Breast cancer survival rates in Sarawak, Malaysia: a central referral centre study

Abstract

Background Breast cancer remains the most common malignancy in Malaysia, with a wide range of survival rates across regions. Sarawak, the largest state in Malaysia faces unique geographic and socioeconomic challenges, often delaying diagnosis and treatment. This study aimed to determine the survival rates and predictors of breast cancer outcomes at the state’s sole public referral centre for cancer.

Methods A retrospective study was conducted among all patients with histologically confirmed breast cancer diagnosed between 2018 and 2022 at Sarawak General Hospital. Sociodemographic, clinical and pathological data were extracted from medical records, whilst mortality was verified via the National Registration Department. Kaplan-Meier and Cox proportional hazards models were used to estimate survival rates and identify prognostic factors.

Results A total of 1,739 patients were analysed. The mean age was 57.5 ± 12.2 years, with 46.5% presenting at advanced clinical stage III–IV. The overall 1-, 3-, and 5-year survival rates were 93.5%, 82.5%, and 74.9%, respectively. Stage at diagnosis and biomarker subtype were independent predictors of survival. Patients with stage III and IV disease had 5.0-fold and 17.8-fold higher all-cause mortality risks compared to patients with stage 1 disease (p < 0.001). ER+, PR+, HER2– tumours had the best prognosis, while triple-negative cancers showed a 2.6-fold higher risk of all-cause death (p < 0.001). Patients from indigenous ethnic communities and those living in rural settings were more likely to present with advanced disease.

Conclusion Breast cancer survival in Sarawak is influenced primarily by disease stage and biomarker profile, with socioeconomic and geographic barriers contributing to delayed diagnosis. Increasing early detection, improving access to oncology care, and developing culturally tailored health literacy programs are essential to improve survival outcomes.