EDITORIAL

Breast Cancer in the Asia–Pacific Region

Alex Yuang-Chi CHANGJohns Hopkins Singapore International Medical Centre, Singapore

Breast cancer is the most commonly diagnosed form ofcancer and the second leading cause of cancer death inwomen worldwide.1 Although breast cancer is typicallyviewed as a “Western” disease due to its associationwith a Western lifestyle and its disproportionately highincidence in North America and Western Europe, it hasemerged as a serious public health problem in the Asia–Pacific region. Over the last two decades, breast cancerincidence and mortality have steadily increased through-out the Asia–Pacific region, with levels in Japan, Korea,and Australia approaching those in the USA and theEU.2,3 The socioeconomic burden of breast cancer isexpected to increase over the next decade with increas-ing population growth, particularly in China andIndia.4–6

The management of breast cancer continues to evolveas our understanding of the molecular pathogenesis andfactors that influence the course of the disease expand. Agrowing body of evidence indicates that breast cancersdemonstrate a heterogeneous natural history andresponsiveness to treatment.7,8 Evidence of this diversitycan be observed in the vast difference in the naturalhistory and responsiveness to treatment between Asianand Western women. Although a large body of literatureexists regarding the natural course and treatment ofbreast cancer in the USA and the EU, data regarding theprevalence, diagnosis, pathology and treatment of breastcancer in the developed, newly developed, and develop-ing Asian countries are sparse.

In March 2008, a panel of experts from the Asia–Pacific region met in Singapore to discuss key issues andbarriers related to the prevention and management ofbreast cancer in this region. This supplement presentsthe highlights of that meeting. Reflecting the combinedexpertise of a distinguished faculty, the articles presentedhere discuss the epidemiology of breast cancer in the

Asia–Pacific region, the natural history of the disease,screening programs, current management, new therapiesfor breast cancer, and the management of special patientpopulations. An important focus of the meeting was acritical review of barriers to effective management andthe need for new clinical therapies.

The first article, by Michael Green, MBBS, and VinodRaina, MD, reviews the epidemiology, natural historyand diagnosis of breast cancer in the Asia–Pacific region,citing the latest figures on its epidemiology and preva-lence. The natural history of this disease in Asia–Pacificwomen is unique, with an earlier onset of disease than inthe West. Breast cancer among younger women in theAsia–Pacific region carries a poorer prognosis. Addition-ally, most Asia–Pacific women with breast cancer con-tinue to be diagnosed when the cancer is at a relativelylate stage, with locally advanced cancers constituting>50% of all cancers diagnosed. This may contribute tohigher rates of breast cancer mortality in developingAsian countries compared with the rest of the world.The authors review screening programs at the time ofwriting for breast cancer among women in the Asia–Pacific region. Many barriers to effective preventionexist, including a lack of awareness, the high cost ofdiagnosis, and a lack of medical professionals and facili-ties in many areas. Despite successful programs in somecountries, health-care systems in the Asia–Pacific regionstill struggle with the socioeconomic burden of imple-menting screening programs.

The next article is a cogent review of the managementof breast cancer by Louis W.C. Chow, MD, and Young-Hyuck Im, MD. This review provides an overview of theclinical experience in the Asia–Pacific region related tosurgical methods, including the movement from radicalmastectomy to breast-conserving surgery. Currentapproaches for locally advanced and metastatic breastcancer, including testing for chemosensitivity, combina-tion therapy with anti-hormonal and targeted anti-growth factor agents and strategies for the treatment ofmetastatic breast cancer are discussed. The presentation

Correspondence: Professor Alex Yuang-Chi Chang, 11 JalanTan Tock Seng, Singapore 308433. Email:alexchang@imc.jhmi.edu

Asia–Pacific Journal of Clinical Oncology 2008; 4(Suppl. 3): S3–S4 doi:10.1111/j.1743-7563.2008.00190.x

© 2008 The AuthorJournal Compilation © Blackwell Publishing Asia Pty Ltd

focuses on some of the challenges and barriers to effec-tive disease management in Asian populations.

Shinji Ohno, MD, and Monica Fornier, MD, discusstwo types of patients with breast cancer who representspecial problems in management. Tumors that are resis-tant to taxanes or multiple-drug regimens and tumorsthat lack estrogen, progesterone and HER2/neu recep-tors (i.e., triple-negative tumors) are associated with anunfavorable prognosis and represent a particular chal-lenge for clinicians as there are few effective treatmentoptions available for patients with these tumor subtypes.This review examines the state of knowledge at the timeof writing regarding the mechanisms of taxane resis-tance and the natural history of triple-negative disease.Strategies for overcoming taxane resistance and improv-ing clinical outcomes for these patient populations at thetime of writing are discussed.

Binghe Xu, MD, reviews the clinical experience todate with the epothilones with a focus on locallyadvanced breast cancer and metastatic disease. Clinicalexperience with the epothilones in clinical developmentis presented with a focus on phase II and III trials ofixabepilone, the first epothilone to be licensed for treat-ing patients with metastatic breast cancer. Ongoingstudies of the epothilones in patients with triple-negativedisease and early breast cancer are also discussed.

Finally Shin-Cheh Chen, MD, and I discussed theneed for breast cancer clinical trials and the develop-ment of consensus treatment guidelines for treatingpatients with breast cancer in the Asia–Pacific region.Despite the recognized differences in the natural historyand responsiveness to breast cancer treatment betweenAsia–Pacific and Western women, the management ofbreast cancer in the Asia–Pacific region often followsevidence-based treatment guidelines based on clinicaltrials conducted in Western populations. Data fromclinical trials and breast cancer registries of Asian

patients would facilitate the best choice of drugs,optimal doses and optimal schedules, and improvedmanagement of breast cancer in the Asia–Pacificregion.

The information in this supplement will be of interestnot only to oncologists, primary care physicians andother medical professionals managing patients withbreast cancer in all countries but especially those in theAsia–Pacific region. We hope that the publication of thisinformation will stimulate an interest in conducing clini-cal studies and advance our goal of improving thequality of care and patient outcomes.

REFERENCES

1 Carlson RW, Anderson BO, Chopra R et al. Treatment ofbreast cancer in countries with limited resources. Breast J2003; 9 (Suppl. 2): S67–74.

2 Yang L, Parkin DM, Li LD, Chen YD, Bray F. Estimationand projection of the national profile of cancer mortality inChina: 1991–2005. Br J Cancer 2004; 90: 2157–66.

3 Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statis-tics, 2002. CA Cancer J Clin 2005; 55: 74–108.

4 Yang L, Parkin DM, Ferlay J, Li L, Chen Y. Estimates ofcancer incidence in China for 2000 and projections for2005. Cancer Epidemiol Biomarkers Prev 2005; 14: 243–50.

5 Satyanarayana L, Asthana S. Life time risk for developmentof ten major cancers in India and its trends over the years1982 to 2000. Indian J Med Sci 2008; 62: 35–44.

6 Agarwal G, Pradeep PV, Aggarwal V, Yip CH, Cheung PS.Spectrum of breast cancer in Asian women. World J Surg2007; 31: 1031–40.

7 Perou CM, Sorlie T, Eisen MB et al. Molecular portraits ofhuman breast tumours. Nature 2000; 406: 747–52.

8 Rouzier R, Perou CM, Symmans WF et al. Breast cancermolecular subtypes respond differently to preoperative che-motherapy. Clin Cancer Res 2005; 11: 5678–85.

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© 2008 The AuthorJournal Compilation © Blackwell Publishing Asia Pty Ltd

Asia–Pac J Clin Oncol 2008; 4(Suppl. 3): S3–S4