BackgroundGail and others developed a model (GAIL) using age-at-menarche, age-at-birth of first live child, number of previous benign breast biopsy examinations, and number of first-degree-relatives with breast cancer as well as baseline age-specific breast cancer risks for predicting the 5-year risk of invasive breast cancer for Caucasian women. However, the validity of the model for projecting risk in South-East Asian women is uncertain. We evaluated GAIL and attempted to improve its performance for Singapore women of Chinese, Malay and Indian origins.MethodsData from the Singapore Breast Screening Programme (SBSP) are used. Motivated by lower breast cancer incidence in many Asian countries, we utilised race-specific invasive breast cancer and other cause mortality rates for Singapore women to produce GAIL-SBSP. By using risk factor information from a nested case-control study within SBSP, alternative models incorporating fewer then additional risk factors were determined. Their accuracy was assessed by comparing the expected cases (E) with the observed (O) by the ratio (E/O) and 95% confidence interval (CI) and the respective concordance statistics estimated.ResultsFrom 28,883 women, GAIL-SBSP predicted 241.83 cases during the 5-year follow-up while 241 were reported (E/O=1.00, CI=0.88 to 1.14). Except for women who had two or more first-degree-relatives with breast cancer, satisfactory prediction was present in almost all risk categories. This agreement was reflected in Chinese and Malay, but not in Indian women. We also found that a simplified model (S-GAIL-SBSP) including only age-at-menarche, age-at-birth of first live child and number of first-degree-relatives performed similarly with associated concordance statistics of 0.5997. Taking account of body mass index and parity did not improve the calibration of S-GAIL-SBSP.ConclusionsGAIL can be refined by using national race-specific invasive breast cancer rates and mortality rates for causes other than breast cancer. A revised model containing only three variables (S-GAIL-SBSP) provides a simpler approach for projecting absolute risk of invasive breast cancer in South-East Asia women. Nevertheless its role in counseling the individual women regarding their risk of breast cancer remains problematical and needs to be validated in independent data.

Hepatocellular carcinoma (HCC) is one of the most common and lethal cancers globally. With advances in therapy for chronic viral hepatitis, changing social circumstances, and increasing practice of HCC surveillance, the epidemiology of HCC is expected to change over time. We explored the temporal trends in HCC in Singapore, a multiethnic Asian country, over the last 3 decades. Patients with HCC were prospectively enrolled and stratified into two cohorts (C1, 1988‐2002; C2, 2003‐2016). Patient and tumor characteristics, management, and survival were compared between the two cohorts, and a survival census was performed on October 31, 2015. There were 1,401 patients, and the mean age at diagnosis of HCC for C1 and C2 was 60.1 and 63.5 years, respectively. Male patient preponderance decreased significantly, with the male to female ratio falling from 5.2:1 to 3.9:1 between C1 and C2. Hepatitis B, although still the predominant risk factor for HCC, showed a significant decline from C1 to C2 (76.5% to 68.2%), while the nonviral etiology increased significantly over the same period (14.4% versus 25.0%, respectively). Significantly more patients in C2 than C1 were diagnosed through surveillance (39.2% versus 11.3%, respectively) and had better physical performance (Eastern Cooperative Oncology Group 0, 62.1% versus 20.4%, respectively). While Child‐Pugh status was comparable, significantly more patients in C2 than C1 had early stage disease (Barcelona Clinic Liver Cancer 0‐A, 39.5% versus 7.4%, respectively), which translated into significantly higher median survival (18.6 months versus 3.8 months, respectively). Conclusion: Over the past 3 decades, hepatitis B‐related HCC has been decreasing while HCC due to nonviral etiology has been increasing significantly. Surveillance to diagnose early stage HCC is important in improving the outcome of HCC. (Hepatology Communications 2017;1:564–571)

Introduction: Screening for scoliosis started in Singapore schools in 1982 and is currently being done for both boys and girls, as part of the annual school-based health screening programme in all primary and secondary schools. The screening levels in the current protocol were based on the 1997 prevalence study by Wong et al. In the study, it appeared that there was a significant increase in prevalence rates between 9- and 11-year-old girls (i.e. between Primary 4 and Primary 6) but there was no data on the prevalence rates of scoliosis in 10-year-old girls (Primary 5) and in 12-year-old girls (Secondary 1). In order to decide on whether to make changes to the screening levels, a review was conducted to determine the prevalence of scoliosis among the 10-year-old girls (in Primary 5) and 12-year-old girls (in Secondary 1). Materials and Methods: A total of 93,626 female students, aged between 9 and 13 years old were screened. The study covered all of the 183 primary schools and only 83 of the 165 secondary schools due to a disruption of health screening in schools during the outbreak of SARS (severe acute respiratory syndrome). In mid-2003, schools in Singapore were closed because Singapore was one of the countries af-fected by SARS. Scoliosis screening was done for all female students in the Primary 4, 5 and 6 levels as well as in the Secondary 1 and 2 levels. Male students were routinely screened for scoliosis in the Primary 6 and Secondary 2 levels. Scoliosis screening was done by measuring the angle of trunk rotation (ATR) using a scoliometer. All students with ATR ≥5° were referred to the Student Health Centre (SHC) where second-tier screening was done. At SHC, if ATR ≥5°, postero-anterior radiograph of the spine was done. Of the 3186 female students in the primary level, aged between 9 and 13 years old who were referred to SHC for the second-tier screen-ing, 2438 attended, and for secondary students aged between 12 and 13 years old, 1587 out of 1720 students attended. Results: The prevalence rates of idiopathic adolescent scoliosis for the 9- to 13-year-old female students were 0.27%, 0.64%, 1.58%, 2.22% and 2.49%, respectively, which showed an increasing trend in the prevalence rates with increasing age. There was a significant increase in the prevalence rates of adolescent idiopathic scoliosis (AIS) in the 10- to 11-year-old females compared to the 9-year-old females (OR, 1.7; 95% CI, 1.1-2.4; P = 0.010). There was also a significant increase in the prevalence rates in the 12- to 13-year-old females (OR, 2.2; 95% CI, 1.4-3.3; P = 0.001). Conclusions: The study showed a significant increase in the prevalence rates of scoliosis in the 10- to 11-year-old female students and again a significant increase in the prevalence rates in the 12- to 13-year-old female students. Since the prevalence rate for the 9-year-old females was quite low (0.27%), and there was a significant increase in the prevalence rates in the 10- to 11-year-old and 12- to 13-year-old females, it was recommended that screening for females be performed every year commencing at 10 years old (Primary 5) until 13 years old (Secondary 2).

No abstract