title: Trends in presentation, management and survival of patients with de novo metastatic breast cancer in a Southeast Asian setting.
abstract: Up to 25% of breast cancer patients in Asia present with de novo metastatic disease. We examined the survival trends of Asian patients with metastatic breast cancer over fifteen years. The impact of changes in patient's demography, tumor characteristics, tumor burden, and treatment on survival trend were examined. Patients with de novo metastatic breast cancer from three hospitals in Malaysia and Singapore (N = 856) were grouped by year of diagnosis: 1996-2000, 2001-2005 and 2006-2010. Step-wise multivariable Poisson regression was used to estimate the contribution of above-mentioned factors on the survival trend. Proportions of patients presenting with metastatic breast cancer were 10% in 1996-2000, 7% in 2001-2005, and 9% in 2006-2010. Patients in 2006-2010 were significantly older, appeared to have higher disease burden, and received more chemotherapy, endocrine therapy, and surgery of primary tumor. The three-year relative survival in the above periods were 20·6% (95% CI: 13·9%-28·2%), 28·8% (95% CI: 23·4%-34·2%), and 33·6% (95% CI: 28·8%-38·5%), respectively. Adjustment for treatment considerably attenuated the relative excess risk of mortality in recent years, compared to other factors. Substantial improvements in survival were observed in patients with de novo metastatic breast cancer in this study.
authors.affiliation: Julius Centre University of Malaya, Centre for Evidence Based Medicine and Clinical Epidemiology, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.|Julius Center for Health Sciences and Primary Care, University Medical Center, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Bhoo-Pathy
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597.
authors.forename: Helena Marieke
authors.initials: HM
authors.lastname: Verkooijen
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
authors.forename: Ern-Yu
authors.initials: EY
authors.lastname: Tan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597.
authors.forename: Hui
authors.initials: H
authors.lastname: Miao
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: Nur Aishah Mohd
authors.initials: NA
authors.lastname: Taib
authors.affiliation: Institution of Medical Epidemiology and Biostatistics, Karolinska Instituet, Nobels Väg 12A, 171 77 Stockholm, Sweden.
authors.forename: Judith S
authors.initials: JS
authors.lastname: Brand
authors.affiliation: National Cancer Centre Singapore, 11 Hospital Dr, Singapore 169610.|Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Dent
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: Mee-Hoong
authors.initials: MH
authors.lastname: See
authors.affiliation: National Clinical Research Centre, Level 3, Dermatology Block, Kuala Lumpur Hospital, 50586 Jalan Pahang, Kuala Lumpur, Malaysia.
authors.forename: ShriDevi
authors.initials: S
authors.lastname: Subramaniam
authors.affiliation: Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
authors.forename: Patrick
authors.initials: P
authors.lastname: Chan
authors.affiliation: Department of Hematology Oncology, National University Cancer Institute, National University Health System, Singapore 119228.
authors.forename: Soo-Chin
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597.
authors.forename: Mikael
authors.initials: M
authors.lastname: Hartman
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
authors.forename: Cheng-Har
authors.initials: CH
authors.lastname: Yip
mesh_terms: D044466:Asian People; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D008296:Malaysia; D008875:Middle Aged; D011379:Prognosis; D047368:Tumor Burden / Q000502:physiology