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  • 1
    Keywords: CANCER ; SURVIVAL ; Germany ; SYSTEM ; POPULATION ; SITES ; PATIENT ; IMPACT ; prognosis ; BREAST ; HEALTH ; COLORECTAL-CANCER ; leukemia ; DATABASE ; LONG-TERM SURVIVAL ; UNITED-STATES ; GASTRIC-CANCER ; TRENDS ; REGISTRY ; cancer registries ; PATIENT SURVIVAL ; PERIOD ANALYSIS ; CANCERS ; EMPIRICAL-EVALUATION ; cancer survival ; UP-TO-DATE ; therapeutic ; Filipino-Americans ; Philippines ; developing countries
    Abstract: Despite the availability of population-based cancer survival data from the developed and developing countries, comparisons remain very few. Such comparisons are important to assess the magnitude of survival discrepancies and to disentangle the impact of ethnic background and health care access on cancer survival. Using the SEER 13 database and databases from the Manila and Rizal Cancer Registries in the Philippines, a 5-year relative survival for 9 common cancers in 1998-2002 of Filipino-American cancer patients were compared with both cancer patients from the Philippines, having the same ethnicity, and Caucasians in the United States, being exposed to a similar societal environment and the same health care system. Survival estimates were much higher for the Filipino-Americans than the Philippine resident population, with particularly large differences (more than 20-30% units) for cancers with good prognosis if diagnosed and treated early (colorectal, breast and cervix), or those with expensive treatment regimens (leukaemias). Filipino-Americans and Caucasians showed very similar survival for all cancer sites except stomach cancer (30.7 vs 23.2%) and leukaemias (37.8 vs 48.4%). The very large differences in the survival estimates of Filipino-Americans and the Philippine resident population highlight the importance of the access to and utilisation of diagnostic and therapeutic facilities in developing countries. Survival differences in stomach cancer and leukaemia between Filipino-Americans and Caucasians in the United States most likely reflect biological factors rather than the differences in access to health care
    Type of Publication: Journal article published
    PubMed ID: 19240723
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  • 2
    Keywords: RECEPTOR ; CANCER ; radiotherapy ; SURVIVAL ; screening ; EPIDEMIOLOGY ; PATIENT ; treatment ; BREAST ; breast cancer ; BREAST-CANCER ; STAGE ; TRIAL ; hormone ; prevention ; MUTATION ; RATES ; chemotherapy ; DATABASE ; MUTATIONS ; PREVALENCE ; ORGANIZATION ; ADJUVANT ; INCIDENCE TRENDS ; BIOPSY ; REGISTRY ; BRCA2 ; cancer registries ; PERIOD ANALYSIS ; RELATIVE SURVIVAL ; CORE ; ADJUVANT CHEMOTHERAPY ; CANCER INCIDENCE ; HORMONE-RECEPTOR STATUS ; PROPORTION ; Filipino-Americans ; Philippines
    Abstract: The breast cancer incidence in the Philippines is among the highest in Asia. Age-standardized incidence rates (ASR) in Metro Manila and Rizal Province derived from the Philippine Cancer Society-Manila Cancer Registry and the Department of Health-Rizal Cancer Registry showed increase from 1980 to 2002, and were significantly higher in 7 cities in Metro Manila and significantly lower in 14 cities/municipalities mostly in Rizal Province. The AJCC Clinical Stage did not change from 1993 to 2002 among incident cases, the average distribution being: I=5%, IIA=20%, IIB=18%, IIIA=9%, IIIB=10%, IV=11%, Unknown=28%. The International Agency for Research on Cancer attempted to run a randomized screening trial in 1995-1997 in the Philippines based on clinical breast examination by trained nurses and midwives. Unfortunately, even after home visits by a team equipped to perform needle biopsy, only 35% of screen-positive cases eventually had a diagnostic test. The estimated prevalence of BRCA mutations among unselected patients in the Philippine General Hospital (PGH) in 1998 was 5.1%, with a prevalence of 4.1% for BRCA2 mutations alone. There is a continuing effort at improving IHC hormone receptor testing at PGH, particularly on early fixation in buffered formalin. It was observed that hormone receptor-positive proportions tended to be higher in core needle biopsy specimens (72%) compared to mastectomy specimens (65%). During the years 1991, 1994 and 1997, 97% of incident cases of early breast cancer underwent modified radical mastectomy, 18% had postoperative radiotherapy, 51% had adjuvant hormone treatment and 47% received adjuvant chemotherapy. Survival of incident cases in 1993 to 2002 was compared to that of Filipino-Americans and Caucasians in the SEER 13 database. The age-adjusted 5-year relative survival, using period analysis, of Metro Manila residents, Filipino-Americans and Caucasians were 58.6%, 89.6% and 88.3% respectively
    Type of Publication: Journal article published
    PubMed ID: 19469648
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  • 3
    Keywords: CANCER ; SURVIVAL ; Germany ; MODEL ; MODELS ; DIAGNOSIS ; SYSTEM ; EPIDEMIOLOGY ; MORTALITY ; POPULATION ; RISK ; PATIENT ; BIOMARKERS ; STAGE ; CARE ; HEALTH ; AGE ; cervical cancer ; CERVICAL-CANCER ; DATABASE ; LONG-TERM SURVIVAL ; MORPHOLOGY ; CARCINOMAS ; UNITED-STATES ; PREVALENCE ; TRENDS ; REGISTRY ; DETERMINANTS ; cancer registries ; PATIENT SURVIVAL ; PERIOD ANALYSIS ; RELATIVE SURVIVAL ; biomarker ; USA ; cancer research ; EMPIRICAL-EVALUATION ; cancer survival ; UP-TO-DATE ; STATE ; CONFIDENCE ; PROPORTION ; Filipino-Americans ; Philippines ; developing countries
    Abstract: Few studies have assessed and compared cervical cancer survival between developed and developing countries, or between ethnic groups within a country. Fewer still have addressed how much of the international or interracial survival differences can be attributed to ethnicity or health care. To determine the role of ethnicity and health care, 5-year survival of patients with cervical cancer was compared between patients in the Philippines and Filipino-Americans, who have the same ethnicity and between Filipino-Americans and Caucasians, who have the same health care system. Cervical cancer databases from the Manila and Rizal Cancer Registries and Surveillance, Epidemiology, and End Results 13 were used. Age-adjusted 5-year survival estimates were computed and compared between the three patient groups. Using Cox proportional hazards modeling, potential determinants of survival differences were examined. Overall 5-year relative survival was similar in Filipino-Americans (68.8%) and Caucasians (66.6%), but was lower for Philippine residents (42.9%). Although late stage at diagnosis explained a large proportion of the survival differences between Philippine residents and Filipino-Americans, excess mortality prevailed after adjustment for stage, age, and morphology in multivariate analysis [relative risk (RR), 2.07; 95% confidence interval (0), 1.68-2.55]. Excess mortality decreased, but persisted, when treatments were included in the multivariate models (RR, 1.78; 95% Cl, 1.41-2.23). A moderate, marginally significant excess mortality was found among Caucasians compared with Filipino-Americans (adjusted RR, 1.22; 95% Cl, 1.01-1.47). The differences in cervical cancer survival between patients in the Philippines and in the United States highlight the importance of enhanced health care and access to diagnostic and treatment facilities in the Philippines. (Cancer Epidemiol Biomarkers Prev 2009;18(8):2228-34)
    Type of Publication: Journal article published
    PubMed ID: 19661081
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  • 4
    Keywords: AGE, CANCER, CANCER PATIENTS, cancer registries, cancer research, cancer survival, CANCER-PATIENTS,
    Abstract: BACKGROUND: In contrast to most other forms of cancer, data from some developing and developed countries show surprisingly similar survival rates for ovarian cancer. We aimed to compare ovarian cancer survival in Philippine residents, Filipino-Americans and Caucasians living in the US, using a high resolution approach, taking potential differences in prognostic factors into account. METHODS: Using databases from the SEER 13 and from the Manila and Rizal Cancer Registries, age-adjusted five-year absolute and relative survival estimates were computed using the period analysis method and compared between Filipino-American ovarian cancer patients with cancer patients from the Philippines and Caucasians in the US. Cox proportional hazards modelling was used to determine factors affecting survival differences. RESULTS: Despite more favorable distribution of age and cancer morphology and similar stage distribution, 5-year absolute and relative survival were lower in Philippine residents (Absolute survival, AS, 44%, Standard Error, SE, 2.9 and Relative survival, RS, 49.7%, SE, 3.7) than in Filipino-Americans (AS, 51.3%, SE, 3.1 and RS, 54.1%, SE, 3.4). After adjustment for these and additional covariates, strong excess risk of death for Philippine residents was found (Relative Risk, RR, 2.45, 95% confidence interval, 95% CI, 1.99-3.01). In contrast, no significant differences were found between Filipino-Americans and Caucasians living in the US. CONCLUSION: Multivariate analyses disclosed strong survival disadvantages of Philippine residents compared to Filipino-American patients, for which differences in access to health care might have played an important role. Survival is no worse among Filipino-Americans than among Caucasians living in the US.
    Type of Publication: Journal article published
    PubMed ID: 19778421
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