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Zhu L, Zhou Q, Huang Z, Yang Y, Yang Y, Du Y, Zhao Y, Yu X, Li T, Chen W. Factors Influencing Breast Cancer Awareness in Rural Southwest China: A Cross-Sectional Study. Int J Womens Health 2024; 16:509-518. [PMID: 38533523 PMCID: PMC10964776 DOI: 10.2147/ijwh.s453857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
Background This study aimed to explore the current knowledge level of breast cancer among rural women in Southwest China and analyze the influencing factors of breast cancer cognition. Methods From May to November 2022, 1468 rural women were invited to participate in this study. Demographic information and the Chinese version of the Breast Cancer Awareness Measure (C-BCAM) were collected through one-on-one investigations. The data were analyzed using descriptive statistics, chi-square tests, and multiple regression analysis in SPSS 26.0. Results The study included a total of 1468 rural women with a median age of 54.0 (IQR, 47.0, 60.0).The average score of breast cancer in the study population was 73.0 (IQR, 66.0, 82.0). Among women in Southwest China, the awareness rates of knowledge on breast cancer symptoms, barriers to seeking medical help, and risk factors were 68.8%, 98.4%, and 62.1%, respectively. The awareness rate was found to increase with higher education levels (P<0.001) and decrease with increasing age (P<0.001). Multivariate logistic regression analysis identified three variables that might influence breast cancer awareness: education level, contraceptive measures, and history of breast disease (all P<0.05). Specifically, history of breast disease (Odds ratio (OR) = 1.907, 95% CI = 1.128 ~ 3.223), middle school education (OR = 2.155, 95% CI = 1.585 ~ 2.928), and junior college education and above (OR = 5.536, 95% CI = 1.898 ~ 16.148) were positive factors for women's breast cancer awareness. Conversely, the use of intrauterine devices (OR = 0.523, 95% CI = 0.384 ~ 0.712) was found to be a negative factor for women's breast cancer awareness. Conclusion This study highlights the insufficient awareness of breast cancer among women in rural area of Southwest China. It emphasizes the necessity of health education to improve female breast cancer awareness.
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Affiliation(s)
- Lingling Zhu
- College of Public Health, Chengdu Medical College, Chengdu, Sichuan, 610500, People’s Republic of China
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Qiang Zhou
- College of Public Health, Chengdu Medical College, Chengdu, Sichuan, 610500, People’s Republic of China
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Ziyue Huang
- Mianyang Maternal and Child Health Care Hospital, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Yuan Yang
- School of Public Health, Xiamen University, Xiamen, Fujian, 361102, People’s Republic of China
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Ying Yang
- Yanting County Maternal and Child Health Hospital, Mianyang, Sichuan, 621600, People’s Republic of China
| | - Yao Du
- Yanting County Maternal and Child Health Hospital, Mianyang, Sichuan, 621600, People’s Republic of China
| | - Yuqian Zhao
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Xiaoping Yu
- School of Preclinical Medicine, Chengdu University, Chengdu, Sichuan, 610106, People’s Republic of China
| | - Tingyuan Li
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Wen Chen
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
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Jiang J, Jiang S, Ahumada-Canale A, Chen Z, Si L, Jiang Y, Yang L, Gu Y. Breast Cancer Screening Should Embrace Precision Medicine: Evidence by Reviewing Economic Evaluations in China. Adv Ther 2023; 40:1393-1417. [PMID: 36800077 PMCID: PMC10070309 DOI: 10.1007/s12325-023-02450-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
The cost-effectiveness of conventional population-based breast cancer screening strategies (e.g. mammography) has been found controversial, while evidence shows that genetic testing for early detection of pathogenic variants is cost-effective. We aimed to review the economic evaluations of breast cancer screening in China to provide an information summary for future research on this topic. We searched the literature to identify the economic evaluations that examined breast cancer screening and testing in China, supplemented by hand-searching the reference lists of the included studies. We finally included five studies satisfying our inclusion criteria. Four articles examined mammography while the rest investigated multigene testing. The existing breast cancer screening programmes were found to be cost-effective among urban Chinese women, but one study concluded that they might cause harm to women in rural areas. Contextual factors, such as data absence, urban-rural disparity, willingness-to-pay threshold, and model design, imposed barriers to cost-effectiveness analysis. Multigene testing was found to be cost-effective and has a promising population impact among all women with breast cancer in China. Future research should investigate the cost-effectiveness of screening and identifying breast cancer through precision medicine technologies, including genetic testing, genome sequencing, cascade testing, and the return of secondary findings.
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Affiliation(s)
- Jingjing Jiang
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Shan Jiang
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Antonio Ahumada-Canale
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
- Faculty of Humanities and Social Sciences, School of Economics, University of Nottingham Ningbo China, Ningbo, Zhejiang, China
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Li Yang
- School of Public Health, Peking University, Beijing, China.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
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Yeong SW, Lee SW, Ong SC. Cost-Effectiveness of Breast Cancer Early Detection Program in Low- and Middle-Income Countries: A Systematic Review. Value Health Reg Issues 2023; 35:57-68. [PMID: 36870173 DOI: 10.1016/j.vhri.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/19/2022] [Accepted: 01/20/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES This review explores the cost-effectiveness of the strategies used in the breast cancer early detection programs of low- to middle-income countries. METHODS A systematic review was performed to identify related studies, published up to August 2021, on PubMed, Cochrane, ProQuest, and the Cumulative Index to Nursing and Allied Health Literature. The Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol were referenced during the reporting process. The Consolidated Health Economic Evaluation Reporting Standards 2022 criteria were used to assess the requirements of the selected studies. Articles with original data and full texts were included in the review. Non-low- to middle-income countries and non-English articles were excluded. RESULTS This review identified 12 suitable studies, wherein 6 investigated the cost-effectiveness of clinical breast examinations (CBEs), whereas 10 looked into mammogram (MMG) with or without CBE. In 2 studies, the cost-effectiveness of raising awareness through mass media and the use of ultrasounds combined with CBE were investigated. Although cost-effective, MMG incurs greater costs and requires more skill to be performed. MMG screenings before the age of 40 years were not cost-effective. The limitations of this review include variability in the methodological approaches of its selected studies. Most of the chosen studies met the Consolidated Health Economic Evaluation Reporting Standards 2022 criteria. CONCLUSIONS This review shows that adopting an age- and risk-based MMG screening approach could be viable in countries with limited resources. Future cost-effectiveness analysis research should include a section on patient and stakeholder engagement with the study's results.
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Affiliation(s)
- Siew Wei Yeong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Sit Wai Lee
- Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
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Shi J, Guan Y, Liang D, Li D, He Y, Liu Y. Cost-effectiveness evaluation of risk-based breast cancer screening in Urban Hebei Province. Sci Rep 2023; 13:3370. [PMID: 36849794 PMCID: PMC9971026 DOI: 10.1038/s41598-023-29985-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023] Open
Abstract
To evaluate the implementations of Cancer Screening Program in Urban Hebei and to model the cost-effectiveness of a risk-based breast Cancer Screening Program. Women aged 40-74 years were invited to participate the Cancer Screening Program in Urban Hebei form 2016 to 2020 by completing questionnaires to collect information about breast cancer exposure. Clinical screening including ultrasound and mammography examination were performed. We developed a Markov model to estimate the lifetime costs and benefits, in terms of quality-adjusted life years (QALY), of a high-risk breast Cancer Screening Program. Nine screening strategies and no screening were included in the study. The age-specific incidence, transition probability data and lifetime treatment costs were derived and adopted from other researches. Average cost-effectiveness ratios (ACERs) were estimated as the ratios of the additional costs of the screening strategies to the QLYG compared to no screening. Incremental cost-effectiveness ratios (ICERs) were calculated based on the comparison of a lower cost strategies to the next more expensive and effective strategies after excluding dominated strategies and extendedly dominated strategies. ICERs were used to compare with a willingness-to-pay (WTP) threshold. Sensitivity analysis was explored the influence factors. A total of 84,029 women completed a risk assessment questionnaire, from which 20,655 high-risk breast cancer females were evaluated, with a high-risk rate of 24.58%. There were 13,392 high-risk females completed the screening program, with participation rate was 64.84%. Undergoing ultrasound, mammography and combined screening, the suspicious positive detection rates were 15.00%, 9.20% and 19.30%, and the positive detection rates were 2.11%, 2.76% and 3.83%, respectively. According to the results by Markov model, at the end of 45 cycle, the early diagnosis rates were 55.53%, 60.68% and 62.47% underwent the annual screening by ultrasound, mammography and combined, the proportion of advanced cancer were 17.20%, 15.85% and 15.36%, respectively. Different screening method and interval yield varied. In the exploration of various scenarios, annual ultrasound screening is the most cost-effective strategy with the ICER of ¥116,176.15/QALY. Sensitivity analyses demonstrated that the results are robust. Although it was not cost effective, combined ultrasound and mammography screening was an effective strategy for higher positive detection rate of breast cancer. High-risk population-based breast cancer screening by ultrasound annually was the most cost-effective strategy in Urban Hebei Province.
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Affiliation(s)
- Jin Shi
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Yazhe Guan
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Di Liang
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Daojuan Li
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Yutong He
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China.
| | - Yunjiang Liu
- Department of Breast Cancer Center, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China.
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Li H, Huang M, Yang Y, Tang J, Ye Y. The Practice and Willingness of Women Towards Opportunistic Screening for Breast and Cervical Cancers in Sichuan Province, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2023; 16:169-183. [PMID: 36785645 PMCID: PMC9921511 DOI: 10.2147/rmhp.s391534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023] Open
Abstract
Purpose To understand the practices and willingness of Chinese women to undergo opportunistic screening for breast cancer (BC) and cervical cancer (CC). Patients and Methods From July to August 2021, a cross-sectional study of 1446 women from six cities in Sichuan Province, China, was conducted. A questionnaire was used to investigate practices, willingness, and barriers to opportunistic screening for BC and CC. Furthermore, potential factors for opportunistic screening willingness were analyzed using the chi-squared test and logistic regression. Results During their lifetime, 312 (21.6%) and 388 (26.8%) women had undergone opportunistic screening for BC and CC, respectively. There were 1069 (73.9%) women willing to accept physician-recommended screening during a medical visit, while 835 (57.7%) were willing to have a voluntary screening at a healthcare institution. The main barriers to reluctance to participate in physician-recommended and voluntary screenings were "no symptoms; hence, no need for screening" and "unwillingness or difficulty in paying screening cost". Ethnic minorities, lower education levels, and menopause were inversely associated, whereas awareness of the screening methods and eligibility for screening were positively associated with physician-recommended and voluntary screenings (P < 0.05). Furthermore, awareness of "two-cancers" screening was positively associated with physician-recommended screening (P < 0.05). Conclusion BC and CC opportunistic screening rates in Sichuan Province were low. The willingness to undergo physician-recommended screening was high, while that towards individual initiative screening was low. Public health education should be strengthened to increase cancer prevention awareness and knowledge of cancer screening, especially for women with low education, ethnic minorities, and post-menopause, for whom tailored interventions are suggested. In addition, novel ways of sharing screening costs need to be explored.
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Affiliation(s)
- Hui Li
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Mingquan Huang
- Department of Breast Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Yonglian Yang
- School of Basic Medical Science, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Jun Tang
- School of Basic Medical Science, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China
| | - Yunli Ye
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China,Correspondence: Yunli Ye, Southwest Medical University, No. 1 Section 1, Xianglin Road, Longmatan District, Luzhou, Sichuan, People’s Republic of China, Tel/Fax +86 0813 3161797, Email
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Feng R, Su Q, Huang X, Basnet T, Xu X, Ye W. Cancer situation in China: what does the China cancer map indicate from the first national death survey to the latest cancer registration? CANCER COMMUNICATIONS (LONDON, ENGLAND) 2022; 43:75-86. [PMID: 36397729 PMCID: PMC9859730 DOI: 10.1002/cac2.12393] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Over the past four decades, the Chinese government has conducted three surveys on the distribution of causes of death and built cancer registration. In order to shine a new light on better cancer prevention strategies in China, we evaluated the profile of cancer mortality over the forty years and analyzed the policies that have been implemented. METHODS We described spatial and temporal changes in both cancer mortality and the ranking of major cancer types in China based on the data collected from three national surveys during 1973-1975, 1990-1992, 2004-2005, and the latest cancer registration data published by National Central Cancer Registry of China. The mortality data were compared after conversion to age-standardized mortality rates based on the world standard population (Segi's population). The geographical distribution characteristics were explored by marking hot spots of different cancers on the map of China. RESULTS From 1973 to 2016, China witnessed an evident decrease in mortality rate of stomach, esophageal, and cervical cancer, while a gradual increase was recorded in lung, colorectal, and female breast cancer. A slight decrease of mortality rate has been observed in liver cancer since 2004. Lung and liver cancer, however, have become the top two leading causes of cancer death for the last twenty years. From the three national surveys, similar profiles of leading causes of cancer death were observed among both urban and rural areas. Lower mortality rates from esophageal and stomach cancer, however, have been demonstrated in urban than in rural areas. Rural areas had similar mortality rates of the five leading causes of cancer death with the small urban areas in 1973-1975. Additionally, rural areas in 2016 also had approximate mortality rates of the five leading causes with urban areas in 2004-2005. Moreover, stomach, esophageal, and liver cancer showed specific geographical distributions. Although mortality rates have decreased at most of the hotspots of these cancers, they were still higher than the national average levels during the same time periods. CONCLUSIONS Building up a strong primary public health system especially among rural areas may be one critical step to reduce cancer burden in China.
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Affiliation(s)
- Ruimei Feng
- Department of EpidemiologySchool of Public HealthShanxi Medical UniversityTaiyuanShanxiP. R. China,Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China
| | - Qingling Su
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China
| | - Xiaoyin Huang
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China
| | - Til Basnet
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China
| | - Xin Xu
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China
| | - Weimin Ye
- Department of Epidemiology and Health Statistics & Key Laboratory of Ministry of Education for Gastrointestinal CancerFujian Medical UniversityFuzhouFujianP. R. China,Department of Medical Epidemiology and BiostatisticsKarolinska InstituteStockholmSweden
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Wang Y, Li Y, Song Y, Chen C, Wang Z, Li L, Liu M, Liu G, Xu Y, Zhou Y, Sun Q, Shen S. Comparison of ultrasound and mammography for early diagnosis of breast cancer among Chinese women with suspected breast lesions: A prospective trial. Thorac Cancer 2022; 13:3145-3151. [PMID: 36177910 PMCID: PMC9663682 DOI: 10.1111/1759-7714.14666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Ultrasound is more widely used than mammography for early diagnosis of breast cancer in China as most Chinese women have small and dense mammary glands. This study compared the diagnostic performance of ultrasound and mammography for breast cancer among Chinese women with suspected breast lesions. METHODS From November 2019 to November 2021, we compared the results of ultrasound and mammography for breast lesion diagnosis in 2737 consecutive participants with suspected breast lesions; all patients underwent biopsies. We measured the sensitivity, specificity, and diagnostic accuracy separately. RESULTS Among the 2737 participants, 2844 breast lesions were detected, including 1935 (68.0%) breast cancers and 909 (32.0%) benign lesions. Of the breast cancers, ultrasound detected 1851 (95.7%), whereas mammography detected 1527 (78.9%). The sensitivity of ultrasound for breast cancer diagnosis was significantly higher than that of mammography (95.7% vs. 78.9%, p < 0.001), whereas the specificity was significantly lower than that of mammography (42.9% vs. 62.3%, p < 0.001). The receiver operating characteristic curves revealed that ultrasound was more accurate in detecting breast cancer than mammography (76.8% vs. 71.3%, p < 0.001). Age, body mass index, and breast density did not influence ultrasound sensitivity and accuracy. CONCLUSIONS Ultrasound is more sensitive and accurate than mammography and detects more breast cancers with a lower specificity.
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Affiliation(s)
- Yingjiao Wang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Yuechong Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Yu Song
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Chang Chen
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Zhe Wang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Linrong Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Mohan Liu
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Guanmo Liu
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Yali Xu
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
| | - Songjie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingChina
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Luo C, Wang L, Zhang Y, Lu M, Lu B, Cai J, Chen H, Dai M. Advances in breast cancer screening modalities and status of global screening programs. Chronic Dis Transl Med 2022; 8:112-123. [PMID: 35774423 PMCID: PMC9215717 DOI: 10.1002/cdt3.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/18/2022] [Indexed: 12/03/2022] Open
Abstract
Breast cancer (BC) is the most prevalent malignancy worldwide, and a continued upward trend has been predicted in the coming decades. Screening in selected targeted populations, which is effective in reducing cancer‐related mortality, has been widely implemented in many countries. This review summarizes the advances in BC screening techniques, organized or opportunistic BC screening programs across different countries, and screening modalities recommended by different academic authorities. Mammography is the most widely used and effective technique for BC screening. Other complementary techniques include ultrasound, clinical breast examination, and magnetic resonance imaging. Novel screening tests, including digital breast tomosynthesis and liquid biopsies, are still under development. Globally, the implementation status of BC screening programs is uneven, which is reflected by differences in screening modes, techniques, and population coverage. The recommended optimal screening strategies varied according to the authoritative guidelines. The effectiveness of current screening programs is influenced by several factors, including low detection rate, high false‐positive rate, and unsatisfactory coverage and uptake rates. Exploration of accurate BC risk prediction models and the development of risk‐stratified screening strategies are highly warranted in future research. Mammography is the most widely used and most effective technique; other complementary techniques include ultrasound, clinical breast examination, and magnetic resonance imaging. Globally, the implementation status of breast cancer screening programs is uneven, which is reflected by differences in screening modes, techniques, and examination coverage. Combining effective risk prediction models and advanced screening techniques for risk‐stratified screening strategies may be the future direction.
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Affiliation(s)
- Chenyu Luo
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Le Wang
- Department of Cancer Prevention Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Hangzhou Zhejiang China
| | - Yuhan Zhang
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Ming Lu
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Bin Lu
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jie Cai
- Department of General Surgery, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hongda Chen
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Min Dai
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Lin X, Chen W, Wei F. Technique Success, Technique Efficacy and Complications of HIFU Ablation for Palliation of Pain in Patients With Bone Lesions: A Meta-Analysis of 28 Feasibility Studies. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1182-1191. [PMID: 33583637 DOI: 10.1016/j.ultrasmedbio.2021.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
Several feasibility studies have reported that high-intensity focused ultrasound (HIFU) ablation can be applied to ease patients' bone pain. However, the effect of HIFU ablation to palliate bone pain remains unclear. To evaluate the technique's success, efficacy, minor complication and major complication on patients suffering from bone pain, we searched the PubMed, MEDLINE, EMBASE and Cochrane Library databases from January 1998 to March 2019. Clinical studies that have assessed the association between bone pain and HIFU ablation were involved. We filtered out 28 feasibility studies, which reported the association between HIFU ablation and bone pain, including a total of 717 patients and 736 bone lesions. Overall, our results indicate that the rate of technique success of HIFU ablation was 93% (95% confidence interval [CI] 89%-96%) for patients with bone lesions. The technique efficacy rate of HIFU ablation for palliation of pain from bone lesions was 80% (95% CI 74%-87%) in all the patients, 96% (91%-100%) in the subgroup of retrospective studies and 77% (69%-85%) in the subgroup of prospective studies. In regard to HIFU ablation treatment safety, the hazard ratio for minor complication was 12% (95% CI 7%-17%), and the hazard ratio for major complication was 2% (95% CI 1%-3%). In conclusion, the summary rates for various considerations of using HIFU ablation for the palliation of bone pain are as follows: technique success is 93%, technique efficacy is 77%, minor complication is 12% and major complication is 2%. Our results suggest that extracorporeal HIFU ablation is a promising method for palliation of pain in bone lesions, with high technique success and efficacy, but low adverse events.
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Affiliation(s)
- Xiaoti Lin
- Department of Breast, Fujian Provincial Maternity and Children's Hospital, Fujian Medical University, Fuzhou, China; Department of Breast Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Weiyu Chen
- Department of Physiology, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China
| | - Fengqin Wei
- Department of Emergency, Fujian Provincial 2nd People's Hospital, Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Zheng S, Zhang X, Greuter MJW, de Bock GH, Lu W. Determinants of Population-Based Cancer Screening Performance at Primary Healthcare Institutions in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063312. [PMID: 33806890 PMCID: PMC8005057 DOI: 10.3390/ijerph18063312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
Background: For a decade, most population-based cancer screenings in China are performed by primary healthcare institutions. To assess the determinants of performance of primary healthcare institutions in population-based breast, cervical, and colorectal cancer screening in China. Methods: A total of 262 primary healthcare institutions in Tianjin participated in a survey on cancer screening. The survey consisted of questions on screening tests, the number of staff members and training, the introduction of the screening programs to residents, the invitation of residents, and the number of performed screenings per year. Logistic regression models were used to analyze the determinants of performance of an institution to fulfil the target number of screenings. Results: In 58% and 61% of the institutions between three and nine staff members were dedicated to breast and cervical cancer screening, respectively, whereas in 71% of the institutions ≥10 staff members were dedicated to colorectal cancer screening. On average 60% of institutions fulfilled the target number of breast and cervical cancer screenings, whereas 93% fulfilled the target number for colorectal cancer screening. The determinants of performance were rural districts for breast (OR = 5.16 (95%CI: 2.51–10.63)) and cervical (OR = 4.17 (95%CI: 2.14–8.11)) cancer screenings, and ≥3 staff members dedicated to cervical cancer screening (OR = 2.34 (95%CI: 1.09–5.01)). Conclusions: Primary healthcare institutions in China perform better in colorectal than in breast and cervical cancer screening, and institutions in rural districts perform better than institutions in urban districts. Increasing the number of staff members on breast and cervical cancer screening could improve the performance of population-based cancer screening.
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Affiliation(s)
- Senshuang Zheng
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 CP Groningen, The Netherlands; (S.Z.); (G.H.d.B.)
- Department of Epidemiology and Health statistics, Tianjin Medical University, Tianjin 300070, China;
| | - Xiaorui Zhang
- Department of Epidemiology and Health statistics, Tianjin Medical University, Tianjin 300070, China;
| | - Marcel J. W. Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9713 CP Groningen, The Netherlands;
- Technical Medical Centre, Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, 7522 NH Enschede, The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 CP Groningen, The Netherlands; (S.Z.); (G.H.d.B.)
| | - Wenli Lu
- Department of Epidemiology and Health statistics, Tianjin Medical University, Tianjin 300070, China;
- Correspondence:
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Cen X, Wang D, Sun W, Cao L, Zhang Z, Wang B, Chen W. The trends of mortality and years of life lost of cancers in urban and rural areas in China, 1990-2017. Cancer Med 2019; 9:1562-1571. [PMID: 31873982 PMCID: PMC7013076 DOI: 10.1002/cam4.2765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 12/18/2022] Open
Abstract
Background With the rapid development of the socioeconomic status, the mortality of several cancers has been changed in China during the past 30 years. We aimed to estimate the trends of mortality and years of life lost (YLLs) of various cancers in urban and rural areas of China from 1990 to 2017. Methods The mortality data were collected from Chinese yearbooks and the age structure of population from the Chinese sixth population census were used as reference to calculate age‐standardized mortality rates (ASMRs) and YLLs rates. Joinpoint regression analysis was implemented to calculate the annual percent change (APC) of mortality rates and YLL rates for cancers. YLLs owing to premature death were calculated as age‐specific cancer deaths multiplied by the reference life expectancy at birth of 80 years for male and 82.5 years for female. Results The ASMRs of all cancers showed significant decreasing trends for urban residents from 1990 to 2017, such downward trend without significance was also observed among rural residents. Interestingly, ASMRs of lung cancer and breast cancer have raised continuously in rural areas since 1990. The age‐standardized YYL rates for urban and rural residents decreased with 1.02% and 0.85% per year, respectively. YLLs in rural areas were higher than those in urban areas, whereas YLLs of urban outstripped those of rural finally with the increasing in YLLs of urban areas (216.71% for men and 207.87% for women). Conclusion The ASMRs and YLL rates of all cancers have declined in urban and rural areas from 1990 to 2017. YLLs increased in urban areas and remained higher level in rural areas after 2014 year. Preventive measures should be strengthened to against cancer, especially for lung cancer.
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Affiliation(s)
- Xingzu Cen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongming Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Sun
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Examining Division for Materials Engineering Inventions, China National Intellectual Property Administration, Beijing, China
| | - Limin Cao
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuang Zhang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihong Chen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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