Close to half (45.4%) of the 2.3 million breast cancers (BC) diagnosed in 2020 were from Asia. While the burden of breast cancer has been examined at the level of broad geographic regions, literature on more in-depth coverage of the individual countries and subregions of the Asian continent is lacking. This narrative review examines the breast cancer burden in 47 Asian countries. Breast cancer screening guidelines and risk-based screening initiatives are discussed.

Singapore launched a population-based organised mammography screening (MAM) programme in 2002. However, uptake is low. A better understanding of breast cancer (BC) risk factors has generated interest in shifting from a one-size-fits-all to a risk-based screening approach. However, public acceptability of the change is lacking. Focus group discussions (FGD) were conducted with 54 women (median age 37.5 years) with no BC history. Eight online sessions were transcribed, coded, and thematically analysed. Additionally, we surveyed 993 participants in a risk-based MAM study on how they felt in anticipation of receiving their risk profiles. Attitudes towards MAM (e.g., fear, low perceived risk) have remained unchanged for ~25 years. However, FGD participants reported that they would be more likely to attend routine mammography after having their BC risks assessed, despite uncertainty and concerns about risk-based screening. This insight was reinforced by the survey participants reporting more positive than negative feelings before receiving their risk reports. There is enthusiasm in knowing personal disease risk but concerns about the level of support for individuals learning they are at higher risk for breast cancer. Our results support the empowering of Singaporean women with personal health information to improve MAM uptake.

Background: Early detection of breast cancer (BC) through mammography screening (MAM) is known to reduce mortality. We examined the differential effect that mammography has on BC characteristics and overall survival and the sociodemographic determinants of MAM utilization in a multi-ethnic Asian population.Methods: This study included 3739 BC patients from the Singapore Breast Cancer Cohort (2010–2018). Self-reported sociodemographic characteristics were collected using a structured questionnaire. Clinical data were obtained through medical records. Patients were classified as screeners (last screening mammogram ≤ 2 years before diagnosis), non-screeners (aware but did not attend or last screen > 2years), and those unaware of MAM. Associations between MAM behaviour (MB) and sociodemographic factors and MB and tumour characteristics were examined using multinomial regression. Ten-year overall survival was modelled using Cox regression.Results: Patients unaware of screening were more likely diagnosed with late stage (OR_{stage III vs stage I (Ref)}[95% CI]: 4.94 [3.45–7.07],p< 0.001), high grade (OR_{poorly vs well-differentiated (reference)}: 1.53 [1.06–2.20],p= 0.022), nodal-positive, large size (OR_{>5cm vs ≤2cm (reference)}: 5.06 [3.10–8.25],p< 0.001), and HER2-positive tumours (OR_{HER2-negative vs HER2-positive (reference)}: 0.72 [0.53–0.97],p= 0.028). Similar trends were observed between screeners and non-screeners with smaller effect sizes. Overall survival was significantly shorter than screeners in the both groups (HR_{non-screeners}: 1.89 [1.22–2.94],p= 0.005; HR_unaware: 2.90 [1.69–4.98],p< 0.001).Non-screeners and those unaware were less health conscious, older, of Malay ethnicity, less highly educated, of lower socioeconomic status, more frequently ever smokers, and less physically active. Among screeners, there were more reported personal histories of benign breast surgeries or gynaecological conditions and positive family history of breast cancer.Conclusions: Mammography attendance is associated with more favourable BC characteristics and overall survival. Disparities in the utility of MAM services suggest that different strategies may be needed to improve MAM uptake.

Close to half (45.4%) of 2.3 million breast cancers (BC) diagnosed in 2020 were from Asia. While the burden of breast cancer has been examined on the level of broad geographic regions, literature on more in-depth coverage of the individual countries and subregions of the Asian continent is lacking. This review examines the breast cancer burden in 47 Asian countries. Breast cancer screening guidelines and risk-based screening initiatives are discussed.

Objectives To explore husbands’ views on breast cancer screening, risk-based screening and their role in influencing their wives’ health-seeking behaviours. Design Qualitative focus group discussion (FGD) supplemented by quantitative data from a cohort study using a structured questionnaire. Setting This study was conducted in a community-based setting, with participants recruited online through non-profit organisations via social media and email. Participants Nineteen husbands of women without breast cancer history participated. The questionnaire data were completed by 3395 women with no breast cancer history. Interventions Not applicable. Primary and secondary outcome measures Not applicable. Results Six key themes emerged from FGDs regarding husbands’ attitudes towards women’s breast cancer screening practices: awareness, priorities, social support structures, fears, incentives and attitudes towards risk-based screening. These themes were supported by the questionnaire data, which also identified additional concerns not raised in FGDs, suggesting a gap in the husband’s awareness and limited health-related communication between spouses. While husbands expressed interest in their wives’ health and provided support in making screening appointments, their influence may be limited by these communication gaps. Most husbands were receptive to risk-based screening but raised concerns around the testing frequency and result interpretation. Conclusions This study highlights the need to actively engage husbands in breast cancer screening discussions and develop support strategies that enhance their involvement. Strengthening spousal communication on breast health may increase screening uptake among women.

Physical activity (PA) is known to reduce breast cancer (BC) risk and improve patient prognosis. However, the association between pre-diagnostic PA and the aggressiveness of BC is unclear. We investigated the associations between PA, BC tumour characteristics, and survival. This retrospective observational study included 7688 BC patients from the Singapore Breast Cancer Cohort (2010–2016). PA information from the questionnaire included intensity (light/moderate/vigorous) and duration (2 h per week). A PA score (1–5) incorporating intensity and duration was calculated. Associations between PA score and tumour characteristics such as stage, histological grade, nodal and hormone receptor status were examined using multinomial regression. Moreover, 10-year overall survival was estimated using Cox regression analysis in 6572 patients after excluding patients with invalid survival data and stage IV disease. Breast tumours associated with higher PA score were more likely to be non-invasive (OR_{invasive vs. non-invasive(reference)} [95% CI]: 0.71 [0.58–0.87], p-trend = 0.001), of lower grade (OR_{poorly vs. well differentiated(reference)}: 0.69 [0.52–0.93], p = 0.014), ER-positive (OR_{ER-negative vs. ER-positive(reference)}: 0.94 [0.89–1.00], p-trend = 0.049), PR-positive (OR_{PR-negative vs. PR-positive(reference)}: 0.82 [0.67–0.99], p = 0.041), HER2-negative (OR_{HER2-negative vs. HER2-positive(reference)}: 1.29 [1.02–1.62], p-trend = 0.002), and less likely to be of HER2-overexpressed subtype (OR_{HER2-overexpressed vs. Luminal A(reference)}: 0.89 [0.81–0.98], p-trend = 0.018). These associations (odds ratios) were more pronounced among post-menopausal patients. A higher PA score did not improve survival. Higher levels of pre-diagnostic PA were associated with less aggressive tumours in BC patients. This illustrated another benefit of PA in addition to its known role in BC risk reduction.