Open Access Open Badges Research article

Closing the global cancer divide- performance of breast cancer care services in a middle income developing country

Gerard CC Lim1, Emran N Aina1, Soon K Cheah1, Fuad Ismail1, Gwo F Ho2, Lye M Tho2, Cheng H Yip2, Nur A Taib2, Kwang J Chong3, Jayendran Dharmaratnam3, Matin M Abdullah4, Ahmad K Mohamed4, Kean F Ho5, Kananathan Ratnavelu6, Chiao M Lim6, Kin W Leong7, Ibrahim A Wahid8, Teck O Lim9* and for the HPMRS Breast Cancer Study Group

Author Affiliations

1 Kuala Lumpur Hospital, Kuala Lumpur, Malaysia

2 Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia

3 Mahkota Cancer Centre, Melaka, Malaysia

4 Sime Darby Medical Centre, Petaling Jaya, Malaysia

5 Mount Miriam Cancer Hospital, Pulau Pinang, Malaysia

6 Nilai Medical Centre, Nilai, Malaysia

7 Gleneagles Medical Centre Pinang, Pinang, Malaysia

8 Beacon International Specialist Centre, Petaling Jaya, Malaysia

9 ClinResearch SB, Kuala Lumpur, Malaysia

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BMC Cancer 2014, 14:212  doi:10.1186/1471-2407-14-212

Published: 20 March 2014



Cancer is the leading cause of deaths in the world. A widening disparity in cancer burden has emerged between high income and low-middle income countries. Closing this cancer divide is an ethical imperative but there is a dearth of data on cancer services from developing countries.


This was a multi-center, retrospective observational cohort study which enrolled women with breast cancer (BC) attending 8 participating cancer centers in Malaysia in 2011. All patients were followed up for 12 months from diagnosis to determine their access to therapies. We assess care performance using measures developed by Quality Oncology Practice Initiative, American Society of Clinical Oncology/National Comprehensive Cancer Network, American College of Surgeons’ National Accreditation Program for Breast Centers as well as our local guideline.


Seven hundred and fifty seven patients were included in the study; they represent about 20% of incident BC in Malaysia. Performance results were mixed. Late presentation was 40%. Access to diagnostic and breast surgery services were timely; the interval from presentation to tissue diagnosis was short (median = 9 days), and all who needed surgery could receive it with only a short wait (median = 11 days). Performance of radiation, chemo and hormonal therapy services showed that about 75 to 80% of patients could access these treatments timely, and those who could not were because they sought alternative treatment or they refused treatment. Access to Trastuzumab was limited to only 19% of eligible patients.


These performance results are probably acceptable for a middle income country though far below the 95% or higher adherence rates routinely reported by centres in developed countries. High cost trastuzumab was inaccessible to this population without public funding support.

Breast cancer; Cancer burden; Developing country; Performance measurement; Healthcare quality; Health policy; Health services research; Health system research