OBJECTIVES. To examine the differences in breast cancer presentation by analysing our recent experience in the diagnosis and management of breast cancer patients.

DESIGN. Retrospective study.

SETTING. Private hospital, Hong Kong.

PATIENTS. Consecutive patients (702 in all) referred to the hospital with newly diagnosed breast cancer over the 5-year period from 2001 to 2006.

MAIN OUTCOME MEASURES. Methods of detection; tumour size, lymph node involvement, and surgical treatment modalities.

RESULTS. Over 80% of these patients presented following self-discovery of a breast mass, whereas routine mammography accounted for only 8%. Screen-detected tumours were smaller than self-discovered tumours (2.02 vs 2.35 cm, P<0.03), and mastectomy rates were lower in mammogram-screened patients than in self-discovered disease (35% vs 50%; P=0.03). In addition, self-detected tumours were significantly more likely to be associated with lymph node involvement than screen-detected tumours (38% vs 20%; P=0.007), confirming a prognostic difference. These uncontrolled data should not be interpreted as proving either the efficacy or the cost-effectiveness of breast screening.

CONCLUSION. The findings suggest a disturbingly low utilisation of mammography in Hong Kong patients, and raise the possibility of a more proactive public health approach to promote such screening for susceptible target groups.

Key words: Breast neoplasms; Breast selfexamination; Mammography; Mass screening; Mastectomy, segmental

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