Breast Cancer Incidence Trends and Projections in Northeastern Thailand.

BACKGROUND: The northeast has the lowest incidence of breast cancer of all regions in Thailand, although national rates are increasing. The heterogeneity in subnational trends necessitates a comprehensive evaluation of breast cancer incidence trends and projections to provide evidence for future region-specific strategies that may be employed to attenuate this growing burden. METHODS: Joinpoint regression and age-period-cohort modeling were used to describe trends from 1988-2012. Data was projected from three separate models to provide a range of estimates of incidence to the year 2030 by age group. RESULTS: Age-standardized rates (ASRs) increased significantly for all women from 1995-2012 by 4.5% per year. Rates for women below age 50 increased by 5.1% per year, while women age 50 years and older increased by 6% per year from 1988-2012. Projected rates show that women age 50 years and older have the largest projected increase in ASRs by 2030 compared to younger women and all women combined. CONCLUSIONS: Breast cancer trends in Khon Kaen are presently lower than other regions but are expected to increase and become comparable to other regions by 2030, particularly for women ages 50 years and older.

A comparison of letrozole and anastrozole followed by letrozole in breast cancer patients.

BACKGROUND: We previously studied the noninferiority of anastrozole (ANZ) versus ANZ followed by letrozole (A-LTZ) due to reimbursement policy. We found that patients with A-LTZ had better overall survival (OS) than did patients with ANZ alone. This study aimed to prove that patients with A-LTZ also had better OS than patients with letrozole (LTZ) alone. METHODS: All medical records of the breast cancer patients taking LTZ with or without ANZ between 2004 and 2013 were reviewed. All patients were divided into two groups: the LTZ group included patients treated with LTZ alone, and the A-LTZ group included patients treated with ANZ who were automatically changed to LTZ due to change of the reimbursement policy. RESULTS: From 359 cases, there were 179 cases in the LTZ group and 180 cases in the A-LTZ group. The mean age of patients in the LTZ group was 53.7 years and in the A-LTZ group was 54.2 years. The distribution of clinical stages among the LTZ group versus the A-LTZ group was 21 versus 4 (stage 1), 86 versus 116 (stage 2), 55 versus 46 (stage 3), and 17 versus 14 (stage 4), respectively. Among the LTZ patients, 63.7% took aromatase inhibitor monotherapy and 36.3% had a switching strategy, while in the A-LTZ group, 53.9% took AI monotherapy and 46.1% had a switching strategy. OS of the A-LTZ group was longer than that of the LTZ group. CONCLUSION: The patients in A-LTZ, taking ANZ followed by LTZ had better OS than those in LTZ, taking LTZ alone.

Effects of switching from anastrozole to letrozole, due to reimbursement policy, on the outcome of breast cancer therapy.

BACKGROUND: Endocrine therapy is one of the standard treatments for estrogen-receptor-positive breast cancer patients. Letrozole is the only aromatase inhibitor (AI) included in Thailand's essential drug list since the change of reimbursement policy in 2008, when patients had to change their AIs (other than letrozole) to letrozole. This study aimed to prove that the efficacy of anastrozole plus letrozole is not less than anastrozole alone. METHODS: All medical records of breast cancer patients taking anastrozole between 2004 and 2013 were reviewed. Some patients were initially treated with anastrozole and then changed to letrozole (A-LTZ group), whereas the other patients were continuously treated with anastrozole until completion of therapy (ANZ group). RESULTS: In a total of 180 (55.9%) out of the 322 cases, anastrozole was replaced with letrozole. The mean age of patients in the ANZ group was 54.9 years and that of those in the A-LTZ group was 54.2 years. Clinical stages (1-4) of the ANZ versus A-LTZ patients were four versus four, 76 versus 116, 46 versus 46, and 16 versus 14, respectively. ANZ patients took AI monotherapy (46.5%) and switching strategy (53.5%), while A-LTZ patients took AI monotherapy (53.9%) and switching strategy (46.1%). The overall survival (OS) of A-LTZ patients was longer than that of ANZ patients. Stage 2 and 4 patients in the A-LTZ group also had better OS than those in the ANZ group, but stage 3 patients had similar OS in both groups. CONCLUSION: Anastrozole can be replaced by letrozole any time during endocrine therapy. The patients taking anastrozole plus letrozole surprisingly seemed to have better OS than patients taking anastrozole alone.