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Breast Unit - University Malaya Medical Centre
Breast Unit - University Malaya Medical Centre
Breast Unit
– University Malaya
Medical Centre
CH Yip
Professor
Department of Surgery
University Malaya Medical Centre
Female Breast Cancer
– NCR report 2003-2005
• 11 952 new cases over 3 years
• Commonest cancer in Malaysia overall
• Commonest cancer in Malaysian women
• Crude rate 41.3 per 100,000
• Age standardised rate (ASR) 46.4 per 100,000
• Cumulative risk 5.0 ie a woman in Malaysia
have a 1 in 20 chance of developing breast
cancer in her lifetime
Female Breast Cancer– NCR report 2003-5
Race Incidence
97
99
07
93
01
03
05
19
19
19
20
19
20
20
20
Breast Cancer in UMMC
Stage at presentation and race 2008 (442 cases)
Malays 72
Chinese 313
Early Stage –Stage 1 and 2 Indians 57
Late Stage – Stage 3 and 4
100%
90% Stage 4
80% Stage 3
70% Stage 2
60% Stage 1
50% Stage 0
40%
30%
20%
10%
0%
Malays Chinese Indians
Hormone receptor status at
presentation
White Hispanic Blacks UMMC
13239 cases.
Gapstur etal Cancer 1996
15 year review of ER status in UMMC
P=0.406
15 year review of ER status in UMMC
P=0.003
15 year review of ER status in UMMC
P=0.007
Ongoing analysis of breast cancer
database
Master of Surgery projects – funding from the
Clinical Masters research grant
1.0
Estimated survival probabilities
0.8
0.584
0.6
0.4
0.2
0.0
0 20 40 60 80 100
Survival times
Stage 2
0.6
Stage 3
0.4
0.2
Stage 4
p < 0.05
0.0
0 20 40 60 80 100
Survival times
Chinese
Indian
Malay
0.8
Estimated survival probabilities
p = 0.0025
0.6
0.4
0.2
0.0
0 20 40 60 80 100
Survival times
Survival analysis
• 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.
• Survival analysis ongoing – comparing
survival in 5-year cohorts
5-year Overall Survival
1.0
76.2%
0.8
Survival Probability
0.6
0.4
59.1%
0.2
patients 93 - 97
patients 98 - 02
0.0
0 20 40 60 80 100
Months
1.0
Chinese
Indian
Malay
0.8
0.8
Survival Probability
0.6
0.6
Survival
0.4
0.4
Others
Malay
0.2
Indian
Chinese
0.2
p= 2.85e-010
0.0
p-value0.00631 0 20 40 60 80 100
0.0
Months
0 20 40 60 80 100
Months
1.0
0.8
Survival Probability
0.6
1993-97
1.0
I
0.4
II
III
IV stg IV
0.8
stg III
0.2
stg II
stg I
stg 0
0.6
p= 0
Survival
0.0
0 20 40 60 80 100
0.4
Months
0.2
0 20 40 60 80 100
Months
Stage 0 NA 100%
Stage 1 82.6% 95%
p=0.
Stage II 72.8% 87.1%
Stage III 39.8% 56.3%
Stage IV 13.2% 20.7%
History of Breast Services
Breast Clinic database - non-dedicated service-
1993-1996 General Surgeons performing surgery and
chemotherapy
1998
In-house radiotherapy services
1996
Dedicated Breast Unit
with surgical
chemotherapy service
1999
Daycare Oncology
chemotherapy service
History of Breast Services
1993 to present
1993 Radiologist services
2000 Reconstruction
2003 Combined pathology meeting
Support Services
Cohort selection
for BRCA1 / 2 screening
n = 282
Patients with
deleterious Patients with Patients with
mutations unclassified variants no mutations
n = 41 n = 63 n = 183
Patients approached
for genetic Patients approached
Other genetic studies
counseling genetic counseling
& family studies
Uptake of BRCA status results
Patients with
deleterious mutations
n = 41
• Worried about
insurance
• Doesn’t think that
Information will be useful
• Doesn’t think they can cope
with the knowledge
Lessons learnt from pilot study