1.A Review of Breast Cancer Research in Malaysia
CH Yip ; N Bhoo Pathy ; SH Teo
The Medical Journal of Malaysia 2014;69(Supplement A):8-22
Four hundred and nineteen articles related to breast cancer
were found in a search through a database dedicated to
indexing all original data relevant to medicine published in
Malaysia between the years 2000-2013. One hundred and fifty
four articles were selected and reviewed on the basis of
clinical relevance and future research implications. Overall,
Malaysian women have poor survival from breast cancer and
it is estimated that half of the deaths due to breast cancer
could be prevented. Five-year survival in Malaysia was low
and varies among different institutions even within the same
disease stage, suggesting an inequity of access to optimal
treatment or a lack of compliance to optimal treatment.
Malaysian women have poor knowledge of the risk factors,
symptoms and methods for early detection of breast cancer,
leading to late presentation. Moreover, Malaysian women
experience cancer fatalism, belief in alternative medicine, and
lack of autonomy in decision making resulting in delays in
seeking or avoidance of evidence-based medicine. There are
ethnic differences in estrogen receptor status, HER2
overexpression and incidence of triple negative breast cancer
which warrant further investigation. Malay women present
with larger tumours and at later stages, and even after
adjustment for these and other prognostic factors (stage,
pathology and treatment), Malay women have a poorer
survival. Although the factors responsible for these ethnic
differences have not been elucidated, it is thought that
pharmacogenomics, lifestyle factors (such as weight-gain,
diet and exercise), and psychosocial factors (such as
acceptance of 2nd or 3rd line chemotherapy) may be
responsible for the difference in survival. Notably,
survivorship studies show self-management programmes and
exercise improve quality of life, highlighting the need to
evaluate the psychosocial impact of breast cancer on
Malaysian women, and to design culturally-, religiously- and
linguistically-appropriate psycho-education programmes to
help women cope with the disease and improve their quality
of life. Research done in the Caucasian populations may not
necessarily apply to local settings and it is important to
embark on local studies particularly prevention, screening,
diagnostic, prognostic, therapeutic and psychosocial
research.
KEY WORDS: breast cancer; Malaysia; review; genetics; screening;
diagnosis; prognosis; treatment; outcome
2.Patterns of breast cancer relapse at University of Malaya Medical Centre
Rozita AM ; Marniza S ; Mastura MY ; Wan Zamaniah WI ; Yip CH ; Taib NA
Journal of University of Malaya Medical Centre 2010;13(1):24-32
Despite being the major cause of cancer-related death in Malaysian women, local data on
patterns of breast cancer relapse and their long term outcomes are still scarce. We conducted
a retrospective study on all patients treated for non-metastatic invasive breast cancer in 1999-
2000 at the University of Malaya Medical Centre (UMMC), who subsequently developed relapse.
We sought to analyse the patterns of relapse, their associated clinicopathological features and
the overall survival ratefollowing the relapses. Univariate and multivariate analyses were used to
analyse demographics and clinicopathological factors. Survival was analysed using the Kaplan
and Meier method and compared by the log rank test. A total of 268 patients with a mean age
of 50, were identified for the study. At a median follow-up of 50 months, 73 patients (27.2%)
had relapsed. Local, regional and distant relapse rates were 5.5%, 1.9% and 19.8% respectively,
whereas, the 5-year survival rates were 61%, 40% and 21% respectively (p < 0.01). Most relapses
occurred within the first five years of diagnosis. Patients with long disease-free interval had better
survival. The most common distant relapse site was the lungs while bone was the distant relapse
site with the best prognosis. Disease stage, nodal status and oestrogen receptor status were
found to have correlation with the risk of relapse. We concluded that the survival of patients with
relapsed breast cancer was associated with the site(s) of first relapse and the disease free interval
and clinicopathological factors can be used to predict the risk of relapse.
Breast Neoplasms