title: Spectrum of very early breast cancer in a setting without organised screening.
abstract: BACKGROUND
  Within a setting without organised breast cancer screening, the characteristics and survival of very early breast cancer were determined.
  
  
  METHODS
  All 4930 women diagnosed with breast cancer in University Malaya Medical Center, Malaysia from 1993 to 2011 were included. Factors associated with very early presentation (stage I) at diagnosis were identified. Tumour characteristics, management patterns, and survival of very early breast cancer were described, and where appropriate, compared with other settings.
  
  
  RESULTS
  Proportion of women presenting with stage I breast cancer significantly increased from 15.2% to 25.2% over two decades. Factors associated with very early presentation were Chinese ethnicity, positive family history of breast cancer, and recent period of diagnosis. Within stage I breast cancers, median tumour size at presentation was 1.5 cm. A majority of stage I breast cancer patients received mastectomy, which was associated with older age, Chinese ethnicity, postmenopausal status, and larger tumours. Chemotherapy was administered in 36% of patients. Five-year age-adjusted relative survival for women with stage I breast cancer was 99.1% (95% CI: 97.6-99.6%).
  
  
  CONCLUSIONS
  The proportion of women presenting with very early breast cancer in this setting without organised screening is increasing. These women seem to survive just as well as their counterparts from affluent settings.
authors.affiliation: 1] Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia [2] Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Bhoo-Pathy
authors.affiliation: National Clinical Research Centre, Hospital Kuala Lumpur, Level 3, Dermatology Block, Jalan Pahang, 50586 Kuala Lumpur, Malaysia.
authors.forename: S
authors.initials: S
authors.lastname: Subramaniam
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: N A
authors.initials: NA
authors.lastname: Taib
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore.
authors.forename: M
authors.initials: M
authors.lastname: Hartman
authors.affiliation: Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: Z
authors.initials: Z
authors.lastname: Alias
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: G-H
authors.initials: GH
authors.lastname: Tan
authors.affiliation: Faculty of Science and Technology, Islamic Science University of Malaysia (USIM), 71800 Nilai, Negeri Sembilan, Malaysia.
authors.forename: R I
authors.initials: RI
authors.lastname: Ibrahim
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: C-H
authors.initials: CH
authors.lastname: Yip
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore.
authors.forename: H M
authors.initials: HM
authors.lastname: Verkooijen
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008296:Malaysia; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging
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