Breast cancer in a transitional society over 18 years: trends and present status in Shanghai, China

Abstract

As a metropolis with rapid social and economic development over the past three decades, Shanghai has a breast cancer incidence that surpasses all other cancer registries in China. In order to estimate the regular changing patterns of female breast cancer in urban Shanghai, population-based incidence data from 1975 to 2004 were studied. In addition, a one-hospital-based in-patient database of 7,443 female breast cancer patients treated surgically between January-1990 and July-2007 were reviewed, retrospectively. We observed that breast cancer incidence increased dramatically over the past 30 years and documented a peak incidence represented by the middle-age group (45-59 years), which emerged in the last 20 years. The incidence peak moved from the 40-44 year group in the previous two decades to the 50-54 year group in the most recent decade. Median age at diagnosis was earlier in Shanghai than in the western countries, although it increased from 47.5-year in 1990 to 50-year in 2007. Considerably higher exposure to reproductive risk factors and relatively fewer hormone-dependent cases were observed. The proportion of asymptomatic cases detected by screening gradually increased, as well as that of early-stage cases (from 78.6% in 1990 to 93.3% in 2007) and carcinoma in situ (14.7% in 2007). Analysis of surgical treatment patterns suggested a trend of less-invasive options. Both age of peak incidence and median age at diagnosis increase with time, which suggests that increased incidence trending along with increasing age, will be observed in the future. Consequently, specific screening protocol should be refined to consider birth cohorts.

A Clinical Database of Breast Cancer Patients Reveals Distinctive Clinico-pathological Characteristics: a Study From Central China

“…In the same time, more specific instruments with easy access and user friendly processes should be developed to :http://dx.doi.org/10.7314/APJCP.2014.15.4.1621 target such population, such as intensified efforts to spread knowledge and practical skills in BC self-examination and early detection through mass media, particularly the ever-increasing internet services. In some developed areas of China (Hong Kong (Kwong et al, 2011) and Shanghai (Fan et al, 2009)), there were double peak incidences of BC which occurred among 45-50 years and > 65 years, which was different with this study.…”

“…One notable fact is the relatively younger age of BC for Chinese females. The median age was 50 years in this study, which was similar to Shanghai (50 years) (Fan et al, 2009), Korean (49 years) (Ko et al, 2012), lower than Western developed countries (the United States: 62 years (Anderson et al, 2006); Canada: 60 years (Turashvili et al, 2011); German: 59 years (Fritz et al, 2010); Belgium: 58 years (Brouckaert et al, 2013) ). Percentage of BC < 50 years in America was 27.0% (Desantis et al, 2013), much lower than this study (47.0%).…”

“…A multi-center study from China showed that percentage of BCS only was 5.6% from 1999 to 2008, due to social, cultural and economic factors (Zhang et al, 2013). Even in Shanghai, the most developed city of China, BCS only accounted for 13.5% in 2007, much lower than developed countries (Fan et al, 2009). In our study, the percentage of BCS only accounted for 5.2% (131/2,525), which is similar to Zhang's study from China (5.6%) (Zhang et al, 2013).…”

“…There have been several studies on the demographic, clinical and pathological characteristics of BC in China, which showed many differences in BC features between Chinese patients and those from Western countries, such as younger onset age, higher proportion of negative hormone receptors, and lower incidence. While those studies have been mainly conducted in socioeconomically developed areas of China such as Shanghai (Fan et al, 2009), Hong Kong (Kwong et al, 2011) and Beijing (Pan et al, 2013), there have been no large-scale clinical studies from central China, a vast region of China's hinterland with lower socio-economic developments. Therefore, this work was aimed to study characteristics of BC in Chinese population in central China by analyzing clinico-pathological information of BC from three tertiary referral hospitals from Wuhan Municipality, the largest population hub in the central China.…”

Effects of Age, Breast Density and Volume on Breast Cancer Diagnosis: A Retrospective Comparison of Sensitivity of Mammography and Ultrasonography in China's Rural Areas

“…As compared with cases in some western countries, patients with breast cancer in Asia including China have their unique epidemiological characteristics and physiological features. For example, there are more patients diagnosed at the younger age, and the density of mammary tissue is higher (Fan et al, 2009;Lee et al, 2009;Han et al, 2011;Li et al, 2011). This leads to the controversy on the application of mammography.…”