Adriano V. Laudico, Cynthia A. Mapua,
Paula Pisani Related Institution
Department of Surgery - Philippine General Hospital - University of the Philippines Manila
Publication Sub Type
Journal Article, Original
Philippine Journal of Surgical Specialties
OBJECTIVE: To describe some population-based clinical practices on early breast cancer in Metro Manila. METHODS: New breast cancer cases registered in 1991, 1994, and 1997 in the cities of Manila, Quezon, Pasay and Caloocan were obtained from the database of the Philippine Cancer Society-Manila Cancer Registry. A sample of 992 cases were randomly selected, of which 738 were included. An abstract form was prepared to collect information on diagnostic tests, TNM stage and treatments received separated into surgery, radiotherapy (RT), chemotherapy (CT) and hormone therapy (HT). After reviewing hospital records, the treating physicians were contacted to obtain additional information. RESULTS: The mean age was 50.3 years, 52.4 percent were less than 50 years. Stage distribution in percent were: I 10.4, IIA 31.2, IIB 28.9, IIIA 15.0, IIIB 12.2. T2 tumors (2cm to 5cm) comprised 48.4 and 49.0 percent had positive axillary nodes. Aside from chest radiographs, only 4 percent had additional preoperative imaging tests. Modified radical mastectomy was done in 96.8 percent of cases, and 97.5 percent of axillary dissections were total axillary dissections. Only 17.9 percent had adjuvant radiotherapy. Adjuvant chemotherapy (CT) was given to 47.0 percent. Among 373 cases with negative axillary nodes, 41.8 percent were given CT. Among 350 women with age 350 years with age 50 years 38 percent received CT. Adjuvant CT use increased over time. Adjuvant hormone therapy (HT) was given to 51.2 percent. Tamoxifen alone was given to 50.5 percent, and only 7 cases underwent oophorectomy. Over time, the use of HT increased among node-negative cases but not in node-positive cases. HT use increased in both age-groups over time. Combined CT and HT were given to 38.0 percent, and this practice increased over time. Prescribing physicians were mainly surgeons (68.9 percent) and medical oncologists (29.2 percent). CONCLUSIONS: Women with early breast cancer in these four cities did not receive surgical treatment as early as those in some developed countries. A major focus should be on strategies to have earlier surgical treatment for women with detected breast lesions. Compliance to local treatment guidelines on adjuvant treatment needs improvement, particularly on high survival benefit modalities that are cost-effective, accessible and sustainable in developing countries. References
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