Challenges in the Management of Breast Cancer in a Low Resource Setting in South East Asia

  • 발행 : 2016.07.01


Background: Breast cancer is the second most common cancer in women in Cambodia, a low income country in South-East Asia. The Sihanouk Hospital Centre of Hope (SHCH) is a charity hospital set up by an international non-governmental organisation, HOPE Worldwide. In 2008, SHCH partnered with AmeriCares, a global health organisation to set up and deliver a breast cancer programme to provide education, diagnosis and treatment for women with breast cancer. The objective of this study is to characterise the presentation, diagnosis, treatment and outcomes of women treated under this program. Materials and Methods: A total of 215 women newly diagnosed with breast cancer from 1 March 2008 until 31 March 2011 were studied. Age at diagnosis, tumour size, histological type, tumour grade, ER, lymph node involvement, treatment modalities (surgery, radiotherapy, chemotherapy, hormone therapy) were recorded. Data on mortality at 3 years were obtained whenever possible. Results: The median age was 47 years old. Some 77.8% were diagnosed with stage 3 and 4 lesions, and 78.5% underwent mastectomy, of which 28.4% the intent was palliative. Of those whose ER status were known, only 48.3% were ER positive. Only 6 patients could afford chemotherapy while only 1 patient had radiotherapy. Hormone therapy was provided free for those who were ER positive. The overall survival rate at 3 years was 39.1%. Conclusions: Breast cancer presents at a late stage, and because treatment is suboptimal, survival is poor in Cambodia. A more aggressive approach to early detection and treatment needs to be developed to improve outcome from this potentially curable disease.


  1. Action Study Group, Kimman M, Jan S, et al (2015). Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries. BMC Med, 13, 190.
  2. Anderson BO, Cazap E, El Saghir NS, et al (2011). Optimisation of breast cancer management in low-resource and middleresource countries: executive summary of the Breast Health Global Initiative consensus, 2010. Lancet Oncol, 12, 387-98.
  3. GLOBOCAN 2012 at
  4. Datta NR, Samiei M, Bodis S (2014). Radiation therapy infrastructure and human resources in low- and middleincome countries: present status and projections for 2020. Int J Radiat Oncol Biol Phys, 89, 448-57.
  5. Eav S, Schraub S, Dufour P, et al (2012). Oncology in Cambodia. Oncol, 82, 269-74.
  6. El Saghir NS, Adebamowo CA, Anderson BO, et al (2011). Breast cancer management in low resource countries (LRCs): consensus statement from the Breast Health Global Initiative. Breast, 20, 3-11.
  7. Fan L, Zheng Y, Yu KD, et al (2009). Breast cancer in a transitional society over 18 years: trends and present status in Shanghai, China. Breast Cancer Res Treat, 117, 409-16.
  8. The World Bank at
  9. Leong SP, Shen ZZ, Liu TJ, et al (2010). Is breast cancer the same disease in Asian and Western countries? World J Surg, 34, 2308-24.
  10. Ng CH, Pathy NB, Taib NA, et al (2014). Do clinical features and survival of single hormone receptor positive breast cancers differ from double hormone receptor positive breast cancers? Asian Pac J Cancer Prev, 15, 7959-64.
  11. Ng CH, Pathy NB, Taib NA, et al (2012). The estrogen receptor negative-progesterone receptor positive breast carcinoma is a biological entity and not a technical artifact. Asian Pac J Cancer Prev, 13, 1111-3.
  12. Porter P (2008). "Westernizing" women's risks? Breast cancer in lower-income countries. N Engl J Med, 358, 213-6.
  13. Saxena N, Hartman M, Bhoo-Pathy N, et al (2012). Breast cancer in South East Asia: comparison of presentation and outcome between a middle income and a high income country. World J Surg, 36, 2838-46.
  14. Seow A, Duffy SW, McGee MA, et al (1996). Breast cancer in Singapore: trends in incidence 1968-1992. Int J Epidemiol, 25, 40-5.
  15. Serey VH, Kim ES, Monchy D (2011). Preliminary data about female malignant breast tumours in Cambodia. Asian Pac J Cancer Prev, 12, 383-5.
  16. Shyyan R, Sener SF, Anderson BO, et al (2008). Guideline implementation for breast healthcare in low- and middleincome countries: diagnosis resource allocation. Cancer, 113, 2257-68.
  17. Taib NA, Yip CH, Low WY (2014). A grounded explanation of why women present with advanced breast cancer. World J Surg, 38, 1676-84.
  18. Yip CH, Buccimazza I, Hartman M, et al (2015). Improving outcomes in breast cancer for low and middle income countries. World J Surg, 39, 686-92.
  19. Yip CH, Pathy NB, Uiterwaal CS, et al (2011). Factors affecting estrogen receptor status in a multiracial Asian country: an analysis of 3557 cases. Breast, 20, 60-4.
  20. Yip CH, Rhodes A (2014). Estrogen and progesterone receptors in breast cancer. Future Oncol, 10, 2293-301.
  21. Yip CH, Taib NA (2012). Challenges in the management of breast cancer in low- and middle-income countries. Future Oncol, 8, 1575-83.