Letter to the Editor

Prevalence of limited cancer knowledge in Singaporeans, its determinants and association with cancer screening☆

Inequalities in cancer screening are little studied in Asian societies. We determined whether area and individual measures of socio-economic status (SES) affected cancer screening participation in Singapore and prospectively evaluated an access-enhancing community-based intervention.

The study population involved all residents aged > 40 years in two housing estates comprising of owner-occupied (high-SES area) and rental (low-SES area) flats. From 2009 to 2011, non-adherents to regular screening for colorectal/breast/cervical cancer were offered free convenient screening over six months. Pre- and post-intervention screening rates were compared with McNemar's test. Multi-level logistic regression identified factors of regular screening at baseline; Cox regression analysis identified predictors of screening post-intervention.

Participation was 78.2% (1081/1383). In the low-SES area, 7.7% (33/427), 20.4% (44/216), and 14.3% (46/321) had regular colorectal, cervical and breast cancer screening respectively. Post-intervention, screening rates in the low-SES area rose significantly to 19.0% (81/427), 25.4% (55/216), and 34.3% (74/216) respectively (p < 0.001). Area SES was more consistently associated with screening than individual SES at baseline. Post-intervention, for colorectal cancer screening, those with higher education were more likely to attend (p = 0.004); for female cancer screening, the higher-income were less likely to attend (p = 0.032).

Access-enhancing community-based interventions improve participation among disadvantaged strata of Asian societies.

This study aims to improve insight in breast cancer characteristics and outcome in the understudied population of elderly Asian women with breast cancer.

We identified 2195 women, ≥ 40 years, diagnosed with breast cancer between 1990–2007 at the National University Hospital in Singapore. Patient and tumor characteristics, treatment and outcome were compared between women diagnosed at age < 65 years and ≥ 65 years.

Older women were more often diagnosed with advanced stages and estrogen receptor positive tumors. They were less likely to have undergone axillary clearance, radiotherapy post breast conserving surgery and chemotherapy for lymph node positive disease. Older women had poorer relative survival than younger women; however these differences largely disappeared after stage stratification.

Similar to Western populations, older Asian breast cancer patients present with more advanced stages and are less likely to receive standard treatment. Older age was not associated with worse survival within different stage strata.