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.
The database of two population-based cancer registries (Philippine Cancer Society-Manila Cancer Registry and Department of Health-Rizal Cancer Registry) was used to generate age-standardized incidence rates of cancer during 1980-2002. Five-year relative survival rates were obtained for incident cases from 1993 to 2002 using a period analysis method. Overall incidence had increased in both males and females. Among males, lung cancer was the leading cancer and reached a peak in 1988-92. Colorectal and prostate cancers showed rising trends and became more common than liver cancer, with stable incidence over time. Stomach cancer incidence fell steeply. Among females, there was a steady increase in incidence of breast cancer. There was a slight decrease in the incidence of the second common cancer, cervical cancer, and colorectal cancer became equally common. Lung cancer incidence in females also reached a peak by 1998-2002 and then slightly decreased. Oral cavity cancer decreased strongly in the last period. In general, survival rates among Philippine residents were one-third lower than among Filipino-Americans and Whites in the USA especially in cancer sites wherein effective early detection methods may be available such as breast, cervix, colorectal and thyroid cancers. Survival was also lower in Philippine leukemia cases, a disease wherein effective treatment is proven in some types but is quite expensive. Lifestyle factors such as smoking, unhealthy diet, physical inactivity, and human papillomavirus and hepatitis B virus infections were associated with some incidence patterns. Late stage at diagnosis was largely responsible for low survival.
Despite the availability of population-based cancer survival data from the developed and developing countries, comparisons remain very few. Such comparisons are important to assess the magnitude of survival discrepancies and to disentangle the impact of ethnic background and health care access on cancer survival. Using the SEER 13 database and databases from the Manila and Rizal Cancer Registries in the Philippines, a 5-year relative survival for 9 common cancers in 1998 -2002 of Filipino-American cancer patients were compared with both cancer patients from the Philippines, having the same ethnicity, and Caucasians in the United States, being exposed to a similar societal environment and the same health care system. Survival estimates were much higher for the FilipinoAmericans than the Philippine resident population, with particularly large differences (more than 20 -30% units) for cancers with good prognosis if diagnosed and treated early (colorectal, breast and cervix), or those with expensive treatment regimens (leukaemias). Filipino-Americans and Caucasians showed very similar survival for all cancer sites except stomach cancer (30.7 vs 23.2%) and leukaemias (37.8 vs 48.4%). The very large differences in the survival estimates of Filipino-Americans and the Philippine resident population highlight the importance of the access to and utilisation of diagnostic and therapeutic facilities in developing countries. Survival differences in stomach cancer and leukaemia between Filipino-Americans and Caucasians in the United States most likely reflect biological factors rather than the differences in access to health care.
The hypothesized benefit of adjuvant luteal phase oophorectomy was not shown in this large trial.
BACKGROUND:In premenopausal women treated for breast cancer, loss of bone mineral density (BMD) follows from menopause induced by chemotherapy or loss of ovarian function biochemically or by surgical oophorectomy. The impact on BMD of surgical oophorectomy plus tamoxifen therapy has not been described. METHODS: In 270 Filipino and Vietnamese premenopausal patients participating in a clinical trial assessing the impact of the timing in the menstrual cycle of adjuvant surgical oophorectomy on breast cancer outcomes, BMD was measured at the lumbar spine and femoral neck before this treatment, and at 6, 12, and 24 months after surgical and tamoxifen therapies. RESULTS: In women with a pretreatment BMD assessment and at least 1 other subsequent BMD assessment, no significant change in femoral neck BMD was observed over the 2-year period (20.006 g/cm 2 , 20.8%, P 5.19), whereas in the lumbar spine, BMD fell by 0.045 g/cm 2 (4.7%) in the first 12 months (P <.0001) and then began to stabilize. CONCLUSIONS:Surgically induced menopause with tamoxifen treatment is associated with loss of BMD at a rate that lessens over 2 years in the lumbar spine and no significant change of BMD in the femoral neck. Cancer 2013;119:3746-52. V C 2013 American Cancer Society.KEYWORDS: bone mineral density; breast cancer; menopause; oophorectomy; tamoxifen; femoral neck; spine; adjuvant drug therapy. INTRODUCTIONIn high-income countries, premenopausal women with hormone receptor-positive tumors account for 15% of the case burden in breast cancer; however, in low-and middle-income countries this percentage is approximately 36%. 1 Globally, one-third of the case burden in breast cancer is in this group. With increasingly effective therapies and the associated increases in long-term survival, the total "costs" of therapies are of concern to afflicted women.Adjuvant ovarian ablation improves survival in premenopausal women with operable breast cancer unselected for hormonal receptor status.2 Meta-analysis data also suggest a trend favoring ovarian ablation over luteinizing hormonereleasing hormone (LHRH) agonist treatment.2 Adjuvant surgical oophorectomy plus tamoxifen improves survival with risk reduction of 0.54 in hormone receptor positive patients.3 A variety of direct but underpowered studies and indirect risk reduction data suggest that this combined hormonal adjuvant treatment may modestly improve results over oophorectomy or tamoxifen alone. [4][5][6][7][8] The direct adjuvant comparison of tamoxifen with or without ovarian ablation or ovarian function suppression is being tested in the SOFT trial, in which, however, the fraction of women treated with surgical oophorectomy may be too small to allow conclusions about this specific combined hormonal treatment. In this context, in high-income countries, many premenopausal women with hormone receptor-positive tumors are treated with chemotherapy and tamoxifen, because of the conclusion that current chemotherapy regimens, particularly with taxanes, provide greater benefits than any hormonal th...
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