A Scoping Review on the Status of Female Breast Cancer in Asia with a Special Focus on Nepal

Figures & data

Table 1 Search Strategy Details

Search Strategy	Details
Inclusion criteria	Participants (P): Female BC of any age, stage, treatment Concepts (C): (concept 1) status of breast cancer or health status indicators of breast cancers (mortality, incidence or prevalence, risk factors, screening, treatment) Concept 2: Breast cancer survivors or survivors’ trends Concept 3: Access to health services or cancer care facilities Context (C): Asia, Nepal
Exclusion criteria	P: Pediatric population C: not mentioned epidemiological features of breast carcinoma, awareness study and study that does not talk about trends of breast cancer survivors status and health care delivery services or access to a cancer care facility C: Europe, Africa, South America, North America, Antarctica, Oceania
Language filter	English
Time filter	2011–2020
Sex	Human, Female

Figure 1 Flow diagram of the study selection process.

Table 2 Comparison of Age-Standardized Incidence Rate and New Cancer Cases of the Breast by Regions in 2012

Area	New Cases	ASIR	Area	New Cases	ASIR
Asia	651.0^Citation22	29.1^Citation19–21	Europe	464.2^Citation19,Citation20	71.1^Citation17,Citation20,Citation22
Eastern Asia	277.1^Citation19–21	27.0^Citation19–21	Central and Eastern Europe	123.6^Citation19,Citation20	47.7^Citation17,Citation20,Citation22
South-Central Asia	223.9^Citation19–21	28.2^Citation19–21	Northern Europe	78.2^Citation19,Citation20	89.4^Citation17,Citation20,Citation22
South-Eastern Asia	107.5^Citation19–21	34.8^Citation19–21	Southern Europe	100.8^Citation19,Citation20	74.5^Citation17,Citation20,Citation22
Western Asia	42.5^Citation19–21	42.8^Citation19–21	Western Europe	161.5^Citation19,Citation20	96.0^Citation17,Citation20,Citation22

Abbreviation: ASIR, age-standardized incidence rate (per 100,000), new estimated cases (thousands).

Table 3 Age Standardized Incidence Rate and New Breast Cancer Cases by Country of Southern Asia, 2012

Country Name	Cases	ASIR
Pakistan	34,038	50.3^Citation24
Afghanistan	3108	35.1^Citation24
Maldives	41	31.6^Citation24
Sri Lanka	3955	30.9^Citation24
Iran (Islamic Republic of)	9795	28.1^Citation24
India	144,937	25.8^Citation24
Bangladesh	14,836	21.7^Citation24
Nepal	1716	13.7^Citation24
Bhutan	13	4.6^Citation24

Abbreviation: ASIR, age-standardized incidence rate.

Figure 2 Age standardized rate of female breast cancer incidence in the West Asian countries, 2012.

Figure 3 Breast cancer ranked globally and in Asian Regions in 2013.

Table 4 Burden of Breast Cancer in the Asian and European Region in 2018

Asian Region	ASIR	European Region	ASIR
Eastern	39.2^Citation9	Central and Eastern	54.5^Citation9
South-Central	25.9^Citation9	Northern	90.1^Citation9
South-Eastern	38.1^Citation9	Southern	80.3^Citation9
Western	45.3^Citation9	Western	92.6^Citation9

Abbreviation: ASIR, age-standardized incidence rate.

Table 5 Estimated Breast Cancer Fatalities (Thousands) and Age-Standardized Rates Mortality by Region in 2012

Area	Mortality	ASRM	Area	Mortality	ASRM
Developing countries	324.3^Citation19	11.5^Citation19,Citation21	Developed countries	197.5^Citation19	14.9^Citation19
Asia	231.0^Citation19	10.2^Citation19,Citation21	Europe	131.3^Citation19	16.1^Citation19
South-Central Asia	104.7^Citation19	13.5^Citation19,Citation21	Central and Eastern Europe	48.7^Citation19	16.5^Citation19
Eastern Asia	68.5^Citation19	6.1^Citation19,Citation21	Western Europe	37.2^Citation19	16.1^Citation19
South-Eastern Asia	43.0^Citation19	14.1^Citation19,Citation21	Southern Europe	27.5^Citation19	14.9^Citation19
Western Asia	14.8^Citation19	15.1^Citation19,Citation21	Northern Europe	17.8^Citation19	16.3^Citation19

Abbreviation: ASRM, age-standardized rates mortality.

Table 6 Incidence and Age-Standardized Rate of Mortality Breast Cancer by Country of Southern Asia, 2012

Country Name	Deaths	ASRM
India	70,218^Citation24	12.7^Citation24
Pakistan	16,232^Citation24	25.2^Citation24
Bangladesh	7142^Citation24	11.0^Citation24
Iran	3304^Citation24	9.9^Citation24
Afghanistan	1695^Citation24	20.6^Citation24
Sri Lanka	1361^Citation24	10.3^Citation24
Nepal	865^Citation24	7.2^Citation24
Maldives	14^Citation24	11.5^Citation24
Bhutan	5^Citation24	1.8^Citation24

Figure 4 Distribution of age specific breast cancer deaths by region in 2018.

Abbreviation: HDI, Human Development Index.

Table 7 Most Common Breast Cancer Screening Modalities in Asian Countries

Low-Income Countries	Middle-Income Countries	High-Income Countries	Nepal
BSE, Clinical Breast Exam, Mammography^Citation71,Citation72,Citation124 Breast Ultrasound^Citation124	Breast Self-Examination, Clinical Breast Exam^Citation74,Citation75	CT Scan, MRI, PET^Citation74 Mammogram,^Citation125,Citation126 Breast USG FANC, CNB, VAB^Citation127 Genetic testing^Citation126	BSE, Ultrasound Mammography, Breast Ultrasound^Citation14 FNAC, Biopsy

Abbreviations: FNAC, Fine Needle Aspiration Cytology; VAB, Vacuum-Assisted Biopsy, CNB; Core Needle Biopsy; USG, Ultrasound.

Table 8 Breast Cancer Treatment Modalities Used in Low-Middle to High Income Countries in Asia

Low- Middle Income Country	High Income Country	Nepal
BCS^Citation36,Citation74 Brachytherapy^Citation74 Cytotoxic drugs^Citation128 Endocrine therapy^Citation74 Mastectomy^Citation33,Citation36,Citation74,Citation128 Radiation therapy^Citation33,Citation36,Citation74 Sentinel node biopsy^Citation33,Citation36 Axillary node dissection^Citation128 Lumpectomy^Citation129	BCS^Citation79,Citation87 Mastectomy^Citation83,Citation87 Chemotherapy, Neo- adjuvant chemotherapy^Citation80 Radiation therapy^Citation87 Hormone therapy, Tamoxifen^Citation80,Citation87	BCS^Citation14,Citation62 Radical or simple mastectomy^Citation14 Radiation therapy^Citation14,Citation62,Citation77 Systemic therapy with cytotoxic drugs^Citation14,Citation62 Hormone therapy, Tamoxifen^Citation14 Immunotherapeutic agents^Citation14

Abbreviation: BCS, Breast Conserving Surgery.

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