Spectrum of very early breast cancer in a setting without organised screening

While breast cancer incidence rates have stabilised or even decreased in affluent western countries, the incidence of breast cancer in most Asian countries continues to escalate over the past few decades (Wang and Cao, 1996; Ravdin et al, 2007; Porter, 2008; Fontenoy et al, 2010). Furthermore, a substantial proportion of Asian patients with breast cancer are diagnosed at advanced stages compared with their western counterparts rendering survival rates to suboptimal levels in this part of the world (Anderson et al, 2011). Early detection is associated with better survival probabilities, where the 5 and 10-year survival rates for women diagnosed with stage 0 or I breast cancer range between 90% and 100% (Owen et al, 2013; Ries and Esner, 2013). The two cornerstones of early detection are awareness of the disease, and both opportunistic and population-based screening. While population-based screening mammography is implemented in many affluent western countries, it is argued as not being cost-effective in most of Asia (Woo et al, 2007; Okonkwo et al, 2008; Kang et al, 2013) and had been offered only in high-income countries including Japan since 1987, Korea since 1999, and Singapore since 2003 (Kwong et al, 2008; Lim et al, 2010). Given that Asia has seen rapid socio-economic development over recent times, it is conceivable that awareness of (breast) cancer in the population has increased, leading to more women presenting at earlier stages of breast cancer despite the absence of organised breast cancer screening programs. Malaysia is a middle-income country in South East Asia, which comprises three major ethnic groups, that is, Malays, Chinese, and Indians. It does not implement population-based mammography screening programme, but adopts opportunistic screening where mammography is targeted and offered to high-risk women. Clinical breast examination (CBE) by trained health professionals and self-breast examination (SBE) are also widely advocated, but as a measure to increase breast cancer awareness among women at risk rather than as a screening method. We sought to determine the trends in presentation of very early breast cancer (stage I), and the associated factors in a Malaysia setting. Tumour characteristics, management patterns, and survival of very early breast cancer were described, and where appropriate, compared with other settings.