From our department’s registry when we analyzed our stage of presentation for the three common cancers, we observed that there was a reduction in late stage presentation.

Breast cancer in stage III and IV were reduced from 60% (1994) to 35% (1998) and cervical cancer in stage III and IV from 60% (1994) to 26% (1998).


These results were published as “Reducing by half the percentage of late stage presentation for breast and cervix cancer over 4 years: A pilot study of clinical downstaging in Sarawak, Malaysia” Annals of Oncology, 2007.18: 1172-1176.

As the pick up rate of PAP smear was only 5% of the cases, it revealed that community awareness played a crucial role in the downstaging. No downstaging was observed for nasopharyngeal cancer. In addition, in the WHO guide for effective programmes; module 3:33, 2007 “A pilot study of early diagnosis in Sarawak, Malaysia”.  Early Detection Cancer control: knowledge into action: was included. This paper was also selected by an US based Breast Cancer. Net - a reputable online news alert on breast cancer research on 8th August 2007.


In early 2010, we further analyzed our data on breast cancer and observed the following findings. These findings were then presented at BGHI, ASCO June 2010 at Chicago, USA and at ESMO, Milan October 2010.


  1. It is possible to significantly reduce late stage diagnosis of breast cancer in LMC without any screening or costly public campaigns;

  2. Increasing the knowledge and practices of health staff and streamlining referral process is the key to the success of this program;

  3. The benefit gained is sustainable over a decade without additional effort.

Our results also suggest that public awareness using community health providers may be more cost effective than media campaigns however this needs to be studied further