J Immigrant Minority Health

DOI 10.1007/s10903-015-0168-2

ORIGINAL PAPER

Breast Cancer Amongst Filipino Migrants: A Review

of the Literature and Ten-Year Institutional Analysis
Jory S. Simpson Kaleigh Briggs Ralph George

Springer Science+Business Media New York 2015

Abstract As one migrates from an area of low to high

incidence of breast cancer their personal risk of developing
breast cancer increases. This is however not equally distributed across all races and ethnicities. This paper
specifically examines Filipino migrants. A literature review
was conducted to summarize breast cancer incidence,
screening practices and trends in treatment amongst Filipino migrants. In addition, a retrospective cohort study was
conducted specifically examining the age in which Filipino
women were diagnosed with breast cancer compared to
Asian and Caucasian counterparts. Filipino women are
diagnosed with breast cancer at a statistically significant
younger age (53.2) compared to their Asian (55.1) and
Caucasian (58.4) counterparts. In addition, they are at an
increased risk of developing more aggressive breast cancer
with noteworthy disparities in the care they are receiving.
The evidence suggest this group is worthy of special focus
when diagnosing and treating breast cancer.
Keywords
Migrants

Breast cancer
Filipino
Philippines

Background

the lowest rates in Asia and sub-Saharan Africa [2, 3].

Global variation can in part be attributed to differences in
exposure to known risk factors for developing breast cancer
[3]. Migrant Studies have consistently shown that when a
woman moves from a region of low incidence to a region
of higher incidence her risk of developing BC increases [4].
The Philippines is a country in Southeast Asia with a
population over 92 million; an estimated 12 million people
of Filipino origin live overseas [5]. Filipinos belong to
several Asian ethnic groups classified linguistically as part
of the Austronesian or Malayo-Polynesian speaking people
[6]. Filipinos are the second largest Asian subgroup in the
United States and a rapidly growing ethnicity in Canada [7,
8]. Given their unique multi-ethnicity and their population
growth in North America, women of Filipina ancestry are
worthy of special focus in discussing the burden of breast
cancer in North America.
St. Michaels Hospital, located in downtown Toronto,
provides care to diverse multiethnic immigrant communities including the Filipino community. After performing a
comprehensive review of the literature examining the
landscape of breast cancer in Filipino migrants we sought
out to compare the presentation and pathologic features of
breast cancer in Filipino women to other Asian ethnicities
and Caucasians at our institution over a ten-year period.

Worldwide, breast cancer (BC) is the most commonly diagnosed cancer with over 1,384,000 new diagnoses made
in 2008 [1]. The incidence however is not equally distributed throughout the world with the highest rates in
North America, Australia/New Zealand and in Europe and

Theoretical Framework/Methods

J. S. Simpson (&)
K. Briggs
R. George

Department of Surgery, St. Michaels Hospital, University of
Toronto, 30 Bond Street, Toronto, ON M5B1W8, Canada
e-mail: simpsonjo@smh.ca

A review of the literature was first conducted with the

assistance of a trained health sciences librarian at St.
Michaels Hospital. On 7 Dec 2012, Medline and Embase
were searched from the year 1947 for citations relevant to

Literature Review

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J Immigrant Minority Health

breast cancer in the Philippines and Filipino women. Indexed terms for breast cancer included: breast neoplasms,
and the narrower terms Carcinoma, ductal, breast, Hereditary Breast and Ovarian Cancer Syndrome, and genes,
BRCA1, genes, BRCA2. Keywords included breast
and neoplasms, cancer and carcinoma and BRCA.
Philippines and Filipino populations were identified
through a mixture of indexed (MeSH) words, and keywords. Appendix summarizes the search strategy for
reproducibility.
Inclusion criteria included articles relevant only to the
incidence, screening, diagnosis and treatment of breast
cancer in Filipino/Pacific Islander women. Exclusion criteria were limited to articles not written in English.
Cohort Study
Study participants included women, undergoing surgical
management of breast cancer at St. Michaels Hospital in
Toronto ON, between the years of 2002 and 2012. In this
retrospective epidemiological cohort study the primary aim
was to investigate the relationship between age at breast
cancer diagnosis and race. Specifically, we wanted to collect data and measure the age in which Filipino women
were diagnosed with breast cancer compared to their Asian
and Caucasian counterparts. We hypothesize that women
of Filipino ancestry are a distinct group with unique breast
cancer properties. Secondary aims included comparing
nuclear grade, receptor status, tumor size, lymph node
status and type of surgery with patient race.
The breast report is a physician-compiled database of
breast surgeries performed over a 10 year period between
the years of 2002 and 2012 at St Michaels Hospital. The
authors independently reviewed the breast report to produce a comprehensive database of breast surgeries performed. Additional information for this database was
obtained from hospital records. This information included
date of birth, date of diagnosis, age at diagnosis, prior
history of breast cancer, family history of breast or ovarian
cancer (specifying relationship and age at diagnosis), patient race, Nottingham nuclear grade, pathological type,
hormone receptor status, tumor size, lymph node status,
Her-2-neu amplification status and type of surgery. Eligible
cases included women with breast cancer undergoing surgery at St. Michaels Hospital between the years 2002 and
2012. Ineligible cases included women presenting with
locally advanced breast cancer including tumors of any size
with direct extension the chest wall and or skin (T4 tumors), women presenting with metastatic disease (M1) and
those women whose race could not be identified. The primary means of identifying the race of database subjects
was patient self-report. Additional means of identifying
race included physician-report.

123

Statistical Analysis
After approval from our institutional research ethnics
committee three groups of patients were identified. Women
of FilipinoPacific decent, East Asian (China, Japan,
Korea, Mongolia and Macau) and Caucasian (European
and North American White) were compared in terms of age
at diagnosis of breast cancer, nuclear grade, tumour size,
lymph node status and type of surgery. Age at diagnosis
followed a normal distribution, thus ANCOVA/Regression
analysis was performed to compare age between race
groups (controlling for personal and family history of
breast cancer as well as body mass index). Categorical
outcomes were compared across race groups using Chi
square test for contingency tables. All analysis was conducted using IBM SPSS software version 22 (IBM Corp.
Released 2013. IBM SPSS Statistics for Windows, Version
22.0. Armonk, NY: IBM Corp.) with a p value of \0.05
considered statistically significant.

Results
Literature Review
In total 125 citations from Medline and 192 from Embase
were obtained. After accounting for duplicates 216 citations were submitted to the reviewer. These were reviewed
for relevance by a single reviewer. In total 42 published
reports were selected to provide an overview of breast
cancer in this population. Publications were categorized
into articles evaluating incidence, screening practices, age
at diagnosis, trends in treatment, pathologic features and
survival. Thus, a comprehensive overview of all aspects of
breast cancer care in Filipino women from initial diagnosis
to completion of treatment and into survivorship was
conducted.
Incidence of Breast Cancer
Asian Americans which include Filipinos are the fastest
growing racial group in the United States and represent
5.6 % of the population [9]. This heterogeneous group has
been characterized by increasing reported rates of cancer
incidence [9]. According to the National Cancer Institutes
Surveillance, Epidemiology, End Results (SEER) Program,
breast cancer was the most commonly diagnosed cancer
with varying degree across Asian American populations
[9]. The age-adjusted incidence rates for breast cancer
amongst Filipina women between 1990 and 1994 was 85.8
per 100,000 persons (82.189.7, 95 % CI). This incidence
rate increased to 99.2 (96.0102.5, 95 % CI) between 1998
and 2002 and continued to rise between 2004 and 2008 to a

J Immigrant Minority Health

rate of 103.7 (100.7106.7, 95 % CI) [9]. These rates were

about 30 % lower than non-Hispanic whites however this
increase in the incidence of breast cancer in Filipino
women was statistically significant (APC = 1.3; 95 % CI
0.91.7) and the second highest amongst all Asian American populations second to only Japanese [9].
The majority of Filipinos in the United States live in
California where the increase in age-adjusted incidence
rates has been most profound (162.5, 144.3182.2 95 %
CI) and has now actually exceeded non-Hispanic Whites
(145.6, 144.6146.7 95 % CI) [1012]. This increasing
incidence rate can in part be attributed to modification of
breast cancer risk profiles upon immigration to Western
countries [11].
Screening Practices
Breast cancer screening prevention includes screening
measures such as mammography, self-breast examination
(SBE) and finally clinical breast examination (CBE). While
guidelines have evolved to exclude a role for SBE and
CBE, mammography remains the gold standard for early
detection of breast cancer [13].
Adherence to preventative practices in the US amongst
Filipino women is reported to be below the national target.
According to the National Health Interview Survey
(NHIS), CDC/NCHS in 2010, 72.4 % of females aged
5074 received a mammogram within the past 2 years with
a national target of 81.1 % [14]. Multiple studies examining cross-sectional data, surveys, in person interviews, focus groups and questionnaires have found the rate of
screening mammography amongst Filipino women to be
between 4171 %. This low rate of adherence to screening
mammography guidelines has consistently been reported
despite accounting for variables such as socioeconomics
and access to care [7, 1518].
Many barriers experienced by Filipino women that have
led to a reduced adherence to breast screening guidelines
have been identified. Ko et al. [7] identified lack of time
as the greatest barrier to obtaining a screening mammogram. This barrier was reported amongst 64 % of the 248
participants in their study. Through focus groups Wu et al.
identified four distinct categories that were reported to be
barriers to breast cancer screenings for Filipino women.
These included; different mind-set and health care systems
in the Philippines regarding early detection influencing
knowledge about breast cancer and screening, unpleasant
experiences with mammography such as pain and discomfort, cultural beliefs about breast health such as not
wanting to talk about breast and finally difficulties in accessing services [19]. In a separate study, pain that is associated with mammography was reported to be the
greatest barrier [18]. An example of cultural belief creating

a barrier might be the Filipino value of bahala na in

which one need not worry about unpleasant circumstances,
as such events are beyond ones control [7]. The current
rate of screening mammography of Filipino women in
Canada remains unknown but because of Canadas universal health care system, issues pertaining to access to
screening mammography should not be a significant barrier. Identification and understanding these complex barriers is fundamental in developing culturally tailored
interventions aimed at increasing the rate of breast cancer
screening.
Age at Diagnosis
Gomez et al. examined data between 1998 and 2004 from
the California Cancer Registry and found that the incidence
rate in US-born Filipina women aged 44 years or younger
was 43.1/100,000 person-years and those 4554 years at
diagnosis 334.3/100,000 person-years which were higher
than the corresponding rates for non-Hispanic White
women 27.1/100,000 and 240.7/100,000 respectively.
Between 1988 and 2004 67.5 % of all breast cancers
among US-born Filipina women were among women
younger than 55 years compared to only 28.9 % among
non-Hispanic White women. Interestingly enough they also
found that the incidence rates for women aged 55 years and
older were also considerably lower than other Asian races
and non-Hispanic White women [20]. These data suggest
that compared to Caucasians and other Asian women,
Filipino women are being diagnosed at a statistically significant younger age.
Trends in Treatment
Ethnic disparities in the treatment of breast cancer are well
documented in the United States and multiple studies have
found that the management of Filipino women differs
compared to other Caucasian as well as other ethnic
groups. Such disparities are found across all treatment
modalities. [21, 22] In 2005 Gelber et al. [21] performed a
retrospective analysis of 235 Filipino women with early
stage breast cancer. They linked data from the Surveillance, Epidemiology and End Results (SEER) programs
Hawaii Tumor Registry to administrative health care
claims. They found that Filipino women were less likely to
undergo breast-conserving surgery (BCS), compared with
white women (OR 0.47; 95 % CI 0.330.66) In addition,
Filipino women were found to be less likely to receive
adjuvant radiation therapy after BCS. In a larger SEER
database study that reviewed 2,508 Filipino women between 1992 and 2000 it found that only 41 % underwent
BCS compared to 59 % for Whites. This was one of the
lowest of all Asian ethnicities examined [23]. Low rates of

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J Immigrant Minority Health

BCS and higher rates of mastectomies has consistently

been shown elsewhere outside of Canada [21, 22, 24, 25].
Patient satisfaction, cosmetic outcome and psychological
outcomes are greatest when a patient undergoes BCS.
While in comparison, more morbidity has been shown
when patients undergo a mastectomy [26]. In addition,
Asian women have been found to have a much lower rate
of breast reconstruction in both the immediate and delayed
setting [27, 28].
BCS followed by adjuvant radiation therapy is known to
produce long term disease-free survival that is equivalent
to mastectomy [29]. However, when radiation therapy is
omitted, even with wide surgical margins, the 10-year
breast cancer recurrence is much higher than if a patient
underwent adjuvant radiation therapy for BCS which is the
standard of care [30]. Filipino women have been shown to
be less likely to receive radiation therapy after BCS than
other ethnic groups and white women (OR 0.80, 95 % CI
0.421.49) [21].

Breast Cancer Pathologic Features

It is becoming ever more apparent that breast cancer is
extremely heterogeneous and a constellation of pathologic
subtypes. The significance of this is that different subtypes
are associated with different risk factors, response to
treatments and subsequently prognosis. Molecular subtypes
of breast cancer have been divided into four distinct categories based on the tumors expression of molecular receptors. Luminal A tumors, which express only estrogen
receptors (ER?) and or progesterone receptors (PR?) and
Luminal B tumors (ER? and or PR?, Her2/neu?) are
associated with favorable outcomes. While Human epidermal growth factor receptor 2 (Her/2 neu) expressing
tumors (ER-, PR-, Her2/ne?) and Basal-like triple
negative tumors (ER-, PR-, Her2/neu-) are associated
with a less favorable prognosis [31]. These important
subtypes have been found to vary by race and ethnicity
[3134].
A recently published study by Sineshaw et al. used
National Cancer Database to identify breast cancer cases
diagnosed in 2010 and 2011, the only 2 years since US
cancer registries began collecting data on patients HER2
receptor status results. In particular, they set out to examine
the odds of breast cancer subtypes in minority populations
versus non-Hispanic whites, stratified by socioeconomic
status. Asian/Pacific Islanders women had a 1.45 times
greater odds of being diagnosed with HER2-overexpressing tumors compared to non-hispanic Whites (OR 1.45;
95 % CI 1.311.61). This result was consistent across each
level of socioeconomic status [32]. This finding has been
appreciated elsewhere [31, 33].

123

Chuang et al. [33] reviewed breast cancer subtypes in

AsianAmericans and found that Filipino women had a
lower proportion of ER positive cancer compared to Chinese and Japanese women. It has also been noted that
Filipino women had a 1.43.1 fold elevation in the risk of
having ER-negative/PR negative breast cancer, features
associated with an overall worse prognosis [34]. This is
consistent with other previous reports [35].
Another pathologic feature related to prognosis is tumor
grade and it has been shown that Filipino women appear to
have a higher proportion of grade 3 tumors (53 %) compared to Chinese (33 %) and Japanese (27 %) women with
breast cancer [33]. Yi et al. [35] also reviewed the
pathology of 10,915 Filipino women with breast cancer and
found that they had a higher grade of tumor as well compared to other Asian subgroups.
Breast Cancer Survival
The current 5-year relative survival in Canada with breast
cancer is 88 % [36]. Differences in survival from breast
cancer between countries and different populations may be
related to dissimilarities in access to and utilization of
preventative health measures and treatments. Redaniel
et al. [37] set out to examine the 5-year relative survival of
Filipino-Americans with breast cancer compared to the
survival of cancer patients in the Philippines who have the
same ethnicity and to Caucasians in the US. They collected
data from the US SEER database and from the National
Capital Region (NCR) in the Philippines. Age adjusted
five-year relative survival was almost identical in FilipinoAmericans (89.1 %) and Caucasians (87.7 %) but much
lower in the Philippine residents (58.4 %). This study
highlights the importance of access to cancer care, as most
cancer care services in the Philippines are provided by
private institutions and expensive for the average Filipino
resident [37].
Filipino women have been found to have the highest
mortality rate (17.5 per 100,000 population) when compared to other Asian ethnic group (Chinese, Vietnamese,
Korean and Japanese) in California. This was however
lower than non-Hispanic White (27.4 per 100,000
population) [38]. Other studies have shown similar findings
that when compared to other major Asian groups, Filipino
women have been found to have the highest mortality rate
from breast cancer despite not having the highest incidence
rate [3941].
Little is known about how Filipino women manage
survivorship following breast cancer and adequate support
group services are almost nonexistent in Filipino communities [42]. Filipino women have a culturally distinct interpretation about surviving breast cancer thus require
cancer support groups that are unique to their needs but

J Immigrant Minority Health

how such groups should be tailored requires a qualitative

research approach that considers the interplay of Filipino
culture, post-immigration networks and attitudes about
religion, fate and health advocacy.

Cohort Study
In total 782 women were identified from our database that
met inclusion criteria into the cohort study. This included
604 Caucasian, 118 East Asian and 60 Filipino women. A
statistically significant difference was found between race
groups with regards to age at diagnosis of breast cancer;
Caucasian women were older at diagnosis with a mean age
(M) of 58.37 (SD = 12.94) than East Asian women

(M = 55.07, SD = 13.03) and Filipino women

(M = 53.24, SD = 9.82). No statistically significant difference was found between East Asian and Filipino
women. Although not statistically significant Filipino
women appear to have a trend towards being diagnosed
with a higher proportion of grade 3 (37.3 %) compare to
Caucasian and Asian (below 30 %). In addition, they appear to have a disproportionally high number of HER-2 neu
amplification tumors. Our data show that Filipino women
were presenting with tumors the same size as their Asian
and Caucasian counterparts but underwent more mastectomies (35.0 %) compare to Caucasian (22.5 %) or East
Asian (28.3 %). Table 1 summarizes the characteristics of
breast cancer in Filipino women diagnosed at our
institution.

Table 1 Characteristics of women diagnosed with breast cancer by race/ethnicity, St. Michaels Hospital 20022012 (n = 782)
Caucasian
n = 604
Personal history of breast cancer
Family history of breast cancer

East Asian
n = 118

Filipino
n = 60

32 (5.3 %)

4 (3.4 %)

4 (6.7 %)

190 (34.9 %)

15 (14.0 %)

9 (15.5 %)

Statistical results
v2(2) = 1.06, p = .59
v2(2) = 24.87, p \ .001

BMI

26.77 5.76

24.17 4.01

25.33 4.09

F(2,639) = 9.78, p \ .001

Age at diagnosisb

58.37 12.94

55.07 13.03

53.24 9.82

F(2,584) = 3.84, p = .02

v2(4) = 6.14, p = .19

Nottingham nuclear grade

1

158 (27.1 %)

26 (22.6 %)

8 (13.6 %)

253 (43.5 %)

55 (47.8 %)

29 (49.2 %)

171 (29.4 %)

34 (29.6 %)

22 (37.3 %)
v2(2) = .84, p = .66

ER/PR receptors
Positive
Negative
HER-2 amplification

452 (81.0 %)

87 (81.3 %)

49 (86.0 %)

106 (19.0 %)

20 (18.7 %)

8 (14.0 %)
v2(2) = 2.18, p = .34

Positive

77 (15.1 %)

14 (14.4 %)

12 (22.6 %)

Negative

432 (84.9 %)

83 (85.6 %)

41 (77.4 %)
v2(2) = 5.78, p = .06

Type of surgery
Lumpectomy

452 (77.5 %)

81 (71.7 %)

39 (65.0 %)

Mastectomy

131 (22.5 %)

32 (28.3 %)

21 (35.0 %)
v2(4) = 2.15, p = .71

Tumor size (mm)

1 (B20)

384 (67.0 %)

68 (62.4 %)

34 (59.6 %)

2 ([20B50)

158 (27.6 %)

35 (32.1 %)

20 (35.1 %)

31 (5.4 %)

6 (5.5 %)

3 (5.3 %)

3 ([50)

v2(6) = 4.75, p = .58

Nodal disease (positive axillary nodes)

0

417 (73.0 %)

76 (69.1 %)

37 (62.7 %)

1 (13)

106 (18.6 %)

24 (21.8 %)

17 (28.8 %)

2 (49)

34 (6.0 %)

8 (7.3 %)

3 (5.1 %)

3 (C10)

14 (2.5 %)

2 (1.8 %)

2 (3.4 %)

For numerical outcomes (age at diagnosis) the reported descriptive statistics are mean SD, while for categorical outcomes the reported
descriptive statistics are N (%)
a

Positive family history of breast cancer is defined as having a first or second degree relative with a prior diagnosis of breast cancer

ANCOVA analysis was conducted controlling for personal and family history of breast cancer as well as BMI. The analysis was followed by
post hoc pair-wise group comparison using Bonferroni method (adjustment)

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J Immigrant Minority Health

Table 2 Summary of the clinicopathology features, treatment trends and survival of breast cancer amongst Filipino migrants
Incidence

SEER database [9]

19901994 85.8 per 100,000
20042008 103.7 per 100,000
California, USA [11]
162.5 per 100,000
145.6 per 100,000 (non-Hispanic Whites)

Mammography screening rate

National target 81.1 % received in last 2 years [14]

Range from 4171 % [7, 1518]

Age at diagnosis

67.5 % of all breast cancer were in women \55 years of age

(28.9 % in non-Hispanic White women) [20]

Treatment trends

Higher mastectomy rate [21, 22, 24, 25]

Lower breast conserving surgery (BCS) [21, 22, 24, 25]
Less likely to receive adjuvant radiation therapy after BCS [21]
Less likely to receive post mastectomy breast reconstruction [27, 28]

Pathologic feature

Higher proportion of HER2/neuoverexpression [3133]

Lower proportion of estrogen receptor positive [33]
Higher proportion of grade 3 tumors [33, 35]

Survival

Highest mortality compared to other Asian ethnic groups (17.5 per 100,000) [3841]
Lack of adequate survivorship support networks [42]

Discusssion
The primary objective of this study was to assess the age in
which Filipino women were being diagnosed with breast
cancer and our results clearly show that they are in fact
being diagnosed at a statistically significant younger age
relative to Caucasians (Caucasian 58.4, East Asian 55.1,
Filipino 53.2, p \ 0.001). This may have a profound effect
on future screening mammography guidelines and further
ignites the current debate of the ideal age to start screening
mammography. In addition, it raises the question whether
or not screening guidelines should be more closely tailored
to an individuals personal risk of breast cancer as opposed
to universal screening recommendations hence a personalized approach.
We were able to show that there is a trend towards more
aggressive tumors as highlighted by our data showing that
22.6 % of Filipino women had tumors that expressed
HER2 compared to only 15 % in Caucasians. In addition,
we observed that only 13 % of tumors in Filipino women
were found to be grade 1 compared to 22 % in East Asians
and 27 % in Caucasians. A higher mastectomy rate was
also observed at our institution despite having universal
access to adjuvant treatments.
Our literature review found that despite having more
aggressive tumors there are disparities in breast cancer care
for Filipino women at all levels of continuum of care, from
screening/diagnosis to issues pertaining specifically to
survivorship. These findings are summarized in Table 2.

123

There therefore appears to be an opportunity to improve

upon the quality of care this community is receiving. Many
questions remain such as: how do we increase awareness
about the benefits of screening mammography in the Filipino community? Should screening start at an earlier age?
And finally, how do we ensure that the Filipino women are
getting the adequate treatment given the aggressive nature
of their breast cancer? Addressing these disparities should
be viewed as a priority in breast cancer research.
The main limitation of our Cohort study was that it was
a single institutional review with relatively small numbers
of patients. Statistically significant differences between the
Filipino women and women of other races for many
prognostically important variables were not found, likely
because of our limited power. Other limitations include
categorizing someone by a single race when they are in fact
multiethnic and collecting data from only those women
who underwent surgery. Patients treated elsewhere, or
deemed ineligible for surgery (metastatic disease) were not
captured in our database thus not included for analysis. In
addition, limited institutional data precluded examining
important outcomes such as screening patterns, breast
cancer survival, and breast reconstruction rate. Although
documented in the literature, these outcomes need to be
examined at an institutional level with a magnified view
into the patient surgical-decision making process which
could explain the higher rate of mastectomies. Despite
these limitations, our findings support those previously
reported elsewhere and only confirm that women of

J Immigrant Minority Health

Filipino descent have unique properties to the breast cancer

they are diagnosed with which makes them distinct from
their Asian counterparts and Caucasians.
New Contribution to the Literature
Many cultural studies scholars and social scientist have
argued that Filipinos are a distinct ethnic group set apart
from other Asian immigrants [42]. Much of the literature
on Filipino women with breast cancer suggests that this
may be true. After performing an extensive review of the
literature this paper appears to be the first review paper
published on breast cancer in Filipino migrants which
provides a concise yet comprehensive overview of all
aspects pertaining to breast cancer in this group of people.
Our institutional analysis is the first of its kind in Canada.
The fact that Filipino women are undergoing more mastectomies only illustrates that ethnic disparities in breast
cancer care exist even when access to health care is
universal.

12
13
14
15
16
17
18
19
20

EmbaseDatabase: Embase Classic ? Embase \1947 to

2012 Week 52[Search Strategy:
1
2
3

4
Appendix: Review of Literature Search Terms
Search for: remove duplicates from 19 [11, 18] Results:
125Database: Ovid MEDLINE(R) In-Process and Other
Non-Indexed Citations and Ovid MEDLINE(R) \1946 to
Present[Search Strategy:
1
2

4
5
6
7
8

9
10
11

exp Breast Neoplasms/(202477)

(breast adj2 neoplasm$).mp. [mp = title, abstract,
original title, name of substance word, subject
heading word, protocol supplementary concept, rare
disease supplementary concept, unique identifier]
(202114)
(breast adj2 cancer$).mp. [mp = title, abstract,
original title, name of substance word, subject
heading word, protocol supplementary concept, rare
disease supplementary concept, unique identifier]
(159596)
exp Breast Neoplasms, Male/(2048)
exp Carcinoma, Ductal, Breast/(10612)
exp Hereditary Breast and Ovarian Cancer Syndrome/(17)
exp Inflammatory Breast Neoplasms/(121)
(breast adj2 carcinoma$).mp. [mp = title, abstract,
original title, name of substance word, subject
heading word, protocol supplementary concept, rare
disease supplementary concept, unique identifier]
(32767)
exp Genes, BRCA1/or BRCA1.mp. (9591)
exp Genes, BRCA2/or BRCA2.mp. (6016)
or/1-10 (243012)

exp Philippines/(5780)
philipin$.mp. (25)
filipino$.mp. (2017)
filipina$.mp. (139)
tagalog.mp. (37)
pinoy.mp. (6)
or/12-17 (6738)
11 and 18 (131)
remove duplicates from 19 (125)

5
6
7
8
9
10
11
12
13
14
15

exp breast tumor/(370103)

[breast adj2 (neoplasm$ or cancer or tumo?r$)].ti,ab.
(243211)
(Hereditary Breast and Ovarian Cancer Syndrome).mp. [mp = title, abstract, subject headings,
heading word, drug trade name, original title, device
manufacturer, drug manufacturer, device trade name,
keyword] (271)
exp BRCA2 protein/or exp breast cancer/or gene
mutation/or exp BRCA1 protein/(559206)
breast carcinoma.mp. or exp breast carcinoma/
(67642)
1 or 2 or 3 or 4 or 5 (647205)
exp philippines/(7874)
philippine.ti,ab. (1785)
exp Filipino/(1214)
Filipin$.ti,ab. (4463)
tagalog.mp. (53)
pinoy$.ti,ab. (17)
or/7-12 (12232)
6 and 13 (326)
limit 14 to female (192)

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