Tan Benita Kiat Tee, Lim Gek Hsiang, Czene Kamila, Hall Per, Chia Kee Seng
Department of General Surgery, Singapore General Hospital, Outram Road, Singapore, Singapore.
Breast Cancer Res. 2009;11(1):R4. doi: 10.1186/bcr2219. Epub 2009 Jan 24.
The difference in breast cancer incidence and prognosis between ethnic groups seeks an explanation. We have recently shown that Swedish women are two to three times more likely to be diagnosed with breast cancer compared with Singaporean women. In the present paper, we compare breast cancer survival in the two countries.
We compared the survival of 10,287 Singaporean women and 17,090 Swedish women with breast cancer. Relative survival ratios were used to describe the prognosis in the two populations. A Poisson regression model was used to calculate relative risks for different follow-up periods, age groups, time of diagnosis and disease stages.
The majority of the Swedish women had local cancer (80%) compared with Singaporean women (51%). The overall 5-year relative survival of the Swedish women appeared better (80%) than that of the Singaporean women (70%). A similar survival pattern was observed, however, between the two countries in a stage-by-stage comparison. Survival improved for all women in Singapore over the two decades, but only in the premenopausal women in Stockholm. In 1980 to 1989, premenopausal Singaporean women had 27% increased risk of death compared with Swedish women, adjusted for stage and year of follow-up, while the postmenopausal women had 48% increased risk. In 1990 to 1999, this risk decreased by 19% and 22% for the premenopausal and postmenopausal Singaporean women compared with the Swedish women.
The stage-dependent prognosis was similar for Singaporean women and for Swedish women. Singaporean women, both premenopausal and postmenopausal, had pronounced improvement in prognosis over the calendar periods, probably contributed by marked economic improvement, leading to better medical facilities and management with increased awareness of patients to diagnosis and treatment, as well as improved treatment options. Improvement seen only in the premenopausal women in Stockholm was probably due to improved treatment options.
不同种族群体之间乳腺癌发病率和预后存在差异，需要对此作出解释。我们最近发现，与新加坡女性相比，瑞典女性被诊断出患有乳腺癌的可能性要高出两到三倍。在本文中，我们比较了两国乳腺癌患者的生存率。
我们比较了10287名新加坡乳腺癌女性患者和17090名瑞典乳腺癌女性患者的生存率。采用相对生存比率来描述这两个人群的预后情况。使用泊松回归模型计算不同随访期、年龄组、诊断时间和疾病分期的相对风险。
与新加坡女性（51%）相比，大多数瑞典女性患有局部癌症（80%）。瑞典女性的总体5年相对生存率（80%）似乎高于新加坡女性（70%）。然而，在分阶段比较中，两国观察到了相似的生存模式。在过去二十年里，新加坡所有女性的生存率都有所提高，但仅斯德哥尔摩的绝经前女性如此。在1980年至1989年期间，在对分期和随访年份进行调整后，绝经前新加坡女性的死亡风险比瑞典女性高27%，绝经后女性则高48%。在1990年至1999年期间，与瑞典女性相比，新加坡绝经前和绝经后女性的这一风险分别降低了19%和22%。
新加坡女性和瑞典女性的分期依赖性预后相似。新加坡绝经前和绝经后女性在整个日历期间的预后都有显著改善，这可能得益于经济的显著改善，带来了更好的医疗设施和管理，患者对诊断和治疗的认识提高，以及治疗选择的改善。仅斯德哥尔摩的绝经前女性出现的改善可能归因于治疗选择的改善。
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