Breast cancer survival in different country settings: Comparisons between a Filipino resident population, Filipino-Americans and Caucasians

Various international comparisons of breast cancer survival have shown discrepancies which may reflect the impact of ethnicity or health care. Using databases from SEER 13 and from the Manila and Rizal Cancer Registries, age adjusted five-year absolute and relative survival estimates were computed and compared between Filipino-American breast cancer patients, Philippine residents and Caucasians in the US. Determinants of survival differences were examined using Cox proportional hazards modelling. Age adjusted five-year relative survival was almost identical in Filipino-Americans (89.1%) and Caucasians (87.7%), but much lower in the Philippine residents (58.4%). Large tumor size, lymph node involvement, distant metastasis, and the large proportion of women not receiving surgery explained a substantial portion of the excess mortality in Philippine residents. The moderate excess risk of Caucasians compared to Filipino-Americans was explained by age differences. Access to, utilization and affordability of cancer care facilities are important for reducing breast cancer deaths in developing countries.