Breast Cancer Survival in Sri Lanka

Abstract

PURPOSE In this study, we report survival data of the largest cohort of patients with breast cancer in Sri Lanka. PATIENTS AND METHODS All female patients with histologically confirmed breast cancer treated at a single unit at the National Cancer Institute of Sri Lanka between 1994 and 2006 were included in the study. Clinical records were reviewed and data obtained on the following clinical and pathologic factors: age, histology, stage at presentation, grade, and immunohistochemistry profile. Treatment details such as type of surgery and use of systemic chemotherapy, hormonal therapy, trastuzumab, and radiation therapy were also collected. In localized cancer, disease-free survival (DFS) was the primary end point, while in patients who presented with de novo metastases, progression-free survival (PFS) was the primary end point. RESULTS A significant proportion of patients presented with de novo metastases (14%) and locally advanced disease (18%). While 57% of patients had hormone-sensitive tumors, human epidermal growth factor receptor 2 overexpression was seen in 14%, and 29% had triple-negative tumors. Only 3% of patients with localized disease were treated with breast-conserving surgery, with the rest undergoing modified radical mastectomy. The 5- year DFS rate was 71.6% (95% CI, 69.2 to 74.0) in patients with localized disease. The median PFS in patients with metastatic disease was 20 months (95% CI, 18 to 22 months), while the median overall survival was 30 months (95% CI, 32 to 35 months). On multivariable analysis, immunohistochemical group and stage were prognostic factors in localized disease, while in patients with metastases, immunohistochemical group and tumor grade were associated with PFS. CONCLUSION More effective screening and early detection programs along with increasing breast-conserving surgery will improve breast cancer outcomes in Sri Lanka.