Reducing by half the percentage of late-stage presentation for breast and cervix cancer over 4 years: a pilot study of clinical downstaging in Sarawak, Malaysia

Ann Oncol. 2007 Jul;18(7):1172-6. doi: 10.1093/annonc/mdm105. Epub 2007 Apr 13.


Background: The registry of the Oncology Departmental in Sarawak General Hospital showed that 79% of nasopharyngeal, 77% of breast and 70% of cervix cancer patients were diagnosed at an advanced stage (stages III and IV) for year 1993. Hence, a low cost Early Cancer Surveillance Program was started in 1994, with the intent of downstaging these three most common cancers in Sarawak.

Materials and methods: The program consisted of (i) training health staff in hospital and rural clinics to improve their skills in early cancer detection, (ii) raising public awareness through pamphlets, posters and sensitization by health staff.

Results: Data analysis revealed that the program achieved downstaging in two of the cancers. Breast cancer in stage III and IV was reduced from 60% (1994) to 35% (1998) (P < 0.0001) and cervical cancer in stage III and IV from 60% (1994) to 26% (1998) (P < 0.0001). No reduction was observed for nasopharyngeal cancer at 88% (1994) to 91% (1998).

Conclusions: The overall cost of this program was <US$34 000. It is cost-effective and easy to implement and would be a valuable alternative in countries where majority of the tumors are found in late stage (III and IV) where screening programs meet important difficulties. Our data analyses revealed important shortcomings in the PAP smear screening program where inadequate groups of women were screened. It resulted in a pick up rate of only 5% of the cases. This finding confirmed the need for the simple and complementary downstaging approach.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / diagnosis*
  • Breast Self-Examination
  • Early Diagnosis*
  • Female
  • Health Personnel / education
  • Humans
  • Malaysia / epidemiology
  • Mass Screening* / economics
  • Mass Screening* / methods
  • Middle Aged
  • Nasopharyngeal Neoplasms / diagnosis
  • Neoplasm Staging
  • Papanicolaou Test
  • Patient Education as Topic / methods
  • Pilot Projects
  • Population Surveillance / methods*
  • Uterine Cervical Neoplasms / diagnosis*
  • Vaginal Smears