BCR Data Reporting

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1 Breast Cancer Facts in Hong Kong 香港乳癌實況 Dr. Carol CH Kwok (Medical Advisor, HKBCF) 郭子熹醫生 ( 香港乳癌基金會醫務顧問 ) 4 th Global Chinese Breast Cancer Organization Alliance Conference April 26,

2 Number of Cancer Cases, Women, All Ages, in the World (total: 6,038,358) 世界婦女癌症個案 ( 所有年齡 )..總計 6,038,358 個案乳癌.. 1,383,523 個案 (22.9%) Source: GLOBOCAN 2008 (IARC):

3 發病率 3 死亡率 Distribution of cancer cases in the world 較發達地區兩性 ( 所有年齡 ) 欠發達地區乳癌

4 乳癌個案 ( 所有年齡 ) 亞洲.. 528,711 個案 (38.2%) Source: GLOBOCAN 2008 (IARC):

5 Breast Cancer: An Increasing Health Burden in Hong Kong 乳癌..不斷增加香港的醫療負擔 11.4% of all cancers diagnosed 確診的癌症個案 24% of all cancers in women 所有女性的癌症個案 8 new cases diagnosed each day 確診新發病例 ( 每天 ) Most frequent cancer in HK women 香港婦女最常見的癌症 Source: HK Cancer Registry

6 新症個案數目 New Cases Registered Top 10 Cancer in Hong Kong Women (2009) 10 種最常見的香港婦女癌症 (2009) 乳癌 Cancer 癌症 Source: HK Cancer Registry

7 No. of new cases 3500 Incidence Trend of Common Cancers Affecting HK Women 香港婦女常見的癌症發病趨勢 3000 新症個案數目乳癌大腸癌肺癌 Breast Colorectum Lung Corpus uteri 500 子宮體 Year 年份 Source: HK Cancer Registry

8 Cumulative Cancer Risk 累積癌症的風險 Cancer 癌症 Male 男性 Female 女性 Breast cancer 乳癌 Colorectal Cancer 大腸癌 Lung Cancer 肺癌 Cervical Cancer 子宮頸癌 1 in every 19 people 每 19 人有 1 人 1 in every 21 people 1 in every 32 people 1 in every 18 people 1 in every 41 people 1 in every 128 people Source: Hong Kong Cancer Registry as in

Female Breast Cancer - Estimated Age-Standardized Incidence Rate (ASR), all ages 女性乳癌的年齡標準化發病率 ( 所有年齡 ) Country ASR* Belgium( 比利時 ) 109.4 New Zealand( 新西蘭 ) 89.4 United Kingdom( 英國 ) 87.

9 Female Breast Cancer - Estimated Age-Standardized Incidence Rate (ASR), all ages 女性乳癌的年齡標準化發病率 ( 所有年齡 ) Country ASR* Belgium( 比利時 ) New Zealand( 新西蘭 ) 89.4 United Kingdom( 英國 ) 87.9 Singapore( 新加坡 ) 59.9 Chinese Taipei ( 中華台北 ) * Rate per 100,000 women 52.8 Japan( 日本 ) 42.7 China( 中國 ) 21.6 *Source: Globocan 2008 **Source: Hong Kong Cancer Stat 2009 Country ASR** Hong Kong ( 香港 ) 54.8 *Source: Globocan 2008 **Source: Hong Kong Cancer Stat

10 Breast Cancer 乳癌 (2008) World Age-Standardized Incidence Rate 全球年齡標準化發病率 Region 地區 ASR(W) per 100,000* World 全球 39 Developed countries 發達國家 66.4 Developing countries 發展中國家 27.3 Hong Kong 香港 49.9 Note: Hong Kong 香港 *Source: WHO HK figures: sourced from HK Cancer Registry female only 10

11 Hong Kong Breast Cancer Foundation 香港乳癌基金會 Inaugurated on 8 March 年 3 月 8 日成立 Founded by breast cancer survivors and concerned health care professionals with first hand experience 由乳癌存活者和擁有第一手經驗的健康護理專業人員創立 Non-profit charitable organization dedicated to patient support, education and early detection, research & advocacy 非牟利慈善組織, 致力提供病人支援推廣乳癌教育研究及倡議 11 11

The first of its kind breast cancerspecific data collection & monitoring system 第一個專為乳癌而設的數據收集和監測系統 Evidence for improving breast cancer care 為改善乳癌護理提供證據 Most comprehensive data (300 variables

12 The first of its kind breast cancerspecific data collection & monitoring system 第一個專為乳癌而設的數據收集和監測系統 Evidence for improving breast cancer care 為改善乳癌護理提供證據 Most comprehensive data (300 variables captured) 包含最全面的數據 Most representative coverage in the territory (27 medical centers, near 7000 patients enrolled) 具有代表性, 參與的診所 / 醫院覆蓋全香港 Public access to reports 報告面向公眾 Research & Advocacy : Hong Kong Breast Cancer Registry 研究及倡議..香港乳癌資料庫 12

13 Breast Cancer Registry 乳癌資料庫 Why we need it? 為什麼我們需要它? If you can t measure it, you can t manage it 如果你無法衡量它, 你不能處理它 Cancer Registries are the eyes and ears of cancer control around the world 癌症資料庫是世界各地控制癌症的眼睛和耳朵 UICC World Cancer Declaration 2006: call to increase number of countries with cancer registries 國際抗癌聯盟 2006 宣言 : 呼籲國家增加屬於她們的癌症資料庫 13

14 Cancer is not a notifiable disease under Hong Kong Food and Health Bureau 根據香港食物及衛生局, 癌症是不須呈報的疾病 14

15 Questions to be Answered 需要回答的問題 How is our breast cancer detection compared to international standard? 乳癌檢測達到國際標準嗎? What is the picture of risk exposures in our patients? 病人的風險因素是什麼? Is our treatment practice up to international standard? 我們的治療符合國際標準嗎? What is the health care costs for breast cancer locally? 本地乳癌的醫療費用是多少? HKBCR provides such information! 香港乳癌資料庫可以提供這些資訊! 15

16 HK Breast Cancer Registry (HKBCR) Mission 使命 Aims to provide vital data, analysis and insights for HKBCF, medical professionals, policy makers and the wider public, to advocate and device more effective cancer control plans 為受乳癌影響人士提供有關本地乳癌個案的資訊及其他患者的治療選擇, 增強他們應對的能力 ; 並為醫護人員提供參考, 以助他們為病人作出適切的治療及護理決定 16 16

17 Breast Cancer Facts in Hong Kong Report No.3 香港乳癌實況第三號報告 - Sept 2011 Data collection period 資料收集時間.. Feb 2008 Apr ,393 patient cohort enrolled into the Registry 5,393 名參加者向乳癌資料庫作登記 2,539 (47.1%) cases recruited from private sector 私立醫院 / 診所 2,854 (52.9%) cases recruited from public sector 公立醫院 Distribution: 24.0% used private health services solely 只使用私立醫院 / 診所醫療服務 38.5% used public health services solely 只使用公立醫院醫療服務 37.5% used mixed private and public health services 混合使用私立及公立醫療服務 17

18 Demographic data 患者統計資料 Number (%) Number of patients 病人數目 5,393 Sex 性別 Female 女性 5388 (99.9%) Male 男性 5 (0.1%) Ethnicity 種族 Chinese 華人 5188 (96.2%) White 白種人 67 (1.2%) Other Asians 其它亞裔人士 62 (1.1%) Black 黑人 2 (0.0%) Unknown 不詳 74 (1.4%) Source: Breast Cancer Facts in Hong Kong Report No.3,

19 Relative Frequency (%) 45 Age distribution 年齡分佈 Mean age at diagnosis (years) (SD) = 49.6 (10.8) Median age at diagnosis (years) = 48.3 Range (years) = Median age at diagnosis (yrs) 發病年齡中位數 ( 歲數 ) Youngest patient 最年輕的患者 : 20.7 years old 14.5 Hong Kong USA Australia Singapore Unknown Source: Breast Cancer Facts in Hong Kong Report No.3, 2011 Age group 年齡組別 N=

20 Sociodemographic Data 患者統計資料 (1) Number (%) Marital Status 婚姻狀況 Never married 未婚 794 (14.7) Now married 已婚 3997 (74.1) Widowed/ divorced/ cohabitating 離婚 / 喪偶 / 同居 564 (10.5) Unknown 不詳 38 (0.7) Occupation 職業 Professional 專業人員 600 (11.1) Clerical 文職人員 1327 (24.6) Non-clerical/ Labor 非文職 / 勞工 938 (17.4) Housewife 家庭主婦 1654 (30.7) Self-employed 自僱人士 176 (3.3) Retired/ unemployed 退休 / 失業 480 (8.9) Unknown 不詳 218 (4.0) 35.7% Source: Breast Cancer Facts in Hong Kong Report No.3,

21 Sociodemographic Data 患者統計資料 (2) Educational level 教育程度 Number (%) No schooling/ Kindergarten 未受教育 / 幼稚園 273 (5.1) Primary school 小學 1098 (20.4) Secondary school 中學 2574 (47.7) Post-secondary or above 預科或以上 1337 (24.8) Unknown 不詳 111 (2.1) Monthly household income 家庭每月入息 < HK$10, (12.4) HK$10,000-HK$29, (25.4) HK$30, (25.2) Unknown 不詳 1991 (36.9) Source: Breast Cancer Facts in Hong Kong Report No.3,

22 Reproductive Factors 生育因素 Menarche 初經 Menopause 更年期 Mean Age 平均年齡 Median Age 年齡中位數 Yes 有 No 沒有 Reproductive history 生育紀錄 Breast feeding 餵哺母乳 Oral contraceptives 口服避孕藥 Hormone replacement therapy 荷爾蒙補充治療 79.0% 21.0% 30.6% 59.8% 30.5% 61.9% 7.7% 82.9% Source: Breast Cancer Facts in Hong Kong Report No.3,

23 Health Background and Life Style 健康背景及生活方式 History of tumour 腫瘤的歷史 Family history of breast cancer 乳癌家族史 No 沒有 (78.6%) No 沒有 (82.2%) BMI < (52.8%) Physical exercise 運動 Never 從不 (31.9%) Benign 良性 (13.0%) Malignant 惡性 (3.2%) 1 st Degree(8.0%) 2 nd Degree(1.2%) (16.6%) <3hrs per week 每週不少於 3 小時 (40.6%) 25.0 (18.6%) 3hrs per week 每週 3 小時或以上 (25.8%) Stress 壓力 Low 低 (30.7%) Moderate(25-50% of time) 中度 (30.7%) High(>50%of time) 高 (36.1%) Meat/dairy rich diet 豐富肉類 / 乳製品 Yes 有 13.1% Smoking 煙 Yes 有 (4.3%) No 沒有 (95.7%) Alcohol Drinking 飲酒 Yes 有 (5.8%) No 沒有 94.2% Source: Breast Cancer Facts in Hong Kong Report No.3,

24 10 Most Common Risk Factor in Breast Cancer Patients 十大在香港乳癌患者中最常見的高危因素 Rank Risk Exposures Number (%) 1 Lack of exercise (<3 hr/ wk) 缺乏運動 ( 每星期 <3 小時 ) 3913 (72.5%) 2 No breast feeding 未曾餵哺母乳 3220 (59.7%) 3 High level of stress (>50% of time) 高度精神壓力 1951 (36.1%) 4 Being overweight/ obese 超重 / 肥胖 1899 (35.2%) 5 Oral contraceptives use 曾服用口服避孕藥 1646 (30.4%) 6 No childbirth / first live birth after age 35 沒有生育 / 35 歲後首次生育 1228 (22.6%) 7 Family history of breast cancer 家族曾有乳癌病歷 827 (15.3%) 8 Having previous breast disease 曾有乳房疾病病歷 788 (14.6%) 9 Early menarche (<12 years old) 提早初經 (<12 歲 ) 719 (13.3%) 10 Meat/ dairy products rich in diets 大量攝取肉類或奶類製品 704 (13.1%) Source: Breast Cancer Facts in Hong Kong Report No.3,

25 Screening Habit 定期乳房檢查習慣 Most common breast screening method: Mammography screening 最常見的乳癌篩查方法 : 乳房 X 光造影 Take-up rate of mammography screening before diagnosis was low compared with the take-up rate of mammography screening program in Western countries 乳房 X 光造影診斷前篩查率較西方國家低 Take up rate of mammography screening, % Hong Kong 香港 * 27.4 New Zealand 新西蘭 80.0 United States 美國 66.0 Australia 澳大利亞 54.9 Singapore 新加坡 40.9 Taiwan 中華台北 31.6 Source: Breast Cancer Facts in Hong Kong Report No.3,

26 Patients over 40, Lower Rate of Regular Breast Self- Examination (BSE) & Clinical Breast Examination (CBE) 40 歲以上的患者, 自我檢查率及醫生臨床檢查率較低 Examination Age 40 or below (%) Age 40 or above (%) Breast self-examination (BSE) 自我檢查 Clinical breast examination (CBE) 醫生臨床檢查 Mammography screening (MMG) 乳房 X 光造影檢查 Breast ultrasound imaging (USG) 乳房超聲波檢查 Source: Breast Cancer Facts in Hong Kong Report No.3,

27 Better educated, higher breast screening rate 擁有較高教育水平者會有較高的定期乳房檢查率 Education Matriculation or above 預科或以上 Secondary 中學 Primary 小學 Non-educated / Kindergarten 未受教育 / 幼稚園 BSE(%) 自我檢查 CBE(%) 醫生臨床檢查 MMG(%) 乳房 X 光造影檢查 Source: Breast Cancer Facts in Hong Kong Report No.3,

28 Professionals and self employed, higher screening rate 專業人士及自僱人士, 定期乳房檢查率較高 Career BSE (%) 自我檢查 Professionals/ Clerical workers 專業人員 / 文職人員 Self-employed 自僱人士 Housewives 主婦 Non-clerical workers / Laborers 非文職 / 勞工 Retired / Unemployed 退休 / 失業 CBE (%) 醫生臨床檢查 MMG (%) 乳房 X 光造影檢查 Source: Breast Cancer Facts in Hong Kong Report No.3,

29 75.2% are self-detected 自我檢查 Self-detected 自我檢查 Screen-detected 篩檢檢查 Median tumour size 腫瘤大小中位數 2.1 cm 1.4 cm Source: Breast Cancer Facts in Hong Kong Report No.3,

30 92.4% presented with painless lumps in self-detected patients 在自我檢測中有無痛的腫塊 Source: Breast Cancer Facts in Hong Kong Report No.3,

Relative Percentage(%) Cancer Staging 癌症分期 (AJCC 2010) 45 41.5 40 35 30 25 20 15 10 5 0 31.1 11.6 11.

31 Relative Percentage(%) Cancer Staging 癌症分期 (AJCC 2010) I II III IV Unstaged Stage 期數 Source: Breast Cancer Facts in Hong Kong Report No.3,

32 Cancer Stage 癌症期數 (AJCC 2010) Median age at diagnosis (years) 診斷時的年齡中位數 Overall % 整體 48.3 Self detected % 自我檢測 Cancer stage distribution 癌症的期數分佈 (AJCC 2010) Screen detected % 篩檢檢查 Stage Stage I Stage IIA Stage IIB Stage III Stage IV Unstaged Source: Breast Cancer Facts in Hong Kong Report No.3,

33 Histological & Molecular Characteristics 組織學和分子特性 Histological and molecular characteristics of invasive breast cancer 入侵性乳癌的組 Number (%) 織學和分子特性 Histological types Ductal 2469 (84.8%) Lobular 130 (4.5%) Others 357 (10.7%) Molecular Characteristics ER (75.3%) PR (63.3%) HER (23.7%) Triple negative (ER-PR-HER2-) 342 (11.6%) Source: Breast Cancer Facts in Hong Kong Report No.3,

34 Treatments 治療方法 Number of treatments done 完成治療的數目 Number 病人數目 (%) (8.3%) (22.5%) (34.3%) (32.2%) 5 87 (2.5%) Types of treatments 治療的類型 Treatment rates 治療率 % of patients treated in private hospitals 私家醫院使用率 % of patients treated in public hospitals 公立醫院使用率 Surgery 手術 98.6% 62.0% 38.0% Radiation therapy 放射治療 63.7% 23.2% 76.8% Chemotherapy 化療 63.2% 20.5% 79.5% Endocrine therapy 荷爾蒙治療 66.2% 22.1% 77.9% Targeted therapy 標靶治療 6.1% 28.4% 71.6% Alternative therapy 另類療法 33.5% Source: Breast Cancer Facts in Hong Kong Report No.3,

35 Breast Cancer Surgery 乳房手術 38.6% patients had breast conserving surgery 乳房保留手術 60.0% patients have mastectomy 全乳切除手術 17.5% patients with mastectomy and breast reconstruction 全乳切除手術及乳房重建 33.3% patients underwent sentinel node biopsy 前哨淋巴結活檢 49.7% patients underwent axillary dissection 腋窩淋巴結清掃 16.6% patients underwent sentinel node biopsy & axillary dissection 前哨淋巴結活檢及腋窩淋巴結清掃 Source: Breast Cancer Facts in Hong Kong Report No.3,

36 Radiotherapy 放射治療 1,236 patients had breast conserving surgery 病人曾接受乳房保留手術 952 patients had mastectomy 病人曾接受全乳切除手術 (45.9% of mastectomy patients required radiotherapy 在接受全乳切除手術的患者裡, 有 45.9% 需要接受放射治療 ) Source: Breast Cancer Facts in Hong Kong Report No.3,

37 Relative Frequency (%) Chemotherapy Regimens 化療療程 % No chemotherapy 無 35.4% Chemotherapy Neoadjuvant 術前輔助 1.8% Adjuvant 輔助 60.3% Palliative 紓緩 0.9% Unknown 不詳 1.4% Treated in public 公立醫院 % Treated in private 私立診所 / 院 % CMF AC T TCy/DC FAC/FEC CMF+A/AC AC+T FAC/FEC+T TAC Others Unknown Type of regimen 37

38 Relative Frequency (%) Forms of Endocrine Therapy 荷爾蒙治療 No endocrine therapy 無 32.2% Endocrine therapy 有 66.2% Unknown 不詳 1.6% Treated in public 公立醫院 % Treated in private 私立診所 / 醫院 % % Tamoxifen Aromatase inhibitor Ovarian suppression Ovarian irradiation Forms of endocrine therapy 4.7 Oophorectomy Others Unknown 38

39 Relative Frequency (%) Type of Drugs for Targeted Therapy 標靶治療 No targeted therapy 沒有 92.4% Targeted therapy 有 6.1% % Unknown 不詳 1.5% Treated in public 公立醫院 % Treated in private 私立診所 / 醫院 % Trastuzumab Lapatinib Avastin Unknown Type of drugs used

40 Conclusion Top three risk factors of breast cancer in Hong Kong 香港三大最常見的乳癌高危因素 Lack of exercise 缺乏運動 No Breastfeeding 未曾餵哺母乳 High level of stress 高水平壓力 Lack of awareness of breast cancer screening 缺乏定期乳房檢查的意識 Higher education level, higher screening rate 擁有較高教育水平者會有較高的定期乳房檢查率 Early detection through screening has earlier stage breast cancer 通過定期檢查發現的乳癌多屬早期乳癌 Tumor size of breast cancer was half by screening compared with selfdetected 通過定期檢查發現的腫瘤大小是自我檢查的一半 40

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