Department of Medicine, Queen's University, Kingston, Canada.
National Cancer Institute, Maharagama, Sri Lanka.
BMC Cancer. 2021 Nov 3;21(1):1175. doi: 10.1186/s12885-021-08929-8.
Although breast cancer is the most common cancer among Sri Lankan women, there is little published data on patient characteristics and treatment in the local context. We aimed to describe disease characteristics and management in a large contemporary cohort of women with breast cancer at the National Cancer Institute of Sri Lanka (NCISL).
All women with invasive primary breast cancers diagnosed during 2016-2020 were identified from the NCISL breast cancer registry. The NCISL sees approximately 40% of all cancer patients in Sri Lanka. Cancer stage at diagnosis was defined according to the Tumour, Node, and Metastasis (TNM) staging system and the Estrogen (ER) and progesterone (PR) receptor status was determined based on the results of immunohistochemistry tests. Descriptive statistics were used to describe the study cohort and treatment patterns.
Over 5100 patients were diagnosed with breast cancer during the study period at the NCISL. The mean age of the women was 56 (SD 12) years. Common co-morbidities were hypertension (n = 1566, 30%) and diabetes mellitus (n = 1196, 23%). Two thirds (66%) of the cancers were early stage (stage I & II) at diagnosis. ER/PR positivity rate was 72% and HER-2 positivity rate was 22%. Two thirds of the women had undergone mastectomy while 68% had undergone axillary clearance. The rate of chemotherapy delivery was 91% for women with node positive disease while 77% of eligible women (i.e., after wide local excision or with > 3 positive lymph nodes) had received adjuvant radiotherapy. Endocrine therapy was initiated in 88% of eligible women with hormone receptor positive disease while rate of trastuzumab use was 59% among women with HER2 positive breast cancer.
High percentage of advanced breast cancer at diagnosis and high prevalence of comorbidities are some of the major challenges faced in the management of breast cancer in Sri Lanka. Given that stage at diagnosis is the most important prognostic factor determining survival, greater efforts are needed to promote early diagnosis of breast cancer. Considerable lapses in the concordance between guideline recommendations and the delivery of cancer care warrants closer assessment and intervention.
尽管乳腺癌是斯里兰卡女性中最常见的癌症，但在当地背景下，关于患者特征和治疗的发表数据很少。我们旨在描述在斯里兰卡国家癌症研究所（NCISL）的大型当代乳腺癌女性队列中的疾病特征和治疗方法。
从 NCISL 乳腺癌登记处确定了 2016 年至 2020 年期间诊断出的所有浸润性原发性乳腺癌女性。NCISL 约占斯里兰卡所有癌症患者的 40%。诊断时的癌症分期根据肿瘤、淋巴结和转移（TNM）分期系统确定，雌激素（ER）和孕激素（PR）受体状态根据免疫组织化学测试的结果确定。使用描述性统计数据描述研究队列和治疗模式。
在研究期间，NCISL 诊断出超过 5100 名乳腺癌女性。女性的平均年龄为 56（SD 12）岁。常见的合并症是高血压（n=1566，30%）和糖尿病（n=1196，23%）。三分之二（66%）的癌症在诊断时处于早期阶段（I 期和 II 期）。ER/PR 阳性率为 72%，HER-2 阳性率为 22%。三分之二的女性接受了乳房切除术，而 68%的女性接受了腋窝清除术。淋巴结阳性疾病的女性中化疗的使用率为 91%，而有资格接受辅助放疗的女性（即接受广泛局部切除或有>3 个阳性淋巴结）中 77%接受了辅助放疗。激素受体阳性疾病中 88%的有资格的女性开始接受内分泌治疗，而 HER2 阳性乳腺癌女性中曲妥珠单抗的使用率为 59%。
诊断时晚期乳腺癌的比例较高和合并症的高患病率是斯里兰卡乳腺癌管理面临的一些主要挑战。鉴于诊断时的分期是决定生存的最重要的预后因素，因此需要做出更大的努力来促进乳腺癌的早期诊断。指南建议与癌症治疗的提供之间存在相当大的差距，这需要更密切的评估和干预。
