Breast cancer incidence is expected to continue to increase for the next 10 years in Asia and may approach rates reported among Asian-Americans. The number and mean age of breast cancer cases is expected to increase as the female Asian population ages, the prevalence of certain risk factors changes (early menarche, late menopause, low parity, late age at first live birth, and low prevalence of breastfeeding), and as Asian countries introduce mass screening programs.

Breast cancer risk is increasing in most Asian female populations, but little is known about the long-term mortality trend of the disease among these populations. We extracted data for Hong Kong (1979Kong ( -2005, Japan , Korea (1985Korea ( -2006, and Singapore from the World Health Organization (WHO) mortality database and for Taiwan from the Taiwan cancer registry. The annual age-standardized, truncated (to ‡20 years) breast cancer death rates for 11 age groups were estimated and joinpoint regression was applied to detect significant changes in breast cancer mortality. We also compared age-specific mortality rates for three calendar periods (1975-1984, 1985-1994, and 1995-2006). After 1990, breast cancer mortality tended to decrease slightly in Hong Kong and Singapore except for women aged 70+. In Taiwan and Japan, in contrast, breast cancer death rates increased throughout the entire study period. Before the 1990s, breast cancer death rates were almost the same in Taiwan and Japan; thereafter, up to 1996, they rose more steeply in Taiwan and then they began rising more rapidly in Japan than in Taiwan after 1996. The most rapid increases in breast cancer mortality, and for all age groups, were in Korea. Breast cancer mortality trends are expected to maintain the secular trend for the next decade mainly as the prevalence of risk factors changes and population ages in Japan, Korea, and Taiwan. Early detection and treatment improvement will continue to reduce the mortality rates in Hong Kong and Singapore as observed in Western countries. (Cancer Sci 2010; 101: 1241-1246 I n Asian countries, the mortality rates from breast cancer are relatively lower than in Western, industrialized countries (1) and have been on the increase until recently in China, (2,3) Japan, (4) Korea, (5,6) and Taiwan.In contrast, breast cancer mortality has been declining in Western countries for decades. (8,9) The decline has been explained in part by the cohort effect in women born after 1920 (a group that had more children and began childbearing at a lower age) and in part to improved management and treatment of women with the disease. In the 1980s, after it was shown in Sweden that mammography screening could lead to reduced breast cancer mortality, (10)(11)(12)(13) other European countries started to establish screening programs. (14) Because of the low breast cancer incidence rates in Hong Kong, Singapore, and Taiwan, population-based screening programs were not recommended in those populations until the early 1990s.(15-17) Taiwan started mammography screening for high-risk groups in 1995, (18) and Japan,Korea, (20) and Singapore (16,21) started organized mammography screening programs in the early 2000s. In Hong Kong, screening is done by voluntary ('opportunistic') mammography. (22) In this paper, we review the most available data on breast cancer mortality in Hong Kong, Japan, Korea, Singapore, and Taiwan, and we attempt to describe and compare their secular changing patterns. Materials and MethodsWe extracted annual breast ca...

Stage IIB Hodgkin lymphoma (HL) patients, with a mediastinum-to-thorax (M/T) ratio of ≥0.33 or extranodal localization have a poor prognosis and are treated either as limited or advanced stage. We compared these two approaches in patients included in two randomized phase III trials enrolling previously untreated early (H10) or advanced stage HL (AHL2011). We included HL patients with Ann-Arbor stage IIB with M/T ≥0.33 or extranodal involvement enrolled in the H10 or AHL2011 trials with available PET at baseline and after two cycles of chemotherapy (PET2). Baseline total metabolic tumor volume (TMTV) was calculated using the 41% SUVmax method. PET2 response assessment used the Deauville score. 148 patients were eligible, including 83 enrolled in the AHL2011 trial and 65 in the H10 trial. The median TMTV value was 155.5 mL (8.3-782.9), 165.6 mL in AHL2011 and 147 mL in H10. PET2 positivity rates were 16.9% (n=14) and 9.2% (n=6) in AHL2011 and H10 patients, respectively. With a median follow-up of 4.1 years (95%CI 3.9-4.4), overall 4-year PFS was 88.0%, 87.0% in AHL2011 and 89.2% in H10. In univariate and mutivariate analyses, baseline TMTV and PET2 response influenced significantly PFS (HR=4.94, HR=3.49 respectively). Notably, among the 16 patients who relapsed, 13 (81%) had a baseline TMTV baseline ≥ 155 mL. Upfront ABVD plus radiation therapy or upfront escBEACOPP without radiotherapy provide similar patient’s outcome in high-risk stage IIB HL. TMTV is useful to stratify these patients at baseline.

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The LNH03-6B trial was a phase 3 randomized trial evaluating the efficacy of first-Line R-CHOP delivered every 2 weeks (R-CHOP14) or 3 weeks (R-CHOP21) in diffuse large B-cell lymphoma patients aged 60-80 years with an age-adjusted IPI score greater than or equal to 1 (registered as NCT00144755). We implemented a prospective long-term follow-up (LTFU) program at the end of this trial. The primary endpoints were progression-free survival (PFS) and Overall survival (OS). Relapse patterns and PFS/OS after the first progression (PFS2/OS2) were secondary endpoints. LNH03-6B was registered with ClinicalTrial.gov number NCT00144755. In the LNH03-6B trial, 304 and 296 patients were assigned to receive 8 cycles of R-CHOP14 or R-CHOP21, respectively. LTFU data were investigated for 256/384 (67%) patients who were still alive at the primary analysis. With a median follow-up of 10.1 years, 213 patients progressed, and 140 patients died without progression. The ten-year PFS was 40.4% (95% CI: 35.9-44.9). Ten-year OS was based on 302 deaths and estimated at 50% (43-56). One hundred and five of the 213 patients (49%) progressed after second-line therapy, and 77 patients died without a second progression (36%). The 1-year PFS2 and 1-year OS2 were estimated at 37.9% [31.4-44.5] and 55.8% [48.8-62.2], respectively. Ten years after randomization, the outcomes of patients treated for DLBCL were similar according to PFS and OS between the RCHOP-14 and R-CHOP21 groups. Progression/relapse led to poor prognosis after second-line chemotherapy in the pre-CAR-T era. Novel approaches in first-line and alternative treatments in second-line treatments are warranted in this population.