Management of primary breast cancer in Hong Kong -- can the guidelines be met?

Secular trends in breast cancer mortality in five East Asian populations: Hong Kong, Japan, Korea, Singapore and Taiwan

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 (1979-2005), Japan (1963-2006), Korea (1985-2006), and Singapore (1963-2006) from the World Health Organization (WHO) mortality database and for Taiwan (1964-2007) from the Taiwan cancer registry. The annual age-standardized, truncated (to > or =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.

How relevant is breast cancer screening in the Asia/Pacific region?

Nationwide breast cancer screening with mammography is well-established in many western countries. Many studies have shown its benefit in mortality reduction. However, breast cancer screening in Asia has been slow to implement, as it was perceived that the breast cancer incidence was low and the parenchyma of Asian women was difficult to assess mammographically. With changing disease patterns, breast cancer is now one of the most common cancers amongst women in Asia. Breast cancer screening has become an important and relevant health problem. However, apart from biological differences between western and Asian women, cultural and economic considerations need to be addressed. This paper looks at the various issues pertaining to the feasibility and relevance of population-based screening in the Asia/Pacific region.

Approach to a lump in the breast: a regional perspective

The clinical presentation, investigation and treatment of women with breast lumps are greatly influenced by geographical factors. These impact disease patterns and their presentation (e.g. socioeconomic/educational status and cultural/religious beliefs) and the availability of specialist health care personnel and facilities. The differential diagnoses of a breast lump include breast cancer, benign solid and cystic lumps and inflammatory conditions. The likelihood of a diagnosis relates more to geographical area, age, ethnic origin, family history of breast cancer, presence of high-risk pathology, endemic infection, smoking, pregnancy and lactation history, puerperal care and health education. Investigations and treatments vary more according to the availability of expertise and facilities (e.g. combined diagnostic clinic staffed by breast surgeon and radiologist; breast radiologist to carry out image-guided diagnostic and therapeutic procedures). This article discusses the clinical assessment and investigation of breast lumps and possible treatments from an Asia Pacific perspective.