone receptors. Sixteen patientshad surgery in the form of either modified radical mastectomy or radical mastectomy. Radiation was used in7 patients in an adjuvant setting. The five year overall survival for stage I, II, III and IV disease was 100% vs78% vs 50% vs 0%( p<0.05). Five year overall survival was 61%. None of the other prognostic factors werestatistically significant. Median follow up was 15 months (3-202 months). Conclusions: Male breast cancer maybe on a slow rise but is still an uncommon disease. Tumor stage and lymph node status are important prognosticmarkers. Public awareness and screening may help in detecting the disease at an earlier stage. Prospective trialsare needed to improve the management of this disease.     

Eight Year Survival Analysis of Patients with Triple Negative Breast Cancer in India

Background: Triple-negative breast cancer (TNBC) often presents as an interval cancer with short survival upon metastasis and thus represents an important clinical challenge. The present study investigated the clinicopathologic characteristics and long term survival outcome of early and locally advanced TNBC. Materials and Methods: Medical records were reviewed retrospectively for 148 consecutive confirmed cases of TNBC treated in a single unit at our centre. Demographic profile, tumor type, histopathology details, treatment and follow-up information was recorded and immunohistochemistry was performed. Results: Age group >50 years was associated with tumors of clinical stage 3 (53.8%), pathological stage 3 (46.2%), pathological grade 3 (45.7%), presence of extracapsular extension (ECE, 48.5%) and lymphovascular invasion (LVI, 64.9%). Locally advanced breast cancers (LABCs) were characterized by pathological stage 3 (96.2%), presence of ECE (100%) and absence of LVI (46.7%) as compared to early breast cancers (EBCs) which had higher incidence of lower stage tumors (100%), absence of ECE (82%) and presence of LVI (91.9%; p-value Conclusions: TNBCs are aggressive tumors which show poor long term survival. Patients with TNBC benefit from chemotherapy, thus better and less toxic treatment options are needed. Identification of newer targets and development of targeted therapies are the need of the hour.     

Breast Cancer Screening in Malaysia: A Policy Review

Background: Breast cancer is the leading cause of cancer among Malaysian women. The implementation of prevention measures including screening has the potential to reduce the burden of breast cancer which caused by late presentation. Aims: This paper aimed to review the public health policy relating to breast cancer screening in Malaysia that was undertaken in order to contribute to policy development regarding cancer prevention, detection and the improvement of services for Malaysian women. Methods: The policy review strategy included a specific search of the website of the Ministry of Health in Malaysia for relevant policies. In addition, we searched Google and Pubmed for breast cancer screening programmes, policies, and guidelines for women in Malaysia. In addition, experts and stakeholders provided additional resources, published in Malay language. Relevant guidelines in the Malay language were translated into English and included the document review. Results: The policy analysis indicated that although it is known that screening, early detection and diagnosis improve survival rates, delayed diagnosis remains a significant issue.  The Ministry of Health policy stipulates the provision of opportunistic mammography screening. However, the uptake is varied, and implementation is challenging due to a lack of awareness about screening and difficulties related to accessing services, especially in rural areas. The establishment and implementation of referral guidelines is essential to receive timely treatment for breast cancer patients. There is a need to enhance the cancer reporting by the doctors to the national cancer registry, in collaboration with government services and the private cancer-care sector to improve the monitoring and evaluation of cancer control policies and programmes. Conclusion: A focus on raising awareness, increasing the accessibility of screening facilities and improving referral processes and the overall connectivity of the cancer care system are key steps to down-staging breast cancer in Malaysia.