title: Breast cancer in South East Asia: comparison of presentation and outcome between a middle income and a high income country.
abstract: BACKGROUND
  There are large differences in socio-economic growth within the region of South East Asia, leading to sharp contrasts in health-systems development between countries. This study compares breast cancer presentation and outcome between patients from a high income country (Singapore) and a middle income country (Malaysia) in South East Asia.
  
  
  METHODS
  Within the Singapore Malaysia Breast Cancer Registry we identified all consecutive patients diagnosed with breast cancer between 1993 and 2007 at the National University Hospital in Singapore (high income country, n=2,141) and the University of Malaya Medical Center in Kuala Lumpur, Malaysia (middle income country, n=3,320). We compared demographics, tumor characteristics, treatment patterns, and survival between patients from both countries.
  
  
  RESULTS
  In Malaysia, patients were less often diagnosed with in situ breast cancer (adjusted odds ratio [ORadj] 0.2; 95% confidence interval [95% CI] 0.1-0.3), more likely to be diagnosed with late stage (III and IV) disease (ORadj for stage III 1.6; 95% CI 1.3-2.0; ORadj for stage IV 1.2; 95% CI 1.1-1.4) as compared to patients from Singapore. Univariate analysis showed that Malaysian patients were at a 72% increased risk of death as compared to Singaporeans. After adjusting for other prognostic factors, the risk decreased by only 5% (ORadj 1.67, 95% CI 1.44-1.92).
  
  
  CONCLUSIONS
  Differences in way of presentation (except stage and tumor size) and treatment of breast cancer patients from the two countries are small. The overall survival of breast cancer patients from Malaysia is much lower than that of Singaporean patients.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, MD3 16 Medical Drive, Singapore, 117597, Singapore.
authors.forename: Nakul
authors.initials: N
authors.lastname: Saxena
authors.forename: Mikael
authors.initials: M
authors.lastname: Hartman
authors.forename: Nirmala
authors.initials: N
authors.lastname: Bhoo-Pathy
authors.forename: Jennifer N W
authors.initials: JN
authors.lastname: Lim
authors.forename: Tar-Ching
authors.initials: TC
authors.lastname: Aw
authors.forename: Philip
authors.initials: P
authors.lastname: Iau
authors.forename: Nur Aishah
authors.initials: NA
authors.lastname: Taib
authors.forename: Soo-Chin
authors.initials: SC
authors.lastname: Lee
authors.forename: Cheng-Har
authors.initials: CH
authors.lastname: Yip
authors.forename: Helena M
authors.initials: HM
authors.lastname: Verkooijen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D019049:Developed Countries; D003906:Developing Countries; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008296:Malaysia / Q000453:epidemiology; D008408:Mastectomy / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012846:Singapore / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome