Breast cancer in Singapore: Trends in incidence 1968-1992

Background. Breast cancer is the most commonly occurring cancer among women in Singapore, a country which has experienced significant changes in lifestyle over the past three decades. The increase in incidence of the disease is a matter of some concern. Methods. Data from the population-based Singapore Cancer Registry for 1968-1992 were used to determine time trends, inter-ethnic differences and the contributions of age, period and cohort effects to the incidence of the disease. Results. Our results revealed an average annual increase of 3.6% over the 25-year period for all women, from 20.2 per 100 000 women in the period 1968-1972 to 38.8 per 100 000 in 1988-1992. There was a statistically significant difference between the three major ethnic groups, the rate of increase being highest in Malays (4.4%) and lowest in Indians (1.4%). The overall increase was attributable to a strong cohort effect that remained significant when adjusted for time period for Chinese women and for all ethnic groups combined. The risk was observed to increase in successive birth cohorts from the 1890s to the 1960s. Conclusions. Our results suggest that breast cancer incidence rates are likely to continue to increase more sharply in the future as women born after the mid-20th century reach the high-risk age groups. They also suggest the pattern by which important aetiological factors for the disease in our population have exerted their effects, and provide support for the role of demographic and lifestyle changes as possible risk factors.