The Correlation Between Age and the Incidence of Breast Cancer in Rsup Dr. Sardjito [Full Text]

THE CORRELATION BETWEEN AGE AND THE INCIDENCE

OF BREAST CANCER IN RSUP DR. SARDJITO

(RESEARCH REPORT)

Scientific Paper Filed In Order :

Annual Scientific Meeting

Compiled by :

dr. Fadli Robby Amsriza, MMR.

Supervisor :

dr. Herjuna Hardianto Sp.B(K)Onk

SURGERY DEPARTMENT

SUB DIVISION ONCOLOGY SURGERY

FACULTY OF MEDICINE GADJAH MADA UNIVERSITY

Dr. SARDJITO HOSPITAL YOGYAKARTA

2015

DAFTAR ISI

DAFTAR ISI.............................................................................................................. ii

LIST OF TABLES..................................................................................................... iv

LIST OF FIGURES.................................................................................................... v

INTISARI................................................................................................................... vi

ABSTRACT............................................................................................................... vii

BAB I INTRODUCTION.......................................................................................... 8

A. Background Issues.............................................................................................. 8

B. Problem Formulation.......................................................................................... 10

C. Objective............................................................................................................. 11

D. Research Benefits................................................................................................ 11

E. Research Authenticity......................................................................................... 11

BAB II LITERATURE REVIEW.............................................................................. 13

A. Anatomy.............................................................................................................. 13

B. Epidemiology...................................................................................................... 16

C. Etiology and Risk Factor..................................................................................... 16

D. Patology.............................................................................................................. 18

E. Diagnostic........................................................................................................... 19

F. Stadium............................................................................................................... 20

G. Breast Cancer Therapy........................................................................................ 21

H. Recurrence of Breast Cancer............................................................................... 22

BAB III RESEARCH METHOD............................................................................... 23

A. Research Type..................................................................................................... 23

B. Research Location............................................................................................... 23

C. Time Research..................................................................................................... 23

D. Population and Research Subject........................................................................ 23

ii

E. Inclusion and Exclusion Criteria......................................................................... 23

F. Operational Definition........................................................................................ 24

G. Metode Pengambilan Sampel.............................................................................. 24

H. Processing and DataAnalysis.............................................................................. 24

BAB IV RESULT AND DISCUSSION.................................................................... 25

A. RESULT.............................................................................................................. 25

B. DISCUSSION..................................................................................................... 28

BAB V CONCLUSIONS AND SUGGESTION....................................................... 34

A. CONCLUSIONS................................................................................................. 34

B. SUGGESTION.................................................................................................... 35

Bibliography............................................................................................................... 36

iii

LIST OF TABLES

Page

Table 1.1 Alike About Breast Cancer Research...................................................... 5

Table 2.1 Breast Cancer Stadium............................................................................ 12

Table 4.1 Proportion of Patients with Breast Cancer distribution by Sex............... 18

Table 4.2 Proportion of Patients with Thyroid Cancer Distribution by Age.......... 18

Table 4.3 Spearman Correlation Test Results Statistics Age Score Against

Breast Cancer Incidence ......................................................................... 19

Table 4.4 Proportion of Patients with Breast Cancer Distribution Based Origin.... 19

Table 4.5 Proportion of Patients with Breast Cancer distribution by type of

Pathology................................................................................................. 20

iv

LIST OF FIGURES

Page

Figure 2.1 Female Breast Anatomy..................................................................... 7

Figure 2.2 Drainage Lymph Glands..................................................................... 8

Figure 4.1 Proportion of Patients with Breast Cancer distribution by Sex.......... 21

Figure 4.2 Proportion Distribution Graph Breast Cancer by Age........................ 22

Figure 4.3 Proportion Distribution Graph Breast Cancer Based on

Region of Origin................................................................................. 24

Figure 4.4 Proportion of Patients with Breast Cancer distribution by type of

Pathology............................................................................................ 25

v

INTISARI

HUBUNGAN USIA TERHADAP ANGKA KEJADIAN KANKER PAYUDARA DI RSUP DR SARDJITO

Fadli Robby Amsriza1, Herjuna Hardianto2

Bagian Ilmu Bedah1, Sub Bagian Bedah Onkologi2,Fakutas Kedokteran Universitas Gadjah Mada – RSUP DR. Sardjito,

Yogyakarta

Latar Belakang:Di Indonesia kanker payudara merupakan kanker dengan insiden tertinggi nomer 1 dan terdapat kecenderungan dari tahun ke tahun insidennya semakin meningkat. Sebagian besar keganasan payudara datang pada stadium lanjut. Jumlah kanker payudara di Indonesia didapatkan kurang lebih 23.140 kasus baru setiap tahun.Tujuan penelitian:Menganalisishubungan usia terhadap angka kejadian kanker payudara di RSUP DR Sardjito Yogyakarta.Metode: Jenis penelitian adalah kuantitatif dengan rancangan cross sectional. Penelitian dilakukan pada Januari 2013 sampai Desember 2013 di RSUP Dr. Sardjito.Sampel penelitian adalah semua penderita kanker payudara (total sampling) yang dirawat di RSUP Dr. Sardjito pada Januari 2013 – Desember 2013. Analisis data dengan korelasi spearman.Hasil: Hasil penelitian menunjukkan bahwa kelompok usia penderita kanker payudara terbanyak adalah 51-60 tahun sebanyak sebanyak 58 kasus (39,73%), diikuti kelompok usia 41-50 tahun sebanyak 48 kasus (32,88%), kelompok usia 61-70 tahun sebanyak 18 kasus (12,33%), kelompok usia >70 tahun sebanyak 9 kasus (6,16%), dan kelompok usia <30 tahun sebanyak 1 kasus (0,68%). Setelah dilakukan analisis dengan korelasi spearman menunjukkan bahwa tidak terdapat hubungan antara usia dengan angka kejadian kanker payudara (p=0,623). Kata Kunci: Usia, Kanker Payudara.

vi

THE CORRELATION BETWEEN AGE AND THE INCIDENCE OF BREAST CANCER IN RSUP DR. SARDJITO

Fadli Robby Amsriza1, Herjuna Hardianto2

Surgery Department1, Sub Division Oncology Sugery2

Faculty of Medicine Gadjah Mada University - Dr. Sardjito Hospital, Yogyakarta

ABSTRACT

Background: In Indonesia, breast cancer is the cancer with the highest incidence of the first number and there is a trend of year-on-year incidence is increasing. Most breast malignancy come at an advanced stage. The number of breast cancer in Indonesia obtained approximately 23.140 new cases every year.Objectives: Analyzing the correlation between age and the incidence of breast cancer in the RSUP DR Sardjito.Methods: The research is a quantitative research with cross sesctional design. The study was conducted on January 2013 to December 2013 at the RSUP Dr. Sardjito. The samples are all breast cancer patients (total sampling) were treated in hospital Dr. Sardjito in January 2013 - December 2013.The data analysis with spearman correlation.Results: The results showed the age group most breast cancer patients is 51-60 years as many as 58 cases (39,73%), followed by 41-50 years by 48 cases (32,88%), 61-70 years by 18 cases (12,33%), >70 years by 9 cases (6,16%), and <30 years as much as 1 cases (0,68%%). After analyzed with spearman correlation, the data showed that there is no correlation between age and the incidence of breast cancer(p=0,623).Keywords: Age, Breast Cancer.

vii

1

BAB I

INTRODUCTION

A. Background Issues

Cancer is a serious threat to the health of our society because of the incidence

and death rates continue to creep up. In the early decades of the 1950s, the main cause

of death in the State China is an infectious disease, tuberculosis and neonatal diseases.

Cancer only position to 9 or 10 as the cause of death. The survey results showed 70

decades the death rate from cancer has occupied the third position, the results of the

final decades of the 80's survey showed the number of cancer deaths in urban areas

reached 128.03 / 100,000 inhabitants, occupying 21.88% of all deaths, or top position

among the various causes of death (Desen, 2011).

Up to now, the cause of cancer is still unclear, various types of cancer has the

particularity of each, are influenced by age, gender, ethnicity, lifestyle genetic

background and many other factors (Desen, 2011). Cancer growth is not confined to

the organ where it came from growing, but can spread keorgan other organs in the

body and almost no cancer which can heal spontaneously without treatment

(Sukardja, 2000).

1

2

Breast cancers are carcinomas derived from epithelial ductal or lobular breast

(Suyatno, et al, 2014). Breast cancer, or known as mammary carcinoma is cancer that

has the highest incidence solid no. 1 in the western countries. In Indonesia, breast

cancer is the cancer with the highest incidence in women (Manuaba, 2010). In men,

only about 1% of all breast cancer incidence (Desen, 2011). Ministry of Health (2009)

stated in 2008 that the Indonesia Health Profile malignant neoplasms ranked first

breast cancer patients in the hospital inpatient 2004-2007, followed by malignant

neoplasms of the uterine cervix and malignant neoplasms of the liver and intrahepatic

bile duct.

n Indonesia, breast cancer is the cancer with the highest incidence number 1 and

there is a trend of year-on-year incidence is increasing. Most breast malignancy come

at an advanced stage. The number of breast cancer in Indonesia obtained

approximately 23 140 new cases each year (200 million population). Muchlis Ramli

et al in research at the RSCM gain stage IIIA and IIIB as much as 43.4%, while stage

IV as much as 14.3%, this is in contrast to developed countries where breast cancer is

found more in early stages (Suyatno, et al., 2014).

In Yogyakarta breast cancer is still the second most cancers, but specifically in

the department of Dr. Sardjito, breast cancer occupies first place malignancy in

women. Research in the department of RSUP DR. Sardjito, RS Panti Rapih, and RS

Patmasuri on 566 patients with breast cancer turns out 369 patients (65.20%) came

from other DIY were scattered from central Java region South (Aryandono, 2006).

3

Recently mammary carcinoma incidence worldwide is likely to increase, while

the mortality decreased. The exact cause of the increased incidence is unclear, there is

an opinion with regard to the increasing standard of living and lifestyle. The main

cause of declining mortality mammary carcinoma include interventions against

mammary carcinoma risk factors, widespread mass screening with mammary photo

and therapeutic advances mammary carcinoma (Desen, 2011). In Indonesia, screening

for breast cancer is still individualized, and sporadic so early programdeteksi still not

efficient and effective. As a result, patients with advanced breast cancer is still fairly

while in tow, ie more than 50% (Manuaba, 2010).

Breast cancer therapy is depend on the stage. The success of breast cancer

treatment depends on the stage of cancer, among others, found time and other

prognostic factors. In western countries, patients usually come in the early stages (I -

II), while in Indonesia and other developing countries (Asia, Africa) at an advanced

stage or locally advanced. The cost of treatment will be greater if the patient comes at

an advanced stage, with therapeutic success terbatas.Belum no clear data on economic

losses in Indonesia are caused by breast cancer (Aryandono, 2006).

Based on the background described above, where breast cancer is a malignancy

of the world's highest incidence tends to increase every year and the absence of data

on the relationship of age on the incidence of breast cancer in Yogyakarta, especially

in DR Sardjito is necessary to do research with title The Correlation Between Age and

The Incidence of Breast Cancer In RSUP DR. Sardjito.

4

B. Problem Formulation

From the picture on the background described above, the results of the

formulation of the problem is whether there is a relationship between age on the

incidence of breast cancer in RSUP DR Sardjito Yogyakarta?

C. Objective

The purpose of this study was to analyze the relationship between age on the

incidence of breast cancer in RSUP DR Sardjito Yogyakarta.

D. Research Benefits

The research benefits to be gained from this research is intended for multiple

parties as follows:

1. For Hospital

a. Provide input to the hospital on the relationship of age on the incidence of

breast cancer.

b. Can be used as a reference by the hospital.

c. As a reference and developer of knowledge in the field of Surgical Oncology.

2. For the Community

a. Raise awareness about breast cancer

b. Provide more detailed information about breast cancer

3. For Researchers

a. Knowing the distribution of breast cancer in more detail

b. Increase knowledge about breast cancer

c. As the initial data to conduct further

5

E. Research Authenticity

Research on the characteristics of cancer, especially breast cancer has been done

in several regions in Indonesia, but specific research on the characteristics of breast

cancer has not been done in RSUP DR Sardjito Yogyakarta.

RESEARCHER RESEARCH LOCATION

TITTLE

Japaries W., Zhesheng W. (2006)

RS Harapan Bunda, Jakarta

Karakteristik pasien dan kinerja unit onkologi komplemen medis – TCM RS Harapan Bunda Jakarta.

Taha M.N.A (2011) RSUP Haji Adam Malik, Medan

Prevalensi dan karakteristik penderita kanker payudara di departemen bedah rumah sakit umum pusat haji adam malik medan

Annur, et al (2013) RSUD Kraton, Kabupaten Pekalongan

Karakteristik ibu yang mengalami kanker payudara di RSUD Kraton kabupaten pekalongan tahun 2013

Table 1.1 Alike About Breast Cancer Research

BAB II

LITERATURE REVIEW

A. Anatomy

Breast occupy the right chest and left rib located between the second or third in

the superior part and the sixth or seventh rib on bagianinferior, with limits on linea

parasternalis medial to the anterior axillary lateral direction linea ataumedia. Breast

bagianmesenkim occupy the pectoralis fascia and muscle hundred anterior. In general,

breast tissue extends into the folds axillary space called the axillary tail of spence

(Bland K., et al, 2007) .In the deep part of the areola mamma are free fatty laktiferous

in which there are ducts dilated sinus form, in this sinus stored breast milk,

Suspensory ligament of Cooper to form a strong fibrous septa that support the breast

parenchyma and the pectoralis fascia stretching from the deep to the superficial fascia

layer in the dermis. Invasion of breast cancer to the ligament cause contractions that

cause the picture on the papilla mamma retraction. While peau d'orange is secondary

to obstruction of lymph nodes (Moore KL, 2007).

6

7

Figure 2.1 Female Breast Anatomy

Breast vascularity comes from a branch of the internal a.mammaria, a.thorakalis

lateralis, a.thorakoakromialis and a.aksilaris. The system includes v.interkostalis veins

from the second to the sixth intercostal spatium to enter v.vertebralis in

posterior.Vena intercostal can also enter v.azygos which empties into the superior

v.cava. Axillary vein receives blood from the superior and lateral part of the breast.

Venous outflow following the arterial system (Bland K, et al, 2007). Innervation of

the skin of the breast by a branch of the cervical plexus and intercostal nerve, being

breast gland tissue by sympathetic nerves, the axilla and medial part of the upper arm

by n. brakius medial cutaneous and n. interkostobrakialis. Bottom of the breast

muscles like pectoralis muscle disarafi by n. pectoralis, m.latissimus dorsi olehn.

torakodorsalis and anterior hundred by n. thoracic longus (Moore KL, 2007).

8

Figure 2.2 Drainage Lymph Glands

Lymph nodes found in many submammaria space located between the

superficial fascia and pectoralis fascia (profundus). The flow of lymphatic vessels

through several groups of lymph nodes that can be used to assess clinicopathologic

breast cancer.

There are six groups of lymph nodes, namely:

1. Mammaria externa (level I), parallel to a. thorakalis lateral from costa six to v.

axillary and occupies the lateral edge of m. pectoralis major and medial axillary

space.

2. Subscapularis (level I), close branches of vasa vasa thorakodorsalis

subscapularis, stretching from v.aksilaris to the lateral thoracic wall.

3. The axillary vein (level I), the second largest group, located caudal and ventral

from v.aksilaris.

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4. Interpectoralis / routers (level II), located between the m. pectoralis major and

m. pectoralis minor, often single, the smallest group, difficult to reach, unless

m. pectoralis major cut.

5. Central (level II), is centrally located between the anterior and posterior linea

aksillaris and placed under the skin and superficial fascia medioaksila, so easily

palpable, embedded in the axillary fat.

6. Subscapular / apical (level III), the highest and most media group, located

kaudoventral v.aksilaris medial section, as high as ligament Halsted (Bland K.,

et al, 2007).

B. Epidemiology

Breast cancer ranks second leading cause of death from cancer in developed

countries after lung cancer. Data in Indonesia in 2012 showed that breast cancer

ranked first of the big 5 in Indonesia, namely 48 998 cancer cases with a mortality of

19,750 (WHO, 2012). In 2008, the estimated incidence of breast cancer incidence in

Europe (40 countries) No 88,4 / 100,000 and the mortality rate of 24.3 / 100000.

Incidence of breast cancer increases as does screening with mammography and in the

old age population are using hormonal replacement therapy after menopause, western-

style diet, obesity, alcohol consumption and smoking (Aebi., Et al, 2011).

C. Etiology and Risk Factor

Causes for certain breast cancer is still unknown. However, the risk for breast

cancer increases in women who have risk factors (Suyatno., et al., 2014). Which

include risk factors for breast cancer are:

10

1. Family history and genes related to breast cancer. study found in women with

primary breast cancer brother, the probability of developing breast cancer is 2-3

times higher compared to women without a family history. Research today

shows that the main gene associated with breast cancer is BRCA-1 and BRCA-2

(Desen, 2011).

2. Gender female. Breast cancer incidence in women compared to men more than

100: 1. In general, one of nine American women will mederita breast cancer

throughout his life (Suyatno., Et al., 2014).

3. Reproduction. Small menarche age, stopping menstruation and menstrual cycles

up short is a high risk factor for breast cancer. Besides that a lifetime is not

married or unmarried, first gave birth over the age of 30 years and after

childbirth is not breastfeeding, berinsiden relatively high (Desen, 2011).

4. Age. According to the National Cancer Institute's Surveillance, Epidemiology

and End Result Program, the incidence of breast cancer is increasing rapidly

during the 4th decade of life. After menopause incidence continues to rise, but

more slowly, peak incidence in the decade of the 5th and 6th and the lowest

level in the decade of the 6th and 7th. One of the eight breast cancer patients

aged less than 45 years and ranges from 2/3 breast cancer patients over the age

of 55 years (Suyatno., et al., 2014).

5. The use of drugs in the past. Long-term use of hormone higher incidence. There

are reports of long-term use of reserpine, methyldopa, tricyclic analgesic, etc.

11

Can cause elevated levels of prolactin, a carcinogenic risk for breast (Desen,

2011).

6. Mammary gland disorders. Patients with severe hyperplastic mammary

cystadenomas berinsiden higher (Desen, 2011). Women who have had breast

cancer have a high risk of getting cancer in the other breast (De Jong., Et al.,

2005). This risk depends on the age at diagnosis. This risk is increased in young

women (Suyatno., et al., 2014).

7. Diet and nutrition. Various studies indicate kasuskelola diet high in fat and

calories directly related to the incidence of breast cancer. There are data

showing that obese people after the age of 50 years have a greater chance of

developing breast cancer. There are reports, that drinking beer can raise levels

of estrogen in the body, women who daily drank beer three times or more the

risk of breast cancer increased by 50-70%. Other studies show a diet high in

cellulose, vitamin A and soy protein can reduce the incidence of breast cancer

(Desen, 2011).

8. Radiation. Radiation at the age under 16 years old have a risk 100 times,

radiation before age 20 had a risk 18 times, aged 20-29 years 6 times the risk of

radiation after age 30 the risk is not significant. Approximately 0.1% of patients

were irradiated will arise sarcoma after 5 years (Suyatno., et al., 2014).

D. Patology

Ductal carcinoma in situ (DCIS) is the most common type of non-invasive

breast cancer, ranging from 15% of all new cases of breast cancer in the USA. In situ

berate in place, so ductal carcinoma in situ means uncontrolled cell growth that is still

12

in the duct (not penetrate the basement membrane), single lesions generally occur in

one breast (Suyatno., et al., 2014).

Lobular carcinoma in situ (LCIS), is characterized by the presence of cell

changes in the lobes or lobules. Incidents are not frequent (4200 cases per year in the

USA) and the risk for invasive breast cancer is slightly smaller than the DCIS, LCIS

is typical in multiple and often bilateral lesions (Suyatno., et al., 2014).

Invasive breast carcinoma is a tumor that is histologically heterogeneous. The

majority of these tumors are adenocarcinomas which grows from the terminal duct.

There are five histologic variants are often of breast adenocarcinoma that is invasive

ductal carcinoma, invasive lobular carcinoma, tubular carcinoma, medullary

carcinoma, carcinoma mucinosum or colloid (Suyatno., Et al., 2014).

Histologic type of breast cancer that rarely are papillary, apocrine, secretory,

and spindle cell squamous cell carcinoma, and carcinosarcoma. Invasive ductal

carcinoma generally have a small area that contains one or more sub-type this

(Suyatno., et al., 2014).

E. Diagnostic

Breast cancer diagnosis is made based on clinical, imaging and pathology/

cytology or histopathology commonly referred to tripple diagnostic procedures (Park

Y, 2011). Three things above if translated into a detailed clinical examination (history

and physical examination), radiodiagnostic examination (mammography/ ultrasound),

cytology (AJH), histopathology as the gold standard (Manuaba, 2010).

13

Diagnosis of breast cancer begins with the history of the complaints and

symptoms of the patient. Changes in the breast, pain, lumps that persist or continues

to expand, nipple retraction, nipple discharge or ulceration that does not heal is an

important information. Complaints are usually also the axillary region. Besides, asked

about the risk factors in patients with age at first menstruation, menstrual or

menopausal status, use of hormonal drugs, a history of previous breast surgery or

other surgery, family history of breast cancer, ovarian cancer and cancer of time age.

Diseases that accompany the patient should also be asked, as it will largely determine

the therapeutic action either surgery, chemotherapy and radiotherapy (Jardines L et al,

2003).

F. Stadium

Stadium T N M0 Tis N0 M0I T1 N0 M0II A T0 N1 M0

T1 N1 M0T2 N0 M0

II B T2 N1 M0T3 N0 M0

III A T0 N2 M0T1 N2 M0T2 N2 M0T3 N1 M0T3 N2 M0

III B T4 N0 M0T4 N1 M0T4 N2 M0

III C Setiap T N3 M0IV Setiap T Setiap N M1

Table 2.1 Breast Cancer Stadium (AJCC, 2010)

14

G. Breast Cancer Therapy

Modality therapy of breast cancer today is among other surgery, radiotherapy,

chemotherapy, hormonal therapy, biological therapy include molecular targeted

therapy / therapeutic immunology (Park Y, 2011).

The type of surgery performed are: radical mastectomy (Halstedt Radical

Mastectomy), Modified Radical Mastectomy (Pateymemotong m.pectoralis minor to

perform axillary dissection to level 3), Modified Radical Mastectomy (Uchincloss &

Maaden) maintain m.pectoralis major and minor), simple mastectomy (Mc Whirter)

plus radiotherapy especially on axillary and BCS (Breast conserving surgery) excision

of the primary tumor with or without axillary dissection and radiotherapy (Manuaba

ed, 2010).

Radiotherapy is lokoregional therapy, and in general with the Co 60 external

beam therapy or brachytherapy X.Radioterapi with only done on a case selectively

and only in facilities that have a flashlight (Kheradmand et al, 2010).

Combination chemotherapy has been the standard is (Manuaba ed, 2010; Park

Y, 2011): CMF (cyclophosphamide-methotrexate-5Fluoro Uracil), CAF; CEF

(cyclophosphamide-Adriamycin / epirubicin-5FluoroUracil), TA (taxanes /

Paclitaxel / Doxetacel-Adriamycin), Gapecitabine (Xeloda-oral) and some other

chemotherapy such as Navelbine, Gemcitabine (+ Cisplatinum) is used as a

chemotherapy ply to 3.

Hormonal therapy, especially in patients with breast cancer with hormonal

receptors (steroid receptors) were positive, especially ER (estrogen receptor) and PR

(progesterone receptor) positive. Ideally hormonal therapy given in ER + and PR +,

15

but in combination with one negative receptors also can be done. Presence of

hormonal receptors ER / PR positive in premenopausal and postmenopausal women

are also different and requires separate consideration. Combination ER / PR positive,

along with HER-2 / NEU positive requires separate consideration (Gabriel et, al,

2010).

H. Recurrence of Breast Cancer

Definition of recurrence showed reappearance of cancer that has been treated

after clinical healing period, ie after a disease-free interval (DFI / Disease-Free

Interval). Recurrences are not related to the appearance of new independent cancer or

development of persistent cancer klinis.Rentang time of the incident, which is often

used as an indicator of the results, in the form of local recurrence, regional, or distant,

death without recurrence, or the growth of new cancer in the other side (Donegan,

2002).

Based on research widodo et. al. (2010) The incidence of recurrence in breast

cancer by 16.51%. Recurrence of breast cancer is influenced by tumor stage

histopathological grading, HER-2 / neu and immunohistochemical subtypes. The most

dominant factor affecting the incidence of recurrence is a subtype

immunohistochemistry (triple negative).

BAB III

RESEARCH METHOD

A. Research Type

This research is a quantitative research with cross sectional research that is done

with the data collected only once, perhaps during periods of daily, weekly, or

monthly, in order to answer the research question (have now, 2006).

B. Research Location

This research was conducted at RSUP Dr. Sardjito.

C. Time Research

This research was conducted in January 2013 until December 2013.

D. Population and Research Subject

The study population was all breast cancer patients treated at the Hospital Dr.

Sardjito in January 2013 - December 2013.

The samples were all breast cancer patients (total sampling) who were treated in

Hospital Dr. Sardjito in January 2013 – December 2013.

E. Inclusion and Exclusion Criteria

Inclusion criteria for this study were:

16

17

1. Patients with breast cancer and had been treated in RSUP DR. Sardjito, both in

the surgery, internal medicine or in another part.

2. Have anatomic pathology examination data.

Exclusion criteria for this study were:

1. Patients diagnosed with breast cancer outside RSUP DR. Sardjito

2. Data incomplete medical records

3. Have the results anatomical pathology from outside RSUP DR. Sardjito

F. Operational Definition

1. Breast cancer patients is someone who has been diagnosed there are

abnormalities in the breast that is evidenced by histopathological examination.

2. Age is the age of breast cancer patients treated in RSUP DR. Sardjito.

G. Metode Pengambilan Sampel.

Data dikumpulkan dari data sekunder yaitu dengan melakukan

pencatatan dari catatan rekam medis penderita kanker payudara yang telah

menjalani rawat inap di RSUP Dr.Sardjito Yogyakarta pada Januari 2013

sampai Desember 2013.Dari catatan medik penderita yang dapat dikumpulkan

diambil data dan variabel yang diperlukan.

H. Processing and DataAnalysis

The data collected were processed using computer assistance and

dilanjutkandengan analysis and presented in bentuktabel grafik.Pengujian frequency

distribution and correlation statistics through Separman used to determine whether

there is a relationship between age and the incidence of breast cancer in the RSUP

DR. Sardjito.

BAB IV

RESULT AND DISCUSSION

A. RESULT

1. Proportion of Patients with Breast Cancer distribution by Sex

No. Sociodemographic N %1. Female 146 1002. Male 0 0

Table 4.1 Proportion of Patients with Breast Cancer distribution by Sex

Based on Table 4.1 it can be seen that all breast cancer patients, amounting to

146 were women (100%).

2. Proportion of Patients with Thyroid Cancer Distribution by Age

No. Sociodemographic n %

1. < 30 y.o 1 0,68

2. 31-40 y.o 12 8,22

3. 41-50 y.o 48 32,88

4. 51-60 y.o 58 39,73

5. 61-70 y.o 18 12,33

6. > 70 y.o 9 6,16

Table 4.2 Proportion of Patients with Thyroid Cancer Distribution by Age

Based on Table 4.2 above can be seen in the characteristics of patients with

breast cancer by age. The largest age group is 51-60 years age group as many as 58

18

19

cases (39.73%), followed by the age group 41-50 years were 48 cases (32.88%), 61-

70 year age group were 18 cases (12, 33%), age group> 70 years as many as 9 cases

(6.16%), and the age group <30 years 1 case (0.68%).

Data with breast cancer by the age of statistical testing through the Spearman

correlation test by SPSS ver. 15.0. Statistical test results can be seen in table 4.3

below.

Age Group Incidence

Spearman’s rho

Age Group Correlation Coefficient 1.000 .257

Sig. (2-tailed) . .623N 6 6

Incidence Correlation Coefficient .257 1.000

Sig. (2-tailed) .623 .N 6 6

Table 4.3 Spearman Correlation Test Results Statistics Age Score Against

Breast Cancer Incidence

3. Proportion of Patients with Breast Cancer Distribution Based Origin

No. Sociodemographic N %

1. Sleman 33 22,92

2. Bantul 21 14,58

3. Kulon Progo 6 4,17

4 Kodya Yogyakarta 18 12,50

5. Jateng 58 40,28

6. Jatim 3 2,08

7. Kalimatan 3 2,08

8. Sulawesi 1 0,69

9. Jakarta 1 0,69

Table 4.4 Proportion of Patients with Breast Cancer Distribution Based Origin

20

Based on Table 4.4 above can be seen in the characteristics of patients with

breast cancer by region of origin. Breast cancer patients mostly came from Central

Java as much as 58 people (40.28%), didikuti Sleman as many as 33 people (22.92%),

Bantul many as 21 people (14.28%), municipality Yogyakaerta as many as 18 people

(12.50% ), Kulon Progo as many as 6 people (4.17%), Kalimantan as many as 3

people (2.08%), East Java, as many as 3 people (2, 08%), Sulawes by 1 person

(0.69%), and Jakarta as much as 1 person (0.69%).

4. Proportion of Patients with Breast Cancer distribution by type of

Pathology

No. Pathological Anatomy Type N %

1. Karsinoma ductal invasif 110 76,39

2. Karsinoma lobular invasif 19 13,19

3. Karsinoma papiler 1 0,69

4. Karsinoma metaplastik 3 2,08

5. Tumor phyloides 8 5,56

6. Glicogen-rich clear cell carcinoma 1 0,69

7 Paget disease 2 1,39

Table 4.5 Proportion of Patients with Breast Cancer distribution by type of

Pathology

Based on Table 4.5 above can be seen in the characteristics of breast cancer

patients based on anatomic pathology examination. Most patients with breast cancer is

invasive ductal carcinoma types as many as 111 people (77.08%), followed by

invasive lobular carcinoma as many as 19 people (13.19%), tumor phyloides as many

as 8 people (5.56%), metaplastic carcinoma were 3 people (2.08%), Paget's disease, as

21

many as 2 people (1.39%), papillary carcinoma by 1 person (0.69%), and glycogen-

rich clear cell carcinoma by 1 person (0.69%).

B. DISCUSSION

1. Proportion of Patients with Breast Cancer distribution by Sex

Proportion of Patients with Breast Cancer distribution by Sex

Laki-Laki

Perempuan

Figure 4.1 Proportion of Patients with Breast Cancer distribution by Sex

Based on Figure 4.1 it can be seen that all breast cancer patients are women

(100%). This is according to research conducted by the Primitive (2004) with the title

Characteristics of Breast Cancer Patients Treated in Hospital Inpatient St. Elisabeth

Medan Year 2000-2002 which shows that all women with breast cancer are as many

as 109 people (100%). Breast cancer, especially regarding women, breast cancer in

men is only about 1% (Desen, 2011). The results support the existence of data that

women have a greater risk factor for developing breast cancer than men with breast

cancer incidence in women than in men of more than 100: 1. In general, one of nine

American women will suffer throughout his life to breast cancer (Suyanto, 2014).

22

2. Proportion of Patients with Breast Cancer Distribution by Age

0.68% 8.22%

32.88%

39.73%

12.33%

6.16%

Patients with Breast Cancer by Age<30 31-40 41-50 51-60 61-70 >70

Figure 4.2 Proportion Distribution Graph Breast Cancer

by Age

Based on Figure 4.2 above can be seen in the characteristics of patients with

breast cancer by age. The largest age group is 51-60 years age group as many as 58

cases (39.73%), followed by the age group 41-50 years were 48 cases (32.88%), 61-

70 year age group were 18 cases (12, 33%), age group> 70 years as many as 9 cases

(6.16%), and the age group <30 years 1 case (0.68%). This is not according to the

research conducted by the Primitive (2004) with the title Characteristics of Breast

Cancer Patients Treated in Hospital Inpatient St. Elisabeth Medan Year 2000-2002

which showed that most thyroid cancer patients is in the age of 35-45 years (51.4%).

The results are consistent with data from the National Cancer Institute's Surveillance,

Epidemiology and Results Program, in which the incidence of breast cancer is

increasing rapidly during the 4th decade of life. After menopause incidence continues

23

to rise but more slowly, peak incidence in the decade of the 5th and 6th and the lowest

level in the decade of the sixth seventh. One of the eight breast cancer patients aged

less than 45 years and ranges from 2/3 breast cancer patients over the age of 55 years

(Suyanto, 2014). Results of this study also according to data from China which is only

found 3 cases less than 20 years old (Desen, 2004). According to the analysis of data

from 6263 cases in Zhongshan University Cancer Hospital, patient age range was 17-

90 years old, median age 47 years. Interval calculated the age of 5 years, most patients

aged 45-49 years (25.2%), followed by 40-44 years (15.8%) and 54-59 years (15.6%)

(Desen, 2004).

Data with breast cancer by the age of statistical testing through the Spearman

correlation test by SPSS ver. 15.0. Statistical test results can be seen in table 4.3

below.

Age Group Incidence

Spearman’s rho

Age Group Correlation Coefficient 1.000 .257

Sig. (2-tailed) . .623N 6 6

Incidence Correlation Coefficient .257 1.000

Sig. (2-tailed) .623 .N 6 6

Table 4.3 Spearman Correlation Test Results Statistics Age Score Against

Breast Cancer Incidence

Based on table 4.3 above can diketahuikorelasi age on the incidence of breast

cancer with significant value 0.623 (p> 0.05). Thus there is no significant

relationship between age and the incidence of breast cancer.

3. Proportion of Patients with Breast Cancer Distribution Based Origin

24

40.28%

22.92%

14.58%

4.17%

12.50%2.08% 0.69% 0.69% 2.08%

Proportion of Patients with Breast Cancer Distribution Based Origin

jateng sleman bantulkulon progo kodya yogyakarta kalimantansulawesi jakarta jatim

Figure 4.3 Proportion Distribution Graph Breast Cancer Based on Region of

Origin

Based on Figure 5.3 above can be seen the characteristics of breast cancer

patients by region of origin. Breast cancer patients mostly came from Central Java as

much as 58 people (40.28%), didikuti Sleman as many as 33 people (22.92%), Bantul

many as 21 people (14.28%), municipality Yogyakaerta as many as 18 people

(12.50% ), Kulon Progo as many as 6 people (4.17%), Kalimantan as many as 3

people (2.08%), East Java, as many as 3 people (2, 08%), Sulawes by 1 person

(0.69%), and Jakarta as much as 1 person (0.69%). Researchers have not found a

similar study conducted in the area of Yogyakarta, which is not found references that

support.

5. Proportion of Patients with Breast Cancer distribution by type of

Pathology

25

76.39%

13.19%

0.69%2.08%

5.56%0.69%1.39%

Breast Cancer Pathology By TypeKarsinoma ductal invasif Karsinoma lobular infasifKarsinoma papiler Karsinoma metaplastikTumor phyloides Glicogen-rich clear cell carcinomaPaget disease

Figure 4.4 Proportion of Patients with Breast Cancer distribution by type

of Pathology

Based on Figure 4.4 above can be seen in the characteristics of breast cancer

patients based on anatomic pathology examination. Most patients with breast cancer is

invasive ductal carcinoma types as many as 111 people (77.08%), followed by

invasive lobular carcinoma as many as 19 people (13.19%), tumor phyloides as many

as 8 people (5.56%), metaplastic carcinoma were 3 people (2.08%), Paget's disease, as

many as 2 people (1.39%), papillary carcinoma by 1 person (0.69%), and glycogen-

rich clear cell carcinoma by 1 person (0.69%). This is consistent with data showing

that the invasive ductal carcinoma is 75% of all breast cancer, invasive lobular

carcinoma is 5-10% of all breast cancers (Suyanto, 2004). The data also showed that

metaplastic carcinoma, rare occurrence of less than 5% of breast cancers (Suyanto,

2004).

26

BAB V

CONCLUSIONS AND SUGGESTIONS

A. CONCLUSIONS

Based on the results of research and discussion, it can be concluded as follows:

1. All breast cancer patients were women (100%).

2. The highest age group is 51-60 years age group as many as 58 cases (39.73%),

followed by the age group 41-50 years were 48 cases (32.88%), 61-70 year age

group were 18 cases (12.33%), age group> 70 years as many as 9 cases

(6.16%), and the age group <30 years 1 case (0.68%).

3. There was no relationship between age on the incidence of breast cancer in the

DR. Sardjito.

4. Breast cancer patients mostly came from Central Java as much as 58 people

(40.28%), didikuti Sleman as many as 33 people (22.92%), Bantul many as 21

people (14.28%), municipality Yogyakaerta as many as 18 people (12, 50%),

Kulon Progo as many as 6 people (4.17%), Kalimantan as many as 3 people

(2.08%), East Java, as many as 3 people (2, 08%), Sulawesi by 1 person

(0.69%), and Jakarta as much as 1 person (0.69%).

27

28

5. Most patients with breast cancer is invasive ductal carcinoma types as many as

111 people (77.08%), followed by invasive lobular carcinoma as many as 19

people (13.19%), tumor phyloides as many as 8 people (5.56%), metaplastic

carcinoma were 3 people (2.08%), Paget's disease, as many as 2 people

(1.39%), papillary carcinoma by 1 person (0.69%), and glycogen-rich clear cell

carcinoma by 1 person (0.69%).

B. SUGGESTION

Based on the research conclusions, suggestions of this study are as follows:

1. Further studies should be done by using a longer time span to get more samples.

29

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