整體癌症特徵以乳癌出現位置作統計,49% 參加者在右邊乳房發現有乳癌腫瘤在左邊乳房發現有乳癌腫瘤, 並有病人兩邊乳房均有乳癌腫瘤 ( 圖 26) 在 27 個雙邊乳癌個案中,85% 為同時性腫瘤 ( 同時確診或兩邊確診時間相距少於 6 個月 ), 另 15% 為非同時性腫瘤 49% 圖 2

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Overall Cancer Characteristics Regarding laterality of breast cancer, cancer occurred in right breast only (49%) patients, in left breast only () and bilateral breasts () (Figure 26).

1 Overall Cancer Characteristics Regarding laterality of breast cancer, cancer occurred in right breast only (49%) patients, in left breast only () and bilateral breasts () (Figure 26). Out of 27 bilateral cases, 85% were synchronous tumours (diagnosed simultaneously or <6 months apart) and 15% were metachronous tumours. A number of imaging and cytohistological examinations were used to confirm the diagnosis of breast cancer. These included diagnostic mammography, breast ultrasound, magnetic resonance imaging (MRI), fine needle aspiration (FNA), core needle biopsy (CNB) or excisional biopsy (Tables 4-5). Table 4. Diagnostic results of mammography, breast ultrasound and magnetic resonance imaging (MRI) 49% Figure 26. Laterality of breast cancers Left breast Right breast Bilateral breasts Breast cancer occurred in the locations of upper outer quadrant (), upper inner quadrant (2%), lower outer quadrant (15%), central () and lower inner quadrant (9%) (Figure 27). Diagnostic method Total no. Normal (BI-RADS 1) Benign (BI-RADS 2) Probably benign (BI-RADS 3) Indeterminate (BI-RADS 4a) Suspicious (BI-RADS 4b) Diagnostic / malignant (BI-RADS 5) Mammogram (12%) 112 () 136 (14%) 367 (3) 13 (1%) 238 (24%) Ultrasound () 45 (5%) 143 (15%) 45 (42%) 12 (1%) BI-RADS: Breast Imaging Reporting And Data System 325 (34%) MRI 96 2 (2%) 2 (2%) 28 (29%) 3 () 6 (6) Table 5. Diagnostic results of fine needle aspiration (FNA), core needle biopsy (CNB) and excisional biopsy Diagnostic method FNA CNB Excisional biopsy 2% Total no. Scanty benign (Class I) 61 6 (1%) 396 (%) Benign (Class II) Atypical (Class III) 31 (5%) 5 () 3 (1%) 6 (2%) % 9% Suspicious (Class IV) Diagnostic / malignant Class V 156 (26%) 358 (6%) 2 (5%) 367 (92.) 111 (99%) FNA: Fine needle aspiration; CNB: Core needle biopsy Figure 27. Location of breast cancers Note: * = percentages add to more than 1% because more than one response could be checked 51

2 整體癌症特徵以乳癌出現位置作統計,49% 參加者在右邊乳房發現有乳癌腫瘤在左邊乳房發現有乳癌腫瘤, 並有病人兩邊乳房均有乳癌腫瘤 ( 圖 26) 在 27 個雙邊乳癌個案中,85% 為同時性腫瘤 ( 同時確診或兩邊確診時間相距少於 6 個月 ), 另 15% 為非同時性腫瘤 49% 圖 26. 乳癌發病位置左邊乳房右邊乳房兩邊乳房乳癌腫瘤位於乳房上外側部 (), 於乳房上內側部 (2%) 乳房下外側部 (15%) 中央 () 及乳房下內側部 (9%) ( 圖 27) 一系列造影及細胞組織性測試, 均用於確診乳癌, 包括診斷性乳房 X 光造影乳房超聲波磁力共振測試幼針活組織抽檢粗針活組織抽檢及切除式活組織檢查 ( 表 4 至 5) 表 4. 乳房 X 光造影乳房超聲波及磁力共振之斷診結果檢查方式總數字正常 (BI-RADS 1) 乳房 X 光造影 (12%) 乳房超聲波 () 磁力共振 96 良性 (BI-RADS 2) 112 () 45 (5%) 2 (2%) 很可能良性 (BI-RADS 3) 136 (14%) 143 (15%) 2 (2%) 不確定 (BI-RADS 4a) 367 (3) 45 (42%) 28 (29%) 懷疑 (BI-RADS 4b) 13 (1%) 12 (1%) 3 () 確診 / 惡性 (BI-RADS 5) 238 (24%) 325 (34%) 6 (6) BI-RADS: 乳房造影報告及數據系統表 5. 幼針活組織抽檢粗針活組織抽檢及切除式活組織檢查之診斷結果檢查方式幼針活組織抽檢粗針活組織抽檢切除式活組織檢查總數字極少良性 ( 等級 1) 6 (1%) (%) -- 2% 良性 ( 等級 2) 異常 ( 等級 3) 31 (5%) 5 () 3 (1%) 6 (2%) 懷疑 ( 等級 4) 確診 / 惡性 ( 等級 5) 156 (26%) 358 (6%) 2 (5%) 367 (9) 111 (99%) 15% 9% 圖 27. 乳癌腫瘤位置備注.. * = 因參加者可作多於一個選擇, 故百份比高於 1% 52

3 Diagnostic mammography was used in 9 of cases. Thirteen percent of the subjects had normal findings. Abnormalities detected included microcalcifications (), followed by opacity (2), architectural distortion (), asymmetric density () and other findings () such as skin thickening and lymph node metastasis (Figure 28). Negative finding Mircocalcifications Opacity Architectural distortion Asymmetric density Other findings 1 2 1% 2% 4% 5% 6% Figure 28. Mammographic findings Note: * = percentages add to more than 1% because more than one response could be checked Heterogeneous or extreme dense breast were found in 75% of the subjects (Figure 29). 6% 5% 4% 2% 1% 73.2% CXR+USG abd Figure 3. Type of staging methods Note: CXR + USG abd: Chest X-ray + Ultrasound abdomen CXR only / USG abd only: Chest X-ray only / Ultrasound abdomen only MRI whole body: Magnetic resonance imaging whole body CTT + CTA + bone scan: CT Thorax + CT Abdomen + bone scan Overall cancer stage 22. PET scan 3.5% CXR only/ USG abd only MRI whole body Type of staging methods.5%.1% CTT+CTA +bone scan From Surveillance Epidemiology and End Results (SEER) program, stage distribution among the Whites for localized, regional and metastasized cancers were 62%, 31% and 4% respectively while were unstaged. 51 The figure from Sweden Cancer Registry reported more local cancers than that from Singaporean Cancer Registry (82% versus 5) during % 4% 9% 16% Fatty Scattered density Heterogeneous density Extreme density The distribution of cancer stage in the subject cohort was: stage (15%), stage I (34%), stage IIA (26%), stage IIB (12%), stage III (12%) and stage IV (1%) (Figure 31). Among the cancers with advanced stage, 6% of cancers metastasized to other organs such as bone, liver and lung (1 patient), bone and liver (1 patient), bone only (2 patients), lung only (1 patient), liver only (1 patient) and thyroid only (1 patient). Figure 29. Breast density Figure 3 showed the common staging methods which were used to determine the extent of cancer spread. Most of the subjects (7) had chest x-ray and ultrasound abdomen, 2 PET scan, 3.5% either chest x-ray or ultrasound abdomen,.5% MRI whole bodyand.1% CT thorax, CT abdomen and bone scan as their staging methods. 1% 12% 15% 12% 34% 26% Figure 31. Overall cancer stage Stage Stage I Stage IIA Stage IIB Stage III Stage IV 53

4 9 個案使用診斷性乳房 X 光造影 1 的乳房 X 光造影檢查屬正常結果不尋常的結果包括微鈣化點 () 不透明影像 (2) 結構扭曲 () 非對稱性陰影 () 及其餘發現 (), 包括皮膚增厚及淋巴轉移等 ( 圖 28) 陰性微鈣化點不透明結構扭曲非對稱性陰影其他發現 1 1% 2% 4% 5% 6% 參加者所佔有百份比圖 28. 乳房 X 光造影的檢查結果備注.. * = 因參加者可作多於一個選擇, 故百份比高於 1% 根據圖 29 顯示,75% 病人的乳房密度為異質性或極高密度 71% 圖 29. 乳房密度 4% 9% 16% 圖 3 列出主要的診斷乳癌期數方式, 用來斷定癌症腫瘤的擴散情況大部份 (7) 是透過胸部 X 光及腹部超聲波作診斷乳癌期數,2 的參加者使用正電子電腦掃描,3.5% 使用胸部 X 光或腹部超聲波,.5% 使用全身磁力共振, 以及.1% 使用胸部電子掃描腹部電子掃描及骨骼掃描來診斷乳癌期數 2 脂肪比例高稀疏密度固質性密度極高密度圖 3. 診斷乳癌期數的方式參加者所佔百份比 6% 5% 4% 2% 1% 整體乳癌期數 73.2% 胸部X 光及腹部超聲波 % 腹部超聲波診斷乳癌期數方式.5%.1% 根據監測流行病學及最終結果計劃 (SEER), 白人的乳癌期數分佈為 62% 癌症範圍局部在乳房內,31% 癌症擴展至乳房周邊淋巴組織,4% 癌症擴散至其他器官, 並有為不明個案 51 除此以外, 瑞典癌症資料庫提供的數據指,199 至 1999 年當地的局部癌症個案, 較新加坡癌症資料庫所記錄的為多 (82% 比 5) 15 參加者的癌症期數分佈為..第期 (15%) 第 I 期 (34%) 第 IIA 期 (26%) 第 IIB 期 (12%) 第 III 期 (12%), 及第 IV 期 (1%) 在晚期個案中,6% 癌細胞擴散至其他器官如骨肝及肺部 (1 名病人 ) 骨與肝臟 (1 名病人 ) 骨骼 (2 名病人 ) 肺部 (1 名病人 ) 肝臟 (1 名病人 ) 及甲狀腺 (1 名病人 ) 12% 26% 12% 圖 31. 病人的癌症期數電子掃描第 Ⅳ 期正1% 15% 34% 振全身磁力共胸部X 光或第期第 Ⅰ 期第 ⅡA 期第 ⅡB 期第 Ⅲ 期骨骼掃胸部電子掃描腹部電子掃描及描54

5 Cancer characteristics of invasive breast cancer In 22 Singapore has introduced a nation-wide mammographic screening program- BreastScreen Singapore, the clinical details showed the median size of lesions were smaller in screen-detected cancers compared to symptomatic cancers (18mm vs. 23mm). 48 In our patient cohort, invasive breast cancer accounted for 85% of all breast cancer cases. More than of invasive breast cancers were early stage, only 15% were advanced stage. The median and mean sizes of invasive breast cancer were 1.8 cm and 2.2cm respectively (range: cm). More than 5% had invasive tumours of 2 cm or below, 4% with tumour size between cm and 4% with tumour size of 5 cm and over (Figure 32). 6% 5% 4% 2% 1% 56% 2. cm 4% Figure 32. Size of invasive breast cancers 4% cm >5. cm Size of invasive breast cancer Cancer characteristics of in situ breast cancer only Among all breast cancers, 15% had carcinoma in situ only. Amongst them, 4% only had lymph node involvement. The median and mean sizes of in situ breast cancer were 2. cm and 2.5 cm respectively (range:.2-9. cm). Fifty-four percent of patients had in situ tumours below 2. cm, 39% between cm and 5 cm and over (Figure 34). 6% 5% 45% 2% 1% 54% 2. cm 39% Figure 34. Size of in situ breast cancers only cm >5. cm Size of in situ cancer Ninety-two percent of invasive breast cancer cases underwent sentinel lymph node biopsy or axillary dissection to detect lymph node involvement. Nodal status was negative in 6% of the patients, 2 had 1-3 positive lymph nodes, had 4-9 positive lymph nodes and 4% had more than1 positive lymph nodes (Figure 33). 55 6% 6% 5% 4% 2 2% 1% 1% Number of positive lymph nodes Figure 33. Number of nodes positive in invasive breast cancer patients

6 入侵性乳癌資料在 22 年, 新加坡政府策動一個全民性的乳房 X 光造影檢查新加坡乳房普查計劃 (BreastScreen Singapore) 經臨床診斷發現, 透過乳癌診斷檢查確診的病人, 其腫瘤面積的中位數, 較出現病徵才確診的病人小 (18 毫米比 23 毫米 ) 48 在我們的參加者中, 入侵性乳癌佔所有乳癌個案的 85% 逾的入侵性乳癌個案屬早期, 只有 15% 屬晚期入侵性乳癌腫瘤大小中位數及平均數分別為 1.8 厘米及 2.2 厘米 ( 範圍厘米 ) 超過 5% 的入侵性腫瘤大小在 2 厘米或以下, 4% 的腫瘤大小介乎 2.1 至 5 厘米,4% 的腫瘤大小在 5 厘米或以上 ( 圖 32) 6% 參加者所佔百份比5% 4% 2% 56% 4% 原位癌資料在所有乳癌病人中,15% 屬原位癌當中只有 4% 病人的癌細胞擴散至淋巴結原位癌個案的大小中位數及平均數分別為 2. 厘米及 2.5 厘米 ( 範圍...2 至 9. 厘米 ) 54% 的原位癌腫瘤在 2 厘米以下,39% 介乎 2.1 至 5 厘米在 5 厘米或以上 ( 圖 34) 參加者所佔百份6% 5% 45% 54% 圖 34. 原位癌腫瘤大小 39% 比2% 1% 2. 厘米或以下厘米 5. 厘米以上原位癌面積 56 1% 2. 厘米或以下圖 32. 入侵性乳癌腫瘤大小 92% 的入侵性乳癌個案透過前哨淋巴組織檢查或腋下淋巴摘除, 診斷癌細胞擴散至腋下淋巴的程度 6% 病人的淋巴結感染測試呈陰性反應 2 有 1 至 3 個陽性淋巴結有 4 至 9 個陽性淋巴結 4% 有 1 個或以上陽性淋巴結 ( 圖 33) 參加者所佔百份比 6% 5% 4% 2% 1% 6% 圖 33. 入侵性乳癌病人的陽性淋巴結數量 4% 厘米 5. 厘米以上入侵性乳癌腫瘤大小 2 1% 陽性淋巴結數量

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