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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: 6] [Impact Index Per Article: 6.0] [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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Afaya A, Laari TT, Seidu AA, Afaya RA, Daniels-Donkor SS, Yakong VN, Ahinkorah BO. Factors associated with the uptake of clinical breast examination among women of reproductive age in Lesotho: analysis of a national survey. BMC Cancer 2023; 23:114. [PMID: 36726101 PMCID: PMC9890772 DOI: 10.1186/s12885-023-10566-2] [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: 07/04/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In low-resource settings with weak health systems, the WHO recommends clinical breast examination (CBE) as the most cost-effective breast screening modality for women. Evidence shows that biennial CBE leads to significant downstaging of breast cancer in all women. Breast cancer is the second most common cancer among women in Lesotho with a weaker healthcare system and a low breast cancer screening rate. This study investigated the prevalence and factors associated with the uptake of CBE among women of reproductive age in Lesotho. METHODS This study used cross-sectional data from the 2014 Lesotho Demographic and Health Survey. A sample of 6584 reproductive-age women was included in this study. We conducted both descriptive and multivariable logistic regression analyses. The study results were presented in frequencies, percentages, and adjusted odds ratios (aOR) with their corresponding confidence intervals (CIs). RESULTS The prevalence of CBE uptake was 9.73% (95% CI: 8.91, 10.61). Women who were covered by health insurance (aOR = 2.31, 95% CI [1.37, 3.88]), those who were pregnant (aOR = 2.34, 95% CI [1.64, 3.35]), those who had one to three children (aOR = 1.81, 95% CI [1.29,2.52]), and women who frequently read newspapers or magazines (aOR = 1.33, 95% CI [1.02,1.72]) were more likely to undergo CBE than their counterparts. Women who were aware of breast cancer (aOR = 2.54, 95% CI [1.63,3.97]), those who have ever had breast self-examination (BSE) within the last 12 months prior to the study (aOR = 5.30, 95% CI [4.35,6.46]), and those who visited the health facility in the last 12 months prior to the study (aOR = 1.57, 95% CI [1.27,1.95]) were also more likely to undergo CBE than their counterparts. Women residing in the Qacha's-nek region (aOR = 0.42, 95% CI [0.26,0.67]) were less likely to undergo CBE than those in the Botha-bothe region. CONCLUSION The study found a low prevalence of CBE uptake among reproductive-age women in Lesotho. Factors associated with CBE uptake include health insurance coverage, being pregnant, those who had one to three children, exposure to media, breast cancer awareness, ever had BSE, and those who visited a health facility. To increase CBE uptake, these factors should be considered when designing cancer screening interventions and policies in order to help reduce the burden of breast cancer in Lesotho.
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Affiliation(s)
- Agani Afaya
- grid.15444.300000 0004 0470 5454Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, 03722 Seoul, South Korea ,grid.449729.50000 0004 7707 5975Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Timothy Tienbia Laari
- Presbyterian Primary Health Care (PPHC), Bolgatanga, Ghana ,grid.9829.a0000000109466120Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdul Aziz Seidu
- grid.1011.10000 0004 0474 1797College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Australia ,REMS Consult Ltd, Takoradi, Ghana ,grid.511546.20000 0004 0424 5478Centre for Gender and Advocacy, Takoradi Technical University, P. O. Box 256, Takoradi, Ghana
| | - Richard Adongo Afaya
- grid.442305.40000 0004 0441 5393Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Silas Selorm Daniels-Donkor
- grid.8241.f0000 0004 0397 2876Department of Nursing, School of Health Sciences, University of Dundee, Scotland, United Kingdom
| | - Vida Nyagre Yakong
- grid.442305.40000 0004 0441 5393Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Bright Opoku Ahinkorah
- REMS Consult Ltd, Takoradi, Ghana ,grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Huang S, Yang Q, Zheng X, Chow KM, Wu J, Zhu J. Predictors of surgery choices in women with early-stage breast cancer in China: a retrospective study. BMC Cancer 2023; 23:23. [PMID: 36609281 PMCID: PMC9825016 DOI: 10.1186/s12885-023-10510-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The breast-conserving surgery and reconstruction rate in China is relatively low when compared with those in Western countries. Moreover, predictors of surgical choices for women with breast cancer in China have not yet been explored. This study aims to explore differences in the surgical choices of women with different demographic and clinical characteristics and the predictors that influence surgical choices of women with early-stage breast cancer. METHODS This retrospective study included women with early-stage (0-II) breast cancer who underwent surgeries at one of two Xiamen University-affiliated hospitals between 2009 and 2017. Using medical records, eleven variables were collected: the woman's age, year of diagnosis, hospital, marital status, payment method, cancer stage, presence of positive axillary lymph node, histology, neoadjuvant chemotherapy, radiotherapy, and the type(s) of surgery they chose. Binary logistic regression was used to analyse predictors of surgical choice. RESULTS A total of 1,787 cases were included in this study. Of the total number of women with breast cancer, 61.3% underwent mastectomy without breast reconstruction, 26.4% underwent mastectomy with breast reconstruction, and the remaining 12.2% chose breast-conserving surgery. Women with different demographic and clinical characteristics underwent different types of surgery. Cancer stage, neoadjuvant chemotherapy, radiotherapy, and the choice of hospital were found to be predictors of breast-conserving surgery. Meanwhile, age, year of diagnosis, payment method, neoadjuvant chemotherapy, and the choice of hospital were found to be predictors of reconstruction after mastectomy in women with early-stage breast cancer. CONCLUSIONS In China, surgical choices for women with breast cancer have diversified. Healthcare workers should understand the surgical preferences of women of different ages. For early detection of breast cancer, knowledge of breast self-examination and breast cancer screening should be provided. Adequate information about the safety of reconstruction and advocacy for medical insurance coverage of reconstruction should be offer. Breast surgeons need specialised training and standardising protocols towards different types of breast surgery. These actions will help women make better, well-informed decisions about their breast surgeries.
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Affiliation(s)
- Sijia Huang
- grid.12955.3a0000 0001 2264 7233Department of Nursing, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Qingmo Yang
- grid.12955.3a0000 0001 2264 7233Department of Breast Surgery, First Affiliated Hospital, Xiamen University, Xiamen, P.R. China
| | - Xujuan Zheng
- grid.263488.30000 0001 0472 9649School of Nursing, Health Science Centre, Shenzhen University, Shenzhen, Guangdong Province P.R. China
| | - Ka Ming Chow
- grid.10784.3a0000 0004 1937 0482The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - Junhua Wu
- grid.12955.3a0000 0001 2264 7233Department of Nursing, School of Medicine, Xiamen University, Xiamen, P.R. China
| | - Jiemin Zhu
- grid.12955.3a0000 0001 2264 7233Department of Nursing, School of Medicine, Xiamen University, Xiamen, P.R. China
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Zhang S, Wang H, Liu B, Yu J, Gao Y. Socioeconomic status index is an independent determinant of breast cancer screening practices: Evidence from Eastern China. PLoS One 2022; 17:e0279107. [PMID: 36516181 PMCID: PMC9749974 DOI: 10.1371/journal.pone.0279107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Breast cancer is the most prevalent malignancy affecting Chinese women, and early routine screening is incredibly important for its prevention and control. This study aimed to investigate the role of socioeconomic status (SES) in female breast cancer screening practices using the composite SES index. METHODS This cross-sectional study involved 1816 women in Eastern China. Data were collected using an online self-administered questionnaire from January 2020 to May 2021. We used principal component analysis to construct the composite SES index using educational level, annual household income, and occupation. Logistic regression was used to analyze the association between the SES index and breast cancer screening utilization. RESULTS Of the participants, 19.27% reported having performed breast self-examination, 12.89% reported having undergone clinical breast examination, and 3.52% reported having received mammography. The SES has a significant influence on the patronage of female breast cancer screening in Eastern China. The composite SES index was found to have a positive and significant association with breast cancer screening practices. An interaction was found between the SES index and patient characteristics, such as health awareness, marital status, and location of residence. In addition, the SES index had a positive effect on breast cancer-related knowledge. CONCLUSIONS Socioeconomic inequalities existed in Eastern China and were related to breast cancer screening patronage. The composite SES index was identified as a significant determinant of breast cancer screening practices. Our results highlighted the negative impacts of socioeconomic inequities on female breast cancer screening utilization. This suggests that reducing socioeconomic inequalities in breast cancer screening requires more focused interventions and concerted outreach activities for groups with lower education levels, lower income, or lower occupational classes.
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Affiliation(s)
- Shunhua Zhang
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
- * E-mail:
| | - Hairuo Wang
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
| | - Binhao Liu
- School of Clinical Medicine, Bengbu Medical College, Bengbu, Anhui, China
| | - Jianwei Yu
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
| | - Yizheng Gao
- School of Medical Imaging, Bengbu Medical College, Bengbu, Anhui, China
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Zhang M, Wei W, Li Q, Chen X, Zhang M, Zuo D, Liu Q. Determinants of Intention to Participate in Breast Cancer Screening among Urban Chinese Women: An Application of the Protection Motivation Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111093. [PMID: 34769613 PMCID: PMC8583142 DOI: 10.3390/ijerph182111093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022]
Abstract
Despite the significance of early detection of breast cancer through screening, the screening uptake in China remains relatively low. Protection motivation theory (PMT) suggested by Rogers is one of the theories concerning threat appeal. This study aimed to apply the protection motivation theory (PMT) in predicting breast cancer screening intention. In this cross-sectional study, a sample of Chinese urban women was recruited using the convenient sampling method from five communities in Wuhan. Data were collected using a self-report questionnaire that included demographic variables, knowledge about breast cancer, six PMT subconstructs, and screening intention. We used the structural equation modeling (SEM) to identify the predictor factors associated with screening intention. Of the total sample (n = 412), 86.65% had intention to participate in screening. Our data fit the hypothesized SEM model well (Goodness of fit index (GFI) = 0.91, adjusted GFI (AGFI) = 0.89, comparative fit index (CFI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, standardized root mean residual (SRMR) = 0.06, and Chi-square/df = 2.01). Three PMT subconstructs (perceived severity, response cost, and self-efficacy) were significantly associated with screening intention. Knowledge, social status, and medical history had significantly indirect associations with screening intention through the mediating effect of PMT subconstructs. Considering the utility of PMT, intervention programs might be more effective based on the subconstructs of PMT, especially to improve self-efficacy, perceived severity, and knowledge, reduce response cost, as well as targeting specific demographic groups.
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Affiliation(s)
- Miao Zhang
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan 430071, China; (M.Z.); (W.W.); (D.Z.)
| | - Wenshuang Wei
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan 430071, China; (M.Z.); (W.W.); (D.Z.)
| | - Qinmei Li
- Wuhan Center for Disease Control and Prevention, Wuhan 430015, China;
| | - Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, FL 32610, USA;
| | - Min Zhang
- Institute of Cancer Prevention and Control, Wuhan 430079, China;
| | - Dan Zuo
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan 430071, China; (M.Z.); (W.W.); (D.Z.)
| | - Qing Liu
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan 430071, China; (M.Z.); (W.W.); (D.Z.)
- Correspondence: ; Tel.: +86-1372-026-4816
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Zhang M, Zhong Y, Bao H, Zhao Z, Huang Z, Zhang X, Li C, Zhou M, Wang L, Wu J, Zheng X, Wang L. Breast Cancer Screening Rates Among Women Aged 20 Years and Above - China, 2015. China CDC Wkly 2021; 3:267-273. [PMID: 34594864 PMCID: PMC8392981 DOI: 10.46234/ccdcw2021.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/24/2021] [Indexed: 11/14/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS TOPIC? Breast cancer is the most common cancer in women in China and around the world. By 2019, 121 countries have instituted a national screening program as a secondary prevention measure for breast cancer. WHAT IS ADDED BY THIS REPORT? Breast cancer screening rates in China were 18.9% in women aged 20 years and above, and 25.7% in women aged 35-64 years in 2015. The screening rate for women aged 20 years and above was significantly higher in urban areas than in rural areas (24.6% vs. 15.0%), and in the eastern region than in the central and western regions (24.0% vs. 15.1% and 15.3%). WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE? Continued efforts should be made to strengthen national and local policy initiatives and financial support for population-based, organized screening programs for breast cancer. Health education and accessibility of screening services to women across the country should be strengthened, especially for women aged 50 years and above.
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Affiliation(s)
- Mei Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yijing Zhong
- Institute of Population Research, Peking University, Beijing, China
| | - Heling Bao
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Zhenping Zhao
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhengjing Huang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chun Li
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Limin Wang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Wu
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoying Zheng
- Institute of Population Research, Peking University, Beijing, China
| | - Linhong Wang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Cao M, Li H, Sun D, He S, Yu Y, Li J, Chen H, Shi J, Ren J, Li N, Chen W. Cancer screening in China: The current status, challenges, and suggestions. Cancer Lett 2021; 506:120-127. [PMID: 33684533 DOI: 10.1016/j.canlet.2021.02.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/29/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022]
Abstract
Substantial progress has been made in cancer screening in China due to the substantial efforts of all levels of the government. Four large-scale population-based screening programs have been launched since 2005. In these programs, individuals at high risk for the most common types of cancer are screened with no cost. However, there are still wide gaps remaining between the cancer screening objectives and reality. In this review, we summarize the current status of cancer screening, identify the major achievements and challenges of cancer screening, and propose some suggested improvements based on the existing evidence. The main challenges include low participation rates, the uneven distribution of medical sources, inadequate funding, and insufficient screening quality. Some suggestions that should be considered to improve the quality of cancer screening include advertising to increase awareness, providing universal training of staff involved in screening programs, optimizing the definition of high-risk populations, integrating new technologies into cancer screening programs, and implementing appropriate management measures among individuals with positive screening results.
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Affiliation(s)
- Maomao Cao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - He Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dianqin Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Siyi He
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yiwen Yu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hongda Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jufang Shi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiansong Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ni Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Bao H, Wang L, Brown M, Zhang M, Hunt K, Di J, Zhao Z, Cong S, Fan J, Fang L, Wang L. A nationally quasi-experimental study to assess the impact of partial organized breast and cervical cancer screening programme on participation and inequalities. BMC Cancer 2020; 20:1191. [PMID: 33276761 PMCID: PMC7716588 DOI: 10.1186/s12885-020-07686-4] [Citation(s) in RCA: 2] [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: 03/12/2020] [Accepted: 11/24/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Organized breast and cervical cancer screening programme could only provide services at no cost for a fraction of socioeconomic-deprived women in China and other low-resource countries, however, little evidence exists for whether such a programme effectively affect the participation and inequalities at the population level. METHODS We used individual-level data from a nationally cross-sectional survey in 2014-2015 for breast and cervical cancer screening participation. Data for intervention and comparison grouping were from 2009 to 2014 national breast and cervical cancer screening programme, and counties covered by the programme were divided into intervention group. We assessed the impact of the intervention on the participation rates and the magnitude of inequalities with two approaches: multivariable multilevel logistic regressions adjusting for individual- and region-level covariates; and a difference analysis combined with propensity score matching that estimated the average intervention effect. RESULTS Of 69,875 included women aged 35-64 years, 21,620 were classified into the intervention group and 43,669 into the comparison group for breast cancer screening; and 31,794 into the intervention group, and 33,682 into the comparison group for cervical cancer screening. Participation rate was higher in intervention group than comparison group for breast cancer screening (25.3, 95% confidential interval [CI], 22.8-27.7%, vs 19.1, 17.4-20.7%), and cervical cancer screening (25.7, 23.8-27.7%, vs 21.5, 19.6-23.5%), respectively. Intervention significantly increased the likelihood of participation for both breast cancer and cervical cancer screening in overall women, rural women and urban women, whereas the effect was significantly higher in rural women than urban women. The average intervention effect on the participation rate was an increase of 7.5% (6.7-8.2%) for breast cancer screening, and 6.8% (6.1-7.5%) for cervical cancer screening, respectively. The inequalities were significantly decreased by 37-41% (P < 0.001) between rural and urban, however, were slightly decreased or even increased in terms of age, education status, and household income. CONCLUSIONS Organized breast and cervical cancer screening programme targeting for a fraction of women could increase the participation rates at population level, however, it could not significantly affect socioeconomic-introduced inequalities. Further studies are need to conduct time-series analyses and strengthen the causal correlation.
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Affiliation(s)
- Heling Bao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Limin Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Matthew Brown
- Center for Global Health, China Office, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Mei Zhang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Katherine Hunt
- Susan G. Komen, 5005 LBJ Freeway, Suite 526, Dallas, TX, 75244, USA
| | - Jiangli Di
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, 12 Dahuisi Road, Haidian District, Beijing, 100081, China
| | - Zhenping Zhao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Shu Cong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Jing Fan
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Liwen Fang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China.
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9
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Momenimovahed Z, Tiznobaik A, Taheri S, Hassanipour S, Salehiniya H. A review of barriers and facilitators to mammography in Asian women. Ecancermedicalscience 2020; 14:1146. [PMID: 33343705 PMCID: PMC7738271 DOI: 10.3332/ecancer.2020.1146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Indexed: 11/29/2022] Open
Abstract
Aim Breast cancer is the most common cancer among women in Asia and one of the major health problems in most countries in the region. Despite extensive advances in treatment, early diagnosis is one of the main methods for increasing the survival rate. It is necessary to evaluate the barriers and facilitators of screening in different societies. This study was conducted to identify the barriers and facilitators of mammography in Asia. Materials and methods To identify the barriers and facilitators of mammography in Asia, a comprehensive search was carried out in databases such as Medline, Web of Science Core Collection and Scopus using keywords, including breast cancer, screening, mammography, barriers, facilitators and the names of each Asian country, as well as a combination of these keywords were used to help the search. Full-text, English language and original articles were included in this study. Results In total, 71 articles were entered into the study. The findings of this study revealed various barriers to mammography in Asian women, including knowledge, sociodemographic factors, cost and insurance, cultural factors, belief, attitude and feeling, fear, pain and embarrassment, self-efficacy, religious, psychological factors, time constraint, fatalism, professional recommendations, communication, social support and access. Also, knowledge, attitude and belief, perceived risk, professional and social factors were found to be facilitators of mammography. Conclusion Knowing the barriers and facilitators to access mammography is the first step in the development of a successful screening program. Awareness and various personal, professional and social factors have emerged as the major barriers to access to mammography in most Asian countries.
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Affiliation(s)
| | | | | | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
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10
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Basu P, Zhang L, Hariprasad R, Carvalho AL, Barchuk A. A pragmatic approach to tackle the rising burden of breast cancer through prevention & early detection in countries 'in transition'. Indian J Med Res 2020; 152:343-355. [PMID: 33380699 PMCID: PMC8061594 DOI: 10.4103/ijmr.ijmr_1868_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 12/16/2022] Open
Abstract
Among the emerging economies Brazil, Russia, India, China and South Africa (together known as the BRICS countries) share collectively approximately 40 per cent of the global population and contribute to 25 per cent of the world gross domestic products. All these countries are facing the formidable challenge of rising incidence of breast cancer and significant number of premature deaths from the disease. A multidimensional approach involving prevention, early detection and improved treatment is required to counteract the growing burden of breast cancer. A growing trend in the prevalence of major preventable risk factors of breast cancer such as obesity, western dietary habits, lack of physical activity, consumption of alcohol and smoking is contributing significantly to the rising burden of the disease in BRICS nations. Specific interventions are needed at the individual and population levels to mitigate these risk factors, preferably within the broader framework of non-communicable disease control programme. Population-based quality assured mammography-based screening of the 50-69 yr old women can reduce breast cancer mortality at least by 20 per cent. However, none of the BRICS countries have been able to implement population-based organized screening programme. Large scale opportunistic screening with mammography targeting predominantly the younger women is causing harms to the women and wasting precious healthcare resources. There are recent national recommendations to screen women with mammography in Brazil and Russia and with clinical breast examination in China (along with ultrasound) and India. Given the challenges of implementing systematic screening of the population, the BRICS countries should prioritize the early diagnosis approach and invest in educating the women about the breast cancer symptoms, training the frontline health providers to clinically detect breast cancers and appropriately refer for diagnostic confirmation, and creating improved access to good quality diagnostic and treatment facilities for breast cancer. The early diagnosis approach has been proved to achieve downstaging and improve survival at a fraction of the resources needed for population screening. The countries also need to focus on improving the services and capacity for multidisciplinary treatment of breast cancer, histopathology and immunohistochemistry, safe administration of chemotherapy and palliative care.
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Affiliation(s)
- Partha Basu
- Screening Group, Early Detection & Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Li Zhang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Roopa Hariprasad
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Andre L. Carvalho
- Screening Group, Early Detection & Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Anton Barchuk
- Faculty of Social Sciences/Health Sciences, Tampere University, Tampere, Finland
- N.N. Petrov National Research Medical Center of Oncology, Saint Petersburg, Russia
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11
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Liu X, Zhou M, Wang F, Mubarik S, Wang Y, Meng R, Shi F, Wen H, Yu C. Secular Trend of Cancer Death and Incidence in 29 Cancer Groups in China, 1990-2017: A Joinpoint and Age-Period-Cohort Analysis. Cancer Manag Res 2020; 12:6221-6238. [PMID: 32801868 PMCID: PMC7398884 DOI: 10.2147/cmar.s247648] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/02/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose China has a heavy cancer burden. We aimed to quantitatively estimate the secular trend of cancer mortality and incidence in China. Methods We extracted numbers, age-specific and age-standardized rates of 29 cancer groups (from 1990 to 2017) from the Global Burden of Disease (GBD) study in 2017. We estimated rates of major cancer types for annual percent change by Joinpoint regression, and for age, period, and cohort effect by an age–period–cohort model. Results In 2017, breast cancer had the highest incidence rate in females. Lung cancer had the highest mortality and incidence rates in males. Although the age-standardized incidence rate of prostate cancer ranked second highest in males, it increased by 112% from 1990 to 2017. Individuals aged over 50 years were at high risk of developing cancer, and the number of deaths at this age accounted for over 89% of all cancers in all age groups. When compared with the global average level, the age-standardized mortality and incidence rates of both liver and esophageal cancers were 2.1 times higher in China, and stomach, lung and nasopharyngeal cancers in China also had high levels (more than 1.5 times higher). During 1990–2017, most of the 29 cancers exhibited an increasing incidence trend, and Joinpoint regression demonstrated increasing mortality of some major cancers. The period effect indicated that the risk of mortality and incidence due to the main cancers generally increased during 1992–2017. Conclusion Trend analysis provided information on the effects of prevention strategies and targeted interventions on the occurrence of different cancers. Etiological studies need to be conducted on some major cancers in the Chinese population.
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Affiliation(s)
- Xiaoxue Liu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, People's Republic of China
| | - Maigeng Zhou
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, People's Republic of China
| | - Fang Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, People's Republic of China
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, People's Republic of China
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, People's Republic of China
| | - Runtang Meng
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, People's Republic of China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, People's Republic of China
| | - Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, People's Republic of China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, People's Republic of China.,Global Health Institute, Wuhan University, Wuhan 430072, People's Republic of China
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12
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Qin VM, McPake B, Raban MZ, Cowling TE, Alshamsan R, Chia KS, Smith PC, Atun R, Lee JT. Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample. BMC Health Serv Res 2020; 20:372. [PMID: 32366235 PMCID: PMC7197140 DOI: 10.1186/s12913-020-05194-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 04/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. Method We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. Findings Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). Conclusion Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities.
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Affiliation(s)
- Vicky Mengqi Qin
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Thomas E Cowling
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Riyadh Alshamsan
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Peter C Smith
- Centre for Health Economics, University of York, York, UK.,Imperial College London, London, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - John Tayu Lee
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
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13
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Wang MZ, Fan J, Jiang I, Sherer R. Graduating Students' Evaluations of Their Training and Clinical Performance in Areas of Women's Health in a Chinese Medical School. J Gen Intern Med 2019; 34:1998-2000. [PMID: 31197732 PMCID: PMC6816643 DOI: 10.1007/s11606-019-05090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Margaret Z Wang
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA.,Department of Psychiatry, University of Texas at Southwestern, Dallas, TX, USA
| | - Jingyi Fan
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ivy Jiang
- Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA.
| | - Renslow Sherer
- Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
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14
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Wu Z, Liu Y, Li X, Song B, Ni C, Lin F. Factors associated with breast cancer screening participation among women in mainland China: a systematic review. BMJ Open 2019; 9:e028705. [PMID: 31455705 PMCID: PMC6720337 DOI: 10.1136/bmjopen-2018-028705] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Although detecting breast cancer at an early stage through screening has been clearly shown to be an effective strategy, the screening participation rate in China remains low. This systematic review sought to synthesise the current evidence to identify factors associated with breast cancer screening participation among women in mainland China. DESIGN This study was a systematic review. DATA SOURCES Studies were collected from PubMed, PsycINFO, CINAHL, EMBASE and three major Chinese databases, specially China National Knowledge Infrastructure, Chongqing VIP and Wanfang Data. ELIGIBILITY CRITERIA All included papers were original research studies with a longitudinal or cross-sectional study design that considered associated factors of breast cancer screening participation among women in mainland China. DATA EXTRACTION AND SYNTHESIS Study selection, data extraction and quality assessment were conducted independently by two reviewers, involving a third to help reach a consensus when necessary. Primary outcomes of interest included factors associated with breast cancer screening participation. RESULTS A total of 19 studies were included in this review. Based on these studies, geographical region, a personal history of breast disease, past screening behaviours for breast disease, physical examination and the availability of medical specialists/equipment for breast examination were consistently associated with participation in breast cancer screening, while residential area, ethnicity and attitude towards breast cancer screening appeared to be associated with participation in breast cancer screening. There were additionally some factors with even more limited evidence with which to ascertain their association with screening participation. CONCLUSIONS There exists a wide range of factors that influence breast cancer screening participation in mainland China. These findings could help to inform future research and policy efforts.
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Affiliation(s)
- Zijing Wu
- School of Nursing, China Medical University, Shenyang, China
| | - Yu Liu
- School of Nursing, China Medical University, Shenyang, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, China
| | - Bing Song
- School of Nursing, China Medical University, Shenyang, China
| | - Cuiping Ni
- School of Nursing, China Medical University, Shenyang, China
| | - Frances Lin
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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15
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Liu PL, Yeo TED. Breast health, risk factors, and cancer screening among lesbian, bisexual, and queer/questioning women in China. Health Care Women Int 2019; 42:947-961. [PMID: 30730783 DOI: 10.1080/07399332.2019.1571062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this study, we examine the health disparities of sexual minority women by surveying 310 lesbian, bisexual, and queer/questioning women (LBQW) in China about their breast health and cancer screening practices. We found that Chinese LBQW, particularly those identified with a masculine gender role and practice chest binding, are vulnerable to breast cancer given their high rates of behavioral risk factors (e.g., cigarette smoking) and symptoms (e.g., breast lumps) but low rates of self and clinical breast examinations. Salient barrier (stigma) and facilitators (social support availability, self-efficacy, and breast cancer information exposure) of breast cancer screening were also identified.
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Affiliation(s)
- Piper Liping Liu
- School of Communication, Hong Kong Baptist University, Hong Kong
| | - Tien Ee Dominic Yeo
- Department of Communication Studies, Hong Kong Baptist University, Hong Kong
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16
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Risk prediction for breast Cancer in Han Chinese women based on a cause-specific Hazard model. BMC Cancer 2019; 19:128. [PMID: 30732565 PMCID: PMC6367757 DOI: 10.1186/s12885-019-5321-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/25/2019] [Indexed: 01/03/2023] Open
Abstract
Background Considering the lack of efficient breast cancer prediction models suitable for general population screening in China. We aimed to develop a risk prediction model to identify high-risk populations, to help with primary prevention of breast cancer among Han Chinese women. Methods A cause-specific competing risk model was used to develop the Han Chinese Breast Cancer Prediction model. Data from the Shandong Case-Control Study (328 cases and 656 controls) and Taixing Prospective Cohort Study (13,176 participants) were used to develop and validate the model. The expected/observed (E/O) ratio and C-statistic were calculated to evaluate calibration and discriminative accuracy of the model, respectively. Results Compared with the reference level, the relative risks (RRs) for highest level of number of abortions, age at first live birth, history of benign breast disease, body mass index (BMI), family history of breast cancer, and life satisfaction scores were 6.3, 3.6, 4.3, 1.9, 3.3, 2.4, respectively. The model showed good calibration and discriminatory accuracy with an E/O ratio of 1.03 and C-statistic of 0.64. Conclusions We developed a risk prediction model including fertility status and relevant disease history, as well as other modifiable risk factors. The model demonstrated good calibration and discrimination ability. Electronic supplementary material The online version of this article (10.1186/s12885-019-5321-1) contains supplementary material, which is available to authorized users.
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17
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Tavakoli Taba S, Brennan PC, Lewis S. Dynamics of breast imaging research: A global scoping review and Sino-Australian comparison case study. PLoS One 2019; 14:e0210256. [PMID: 30629713 PMCID: PMC6328195 DOI: 10.1371/journal.pone.0210256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 12/19/2018] [Indexed: 01/01/2023] Open
Abstract
This study presents a quantitative analysis of global breast imaging research over the last eight decades. A dedicated Sino-Australian case study via a social network analysis (SNA) is included as China and Australia have a recent rapidly increasing number of research partnerships and strategic education/economic connections. Bibliographic data was extracted via Scopus and analysed for the social network parameters of degree centrality, closeness centrality, betweenness centrality and multiple cohesion measures in order to explore research collaboration networks at the organisational level. Within the last three decades there has been a tremendous increase in the publication rate within the scientific domain of breast imaging research, however, there is a significant lag in the development of this research area in China compared with Australia. Breast imaging research in China is considerably more insular, with less international collaboration and reduced variation between collaborators than Australia. The impact of national breast screening programs and novel cancer technologies upon collaboration networks is discussed alongside the ability of networks paradigm to reveal both frailties in research connections and to highlight networking strategies.
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Affiliation(s)
- Seyedamir Tavakoli Taba
- Medical Imaging Optimisation and Perception Group (MIOPeG), Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Patrick C. Brennan
- Medical Imaging Optimisation and Perception Group (MIOPeG), Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Sarah Lewis
- Medical Imaging Optimisation and Perception Group (MIOPeG), Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
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18
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Li X, Deng Y, Tang W, Sun Q, Chen Y, Yang C, Yan B, Wang Y, Wang J, Wang S, Yang F, Ding Y, Zhao G, Cao G. Urban-Rural Disparity in Cancer Incidence, Mortality, and Survivals in Shanghai, China, During 2002 and 2015. Front Oncol 2018; 8:579. [PMID: 30560091 PMCID: PMC6287035 DOI: 10.3389/fonc.2018.00579] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/19/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction: Disparities in the incidence, mortality, and survival of cancer types between urban and rural areas in China reflect the effects of different risk factor exposure, education, and different medical availability. We aimed to characterize the disparities in the incidence, mortality, and survivals of cancer types between urban and rural areas in Shanghai, China, 2002-2015. Materials and Methods: The incidence and mortality were standardized by Segi's world standard population. Trends in the incidence and mortality of cancers were compared using annual percent change. The 5-year observed and relative survivals were calculated with life table and Ederer II methods. Results: Age-standardized incidences and mortalities were 212.55/105 and 109.45/105 in urban areas and 210.14/105 and 103.99/105 in rural areas, respectively. Female breast cancer and colorectal cancer occurred more frequently in urban than in rural areas, quite in contrast to liver cancer and cervical cancer. Cancers of lung and bronchus, liver, stomach, and colon and rectum were the leading causes of cancer death in both areas. Age-standardized incidence of female breast cancer and colorectal cancer in urban areas increased while gastric cancer and liver cancer decreased in both areas. Age-standardized mortalities of cancers of breast, esophagus, stomach, colon and rectum, liver, and lung and bronchus decreased in both areas. For all cancers combined, the 5-year observed and relative survivals of cancer patients were higher in urban than in rural areas. The 5-year observed and relative survivals of cancers of liver, pancreas, stomach, brain and central nervous system (CNS), and prostate were higher in urban than in rural areas. The 5-year observed and relative survivals of cervical cancer were higher in rural than in urban areas. Conclusions: Factors promoting female breast cancer and colorectal cancer in urban areas and liver cancer and cervical cancer in rural areas should be specifically intervened in cancer prophylaxis. Improved medical services can greatly prolong the survival of major cancers in rural areas.
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Affiliation(s)
- Xiaopan Li
- The Key Laboratory of Public Health and Safety of Education Ministry, School of Public Health, Fudan University, Shanghai, China.,Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Yang Deng
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Weina Tang
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Qiao Sun
- Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Yichen Chen
- Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Chen Yang
- Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Bei Yan
- Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Yingying Wang
- Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Jing Wang
- Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Shuo Wang
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Fan Yang
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Yibo Ding
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Genming Zhao
- The Key Laboratory of Public Health and Safety of Education Ministry, School of Public Health, Fudan University, Shanghai, China
| | - Guangwen Cao
- Department of Epidemiology, Second Military Medical University, Shanghai, China
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19
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Gan YX, Lao CK, Chan A. Breast cancer screening behavior, attitude, barriers among middle-aged Chinese women in Macao, China. J Public Health (Oxf) 2018; 40:e560-e570. [PMID: 29741646 DOI: 10.1093/pubmed/fdy077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 04/19/2018] [Indexed: 11/15/2022] Open
Abstract
Background Breast cancer is the third leading cause of death from cancer among females in Macao, but little is known about local practice of breast cancer screening. The study aims to evaluate breast cancer screening behaviors and to identify the predictors of insufficient knowledge and attitudes towards breast cancer and its screening among female residents. Methods This was a cross-sectional study conducted from April to June 2016 in Macao. Quota sampling of women completed the modified Chinese Breast Cancer Screening Beliefs questionnaire (CBCSB) to assess their breast cancer-related perceptions, screening attitudes and behaviors. Univariate and multivariate logistic regressions were performed to identify the predictors of poor-screening practices, attitudes, knowledge and perceived barriers to mammography. Result A total of 417 women (mean age±SD: 50.5±5.7) completed surveys, with 160 (38.4%), 196 (47.0%) and 103 (24.7%) women received breast self-examination, clinical breast examination and mammography as recommended, respectively. Nulliparity (OR=2.56, 95% CI = 1.14-5.73) and low education (OR = 1.72, 95% CI = 1.04-2.84) were significantly associated with negative attitude towards health check-ups. Women did not know anyone with breast cancer (OR = 2.30, 95% CI = 1.50-3.55) were more likely to have insufficient knowledge about breast cancer. Low education (OR = 1.95, 95% CI = 1.25-3.04) and not knowing anyone with breast cancer (OR = 2.02, 95% CI = 1.31-3.13) were identified as predictors for perceived barriers to mammography. Conclusion Recommendations for breast cancer screening are poorly followed by the residents in Macao, and a culturally tailored educational program is urgently needed to raise the public's awareness of the disease and the screening practices.
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Affiliation(s)
- Yan Xiang Gan
- Oncology Pharmacy, National Cancer Centre Singapore, Singapore
| | - Cheng-Kin Lao
- School of Health Sciences, Macao Polytechnic Institute, Macao SAR, China
| | - Alexandre Chan
- Oncology Pharmacy, National Cancer Centre Singapore, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore, Singapore
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20
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Holzhauser C, Da Rosa P, Michael S. Forecasting Participants in the All Women Count! Mammography Program. Prev Chronic Dis 2018; 15:E130. [PMID: 30367718 PMCID: PMC6219850 DOI: 10.5888/pcd15.180177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The All Women Count! (AWC!) program is a no-cost breast and cervical cancer screening program for qualifying women in South Dakota. Our study aimed to identify counties with similar socioeconomic characteristics and to estimate the number of women who will use the program for the next 5 years. METHODS We used AWC! data and sociodemographic predictor variables (eg, poverty level [percentage of the population with an annual income at or below 200% of the Federal Poverty Level], median income) and a mixture of Gaussian regression time series models to perform clustering and forecasting simultaneously. Model selection was performed by using Bayesian information criterion (BIC). Forecasting of the predictor variables was done by using an autoregressive integrated moving average model. RESULTS By using BIC, we identified 5 clusters showing the groups of South Dakota counties with similar characteristics in terms of predictor variables and the number of participants. The mixture model identified groups of counties with increasing or decreasing trends in participation and forecast averages per cluster. CONCLUSION The mixture of regression time series model used in this study allowed for the identification of similar counties and provided a forecasting model for future years. Although several predictors contributed to program participation, we believe our forecasting analysis by county may provide useful information to improve the implementation of the AWC! program by informing program managers on the expected number of participants in the next 5 years. This, in turn, will help in data-driven resource allocation.
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Affiliation(s)
- Calla Holzhauser
- Mathematics and Statistics Department, South Dakota State University, AME Building, Box 2225, Brookings, South Dakota 57007.
| | - Patricia Da Rosa
- Office of Research, College of Nursing, South Dakota State University, Brookings, South Dakota
| | - Semhar Michael
- Mathematics and Statistics Department, South Dakota State University, Brookings, South Dakota
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21
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Dong X, Jiang J. Association Between Cancer and Utilization of Traditional Chinese Medicine in U.S. Chinese Women: Findings From the PINE Study. Gerontol Geriatr Med 2018; 4:2333721418778199. [PMID: 30038950 PMCID: PMC6050798 DOI: 10.1177/2333721418778199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 12/29/2017] [Accepted: 02/05/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: To examine U.S. Chinese older women and the association between
their cancer screening behaviors and self-reported cancers with Traditional Chinese
Medicine (TCM) use across sociodemographic characteristics. Method: Through
the Population Study of Chinese Elderly in Chicago (PINE), 1,830 Chinese older women
self-reported history of cancer screening, presence of women’s cancers, and TCM use
according to type. Analyses were performed using multivariate regression models.
Results: Chinese older women who underwent breast cancer screening are more
likely to use herbal TCM (rate ratio [RR] = 1.15, 95% confidence interval [CI] = [1.03,
1.29]), acupuncture (RR = 1.62, CI = [1.21, 2.15]), massage therapy (RR = 2.05, CI =
[1.46, 2.88]), and tai chi (RR = 1.86, CI = [1.28, 2.69]). Those who had cervical cancer
screening are more likely to use herbal TCM (RR = 1.32, CI = [1.17, 1.48]), acupuncture
(RR = 1.66, CI = [1.27, 2.18]), massage therapy (RR = 1.61, CI = [1.17, 2.21]), tai chi
(RR = 1.69, CI = [1.19, 2.40]), and other forms of TCM (RR = 1.36, CI = [1.04, 1.79]).
Those with cervical cancer are less likely to use herbal TCM (RR = 0.42, CI = [0.19,
0.93]). Conclusion: Contrary to previous studies, our results suggest that
U.S. Chinese older women who have engaged in cancer screening use TCM while those with
self-reported cancer did not use TCM at a higher rate. This warrants further research on
TCM utilization to identify reasons of use in this population and encourage
patient-centered care.
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Bao Y, Kwok C, Lee CF. Breast cancer screening behaviors among Chinese women in Mainland China. Nurs Health Sci 2018; 20:445-451. [PMID: 29920900 DOI: 10.1111/nhs.12533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 03/15/2018] [Accepted: 04/06/2018] [Indexed: 01/01/2023]
Abstract
In the present study, we reported on the current breast cancer screening rates among Chinese women in China and examined whether demographic factors and cultural beliefs were associated with their screening behavior. A cross-sectional survey was conducted with a convenience sample of 494 Chinese women who completed the modified Breast Cancer Screening Beliefs Questionnaire (BCSBQ). Two-sample t-tests and multivariable logistic regression were employed to analyze the data. The results indicated that participation in screening practices ranged from 27.5% for breast self-examination (BSE), 36.4% for clinical breast examination, 23.5% for mammography, and 40% for ultrasonography. Women who had previously engaged in one of the four screening practices had significantly higher scores on the three subscales of the modified BCSBQ. Being older and having a friend who had been diagnosed with breast cancer were shown to be predictors for BSE and participation in either mammography or ultrasonography, respectively. Education levels were also shown to be positively associated with the four screening measures. We suggest that cultural beliefs about breast cancer and screening practices play a significant role in Chinese women's screening behavior.
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Affiliation(s)
- Yingyi Bao
- School of Stomatology and Medicine, Foshan University, Foshan, China
| | - Cannas Kwok
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Chun Fan Lee
- School of Public Health, The University of Hong Kong, Hong Kong
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Yang L, Wang J, Cheng J, Wang Y, Lu W. Quality assurance target for community-based breast cancer screening in China: a model simulation. BMC Cancer 2018. [PMID: 29514679 PMCID: PMC5840933 DOI: 10.1186/s12885-018-4168-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to clarify the feasibility of a community-based screening strategy for breast cancer in Tianjin, China; to identify the factors that most significantly influenced its feasibility; and to identify the reference range for quality control. Methods A state-transition Markov model simulated a hypothetical cohort of 100,000 healthy women, the start aged was set at 35 years and the time horizon was set to 50 years. The primary outcome for the model was the incremental cost-utility ratio (ICUR), defined as the program’s cost per quality-adjusted life year (QALY) gained. Three screening strategies providing by community health service for women aged 35 to 69 years was compared regarding to different intervals. Result The probability of the ICUR being below 20 272USD (i.e., triple the annual gross domestic product [3 GDPs]) per QALY saved was 100% for annual screening strategy and screening every three years. Only when the attendance rate was > 50%, the probability for annual screening would be cost effective > 95%. The probability for the annual screening strategy being cost effective could reach to 95% for a willingness-to-pay (WTP) of 2 GDPs when the compliance rate for transfer was > 80%. When 10% stage I tumors were detected by screening, the probability of the annual screening strategy being cost effective would be up to 95% for a WTP > 3 GDPs. Conclusion Annual community-based breast cancer screening was cost effective for a WTP of 3 GDP based on the incidence of breast cancer in Tianjin, China. Measures are needed to ensure performance indicators to a desirable level for the cost-effectiveness of breast cancer screening. Electronic supplementary material The online version of this article (10.1186/s12885-018-4168-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lan Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.,Tianjin Binhai New Area Tanggu Center for Disease Control and Prevention, Tianjin, 300451, China
| | - Jing Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Juan Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.,Collaborative Innovation Center of Chronic disease prevention and control, Tianjin Medical University, Tianjin, 300070, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China. .,Collaborative Innovation Center of Chronic disease prevention and control, Tianjin Medical University, Tianjin, 300070, China.
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Wen D, Wen X, Yang Y, Chen Y, Wei L, He Y, Shan B. Urban rural disparity in female breast cancer incidence rate in China and the increasing trend in parallel with socioeconomic development and urbanization in a rural setting. Thorac Cancer 2018; 9:262-272. [PMID: 29280294 PMCID: PMC5792727 DOI: 10.1111/1759-7714.12575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Worldwide breast cancer incidence correlates with socioeconomic status and increases in parallel with westernization, however urban-rural disparity and trends have not been adequately investigated in China. METHODS The age standardized rate (ASR) of female breast cancer by population-based cancer registration was compared between urban Shijiazhuang city and rural Shexian County in relation to socioeconomic status. The increasing trend of breast cancer in Shexian County from 2000-2015 was examined using Joinpoint analysis and the correlation with gross domestic product (GDP) per capita was analyzed. RESULTS In 2012, the ASR of female breast cancer in Shijiazhuang was more than three times higher than in Shexian County (45.5/1 00 000 vs.13.8/1 00 000; P < 0.01) when the GDP per capita was 2.6 times higher (US$6964.80 vs. US$2700). In parallel with rapid socioeconomic development and urbanization, the biennial ASR of female breast cancer in Shexian county has increased significantly from 2.8/1 00 000 in 2000-2001 to 17.3/1 00 000 in 2014-2015, with an average biennial percent change of +10.2% (P < 0.01). The Pearson correlation between ASR and GDP was significantly positive (r = 0.94, P < 0.01). CONCLUSION The incidence of breast cancer in women in China is increasing along with lifestyle westernization and changing reproductive patterns associated with socioeconomic development and urbanization. Urgent prevention measures, including the development of a healthy diet, giving birth at a younger age, an increase in breastfeeding, limiting menopause estrogen therapy, and control of alcohol consumption, are required.
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Affiliation(s)
- Denggui Wen
- Cancer CenterFourth Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Xiaoduo Wen
- Cancer CenterFourth Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Yi Yang
- Department of Medical ImagingFourth Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Yuetong Chen
- Cancer CenterFourth Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Lizhen Wei
- Cancer CenterFourth Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Yutong He
- Cancer CenterFourth Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Baoen Shan
- Cancer CenterFourth Hospital of Hebei Medical UniversityShijiazhuangChina
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25
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Wang MY, Lin GZ, Li Y, Dong H, Liao YH, Liu HZ, Ren ZF. Knowledge, Attitudes, Preventive Practices and Screening Intention about Colorectal Cancer and the Related Factors among Residents in Guangzhou, China. Asian Pac J Cancer Prev 2017; 18:3217-3223. [PMID: 29281875 PMCID: PMC5980874 DOI: 10.22034/apjcp.2017.18.12.3217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: In Guangzhou, China, colorectal cancer (CRC) is the second most commonly diagnosed cancer.
The government initiated a CRC screening program in 2015, and investigating the knowledge, attitudes, and practices
toward CRC would help facilitate the participation of the program. Methods: A cross-sectional survey was conducted
from October 2014 to September 2015. Questionnaires were passed out with a cluster sample in 15 randomly selected
primary schools of Guangzhou China, and one of each student’s family members aged between 20 to 65 years old
were included. Results: A total of 6839 questionnaires were obtained and the successful response rate was 78.5%.
The majority (88.3%) of them were under 46 years old and female subjects accounted for 65.8%. Over 80% of the
respondents knew that CRC was able to be cured by early diagnosis and treatment and that tobacco use, alcohol abuse,
and dietary without enough fruits or vegetables may increase the risk of CRC, although a few knowledge scores were
relatively low, such as physical exercise as a protective factor and bowel habits change as a symptom suggestive of
CRC. In contrast, only 52.2% of the subjects were sure to participate in a future CRC screening provided by local
government. We further found that the higher level of knowledge about CRC risk and positive cancer preventive attitude
and practice were associated with higher education level, female gender, and positive family history. Conclusion: These
results suggested that the priority may be laid on improving the conversion from knowledge to practice to implement
screening program in Guangzhou, while efforts should also be made to improve public awareness about CRC.
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Affiliation(s)
- Min-Yi Wang
- Department of Statistics and Epidemiology,School of Public Health, Sun Yat-sen University, China.
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26
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Preliminary effectiveness of breast cancer screening among 1.22 million Chinese females and different cancer patterns between urban and rural women. Sci Rep 2016; 6:39459. [PMID: 27995968 PMCID: PMC5171648 DOI: 10.1038/srep39459] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
Abstract
To determine the preliminary effectiveness of breast cancer screening among Chinese females, 1226714 women aged 35–69 years first received clinical breast examinations. Urban women with suspected cancer received mammography followed by breast ultrasound (BUS), while rural suspected women underwent BUS followed by mammography. After one-year follow-up, 223 and 431 breast cancers were detected among urban and rural women (respectively), with overall detection rates of 0.56/1000 and 0.52/1000. Higher detection rates were significantly associated with older age at screening for both urban and rural women; additionally, urban women were at significantly higher risk if they had no job, no insurance, or were obese; additional risk factors specific to rural women included Han nationality, higher income, being unmarried, and having a family history of cancer (all P values < 0.05). Among screening-detected breast cancers in urban vs. rural women, 46.2% and 38.8% (respectively) were early stage, 62.5% and 66.3% were ≤2 centimeters, 38.0% and 47.3% included lymph-node involvement, and 14.0% and 6.0% were identified as carcinoma in situ. All abovementioned cancer characteristics were significantly better than clinic-detected cancers (all P values < 0.001). In conclusion, several important differences were found between urban and rural women in screening effectiveness and patterns of cancer distribution.
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27
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Li T, Mello-Thoms C, Brennan PC. Descriptive epidemiology of breast cancer in China: incidence, mortality, survival and prevalence. Breast Cancer Res Treat 2016; 159:395-406. [PMID: 27562585 DOI: 10.1007/s10549-016-3947-0] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/13/2016] [Indexed: 01/24/2023]
Abstract
Breast cancer is the most common neoplasm diagnosed amongst women worldwide and is the leading cause of female cancer death. However, breast cancer in China is not comprehensively understood compared with Westernised countries, although the 5-year prevalence statistics indicate that approximately 11 % of worldwide breast cancer occurs in China and that the incidence has increased rapidly in recent decades. This paper reviews the descriptive epidemiology of Chinese breast cancer in terms of incidence, mortality, survival and prevalence, and explores relevant factors such as age of manifestation and geographic locations. The statistics are compared with data from the Westernised world with particular emphasis on the United States and Australia. Potential causal agents responsible for differences in breast cancer epidemiology between Chinese and other populations are also explored. The need to minimise variability and discrepancies in methods of data acquisition, analysis and presentation is highlighted.
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Affiliation(s)
- Tong Li
- Medical Image Optimisation and Perception Group (MIOPeG), Department of Medical Imaging & Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Cumberland Campus, 75 East Street, Lidcombe, NSW, 2141, Australia.
| | - Claudia Mello-Thoms
- Medical Image Optimisation and Perception Group (MIOPeG), Department of Medical Imaging & Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Cumberland Campus, 75 East Street, Lidcombe, NSW, 2141, Australia
| | - Patrick C Brennan
- Medical Image Optimisation and Perception Group (MIOPeG), Department of Medical Imaging & Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Cumberland Campus, 75 East Street, Lidcombe, NSW, 2141, Australia
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28
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Sözmen K, Unal B, Sakarya S, Dinc G, Yardim N, Keskinkilic B, Ergör G. Determinants of Breast and Cervical Cancer Screening Uptake Among Women in Turkey. Asia Pac J Public Health 2016; 28:528-38. [DOI: 10.1177/1010539516654541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of the study was to assess the influence of sociodemographic characteristics on breast and cervical cancer screening among women 30 years and older in Turkey. We used data from the National Chronic Diseases and Risk Factors Survey conducted by the Ministry of Health in 2011. Multivariate logistic regression analysis was used to assess the association of sociodemographic factors, lifestyle variables, and cancer screening. Overall, 22.0% of women ever had a Pap smear test for cervical cancer screening and 19.0% ever had a mammography for breast cancer screening(n = 6846). Individuals with a university degree, social security, doing moderate physical activity, and consuming 5 portions of fruit or vegetable/day were more likely to receive Pap smear test and mammography. Residing in the eastern region and living in rural area was associated with lower likelihood of receiving both types of screening.
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Affiliation(s)
| | | | | | | | - Nazan Yardim
- Turkish Institute of Public Health, Ministry of Health, Ankara, Turkey
| | - Bekir Keskinkilic
- Turkish Institute of Public Health, Ministry of Health, Ankara, Turkey
| | - Gül Ergör
- Dokuz Eylul University, Izmir, Turkey
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29
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Huang Z, Wen W, Zheng Y, Gao YT, Wu C, Bao P, Wang C, Gu K, Peng P, Gong Y, Zhang M, Xiang Y, Zhong W, Jin F, Xiang YB, Shu XO, Beeghly-Fadiel A. Breast cancer incidence and mortality: trends over 40 years among women in Shanghai, China. Ann Oncol 2016; 27:1129-1134. [PMID: 27013394 PMCID: PMC4880061 DOI: 10.1093/annonc/mdw069] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/02/2015] [Accepted: 02/07/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breast cancer incidence rates are increasing among Asian women, likely due to the changes in risk factors caused by globalization. Trends in breast cancer rates among Chinese women may differ from other Asian regions due to the implementation of a nationwide family planning program and resulting changes in women's reproductive practices. Appraisal of cancer trends can direct cancer control and public health planning, but relevant studies in China are scarce due to a lack of long-term data. We sought to evaluate secular time trends in breast cancer incidence and mortality using 40 years of cancer registry data for women in urban Shanghai. MATERIALS AND METHODS Data on invasive breast cancer incidence and mortality were collected by the Shanghai Cancer Registry. Age-standardized rates (ASRs) for incidence and mortality were calculated using the Segi/Doll 1960 world standard population. Age, period, and birth cohort effects were evaluated using age-period-cohort (APC) Poisson regression models. Overall linear trends, interpreted as the estimated annual percentage change (EAPC), were derived from the net drift in age-drift models. RESULTS A total of 53 885 breast cancer cases and 17 235 breast cancer-specific deaths were documented among women in urban Shanghai between 1 January 1973 and 31 December 2012. Breast cancer incidence and mortality ASRs increased by 141.2% and 26.6%, respectively. Significant age, cohort, and period effects were identified in both incidence and mortality APC models; cohort effects were pronounced. Overall, a substantial increase in breast cancer incidence (EAPC = 2.96%/year) and a moderate increase in breast cancer mortality (EAPC = 0.87%/year) was observed. A notable downward trend in mortality was identified among younger women born after 1960. CONCLUSIONS Forty years of cancer registry data document a tremendous increase in incidence and a slight increase in mortality for breast cancer among women in Shanghai. Effective, appropriate, and affordable breast cancer prevention and control strategies are urgently needed in China.
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Affiliation(s)
- Z Huang
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - W Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA
| | - Y Zheng
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China.
| | - Y T Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai
| | - C Wu
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - P Bao
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - C Wang
- Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - K Gu
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - P Peng
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Y Gong
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - M Zhang
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Y Xiang
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - W Zhong
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - F Jin
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai
| | - Y B Xiang
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai
| | - X O Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA
| | - A Beeghly-Fadiel
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA
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Abstract
China is one of the largest and most populated countries in the world. It has undergone rapid economic growth in recent years. However, the development is not equitable, and the distribution of wealth significantly varies among the regions in China. Geographical and socioeconomic inequalities, together with the lack of an equitable national social support system, cause the high variance of health outcomes among the regions. Furthermore, the fast growth of the economy has evoked many environmental challenges and puts much pressure on the population. The severe environmental deterioration, especially of the atmosphere and water bodies, has affected the health of the people living in China. As a result, cancer has become a major public health issue, and an alarming increase in incidence and mortality has been reported. However, cancer incidence and mortality vary in different areas in China. Cancer and cancer treatment disparities have existed for years. This article will discuss the existing health and cancer disparities associated with the risk factors and how these disparities are managed in China.
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Affiliation(s)
- Qi Wang
- Department of Nursing, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jie Jiao
- Department of Nursing, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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31
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Feng R, Shen X, Chai J, Chen P, Cheng J, Liang H, Zhao T, Sha R, Li K, Wang D. Assessment and model guided cancer screening promotion by village doctors in China: a randomized controlled trial protocol. BMC Cancer 2015; 15:674. [PMID: 26458906 PMCID: PMC4603763 DOI: 10.1186/s12885-015-1688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/07/2015] [Indexed: 11/29/2022] Open
Abstract
Background Proven cost-effectiveness contrasted by low uptake of cancer screening (CS) calls for new methodologies promoting the service. Contemporary interventions in this regard relies primarily on strategies targeting general or specific groups with limited attention being paid to individualized approaches. This trial tests a novel package promoting CS utilization via continuous and tailored counseling delivered by primary caregivers. It aims at demonstrating that high risk individuals in the intervention arm will, compared to those in the delayed intervention condition, show increased use of CS service. Methods/Design The trial adopts a quasi-randomized controlled trial design and involves 2160 high risk individuals selected, via rapid and detailed risk assessments, from about 72,000 farmers aged 35+ in 36 administrative villages randomized into equal intervention and delayed intervention arms. The CS intervention package uses: a) village doctors and village clinics to deliver personalized and thus relatively sophisticated CS counseling; b) two-stage risk assessment models in identifying high risk individuals to focus the intervention on the most needed; c) standardized operation procedures to guide conduct of counseling; d) real-time effectiveness and quality monitoring to leverage continuous improvement; e) web-based electronic system to enable prioritizing complex determinants of CS uptake and tailoring counseling sessions to the changing needs of individual farmers. The intervention arm receives baseline and semiannual follow up evaluations plus CS counseling for 5 years; while the delayed intervention arm, only the same baseline and follow-up evaluations for the first 5 years and CS counseling starting from the 6th year if the intervention proved effective. Evaluation measures include: CS uptake by high risk farmers and changes in their knowledge, perceptions and self-efficacy about CS. Discussion Given the complexity and heterogeneity in the determinant system of individual CS service seeking behavior, personalized interventions may prove to be an effective strategy. The current trial distinguishes itself from previous ones in that it not only adopts a personalized strategy but also introduces a package of pragmatic solutions based on proven theories for tackling potential barriers and incorporating key success factors in a synergetic way toward low cost, effective and sustainable CS promotion. Trial registration ISRCTN33269053 Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1688-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rui Feng
- Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, Anhui, China.
| | - Xingrong Shen
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Jing Chai
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Penglai Chen
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Jing Cheng
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Han Liang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Ting Zhao
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Rui Sha
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Kaichun Li
- Luan Center for Disease Control and Prevention, Luan, Anhui, China.
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China. .,Collaboration Center for Cancer Control, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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32
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SONG XINGLI, REN YI, ZHANG JING, WANG GANG, HAN XUEDONG, ZHENG WEI, ZHEN LINLIN. Targeted delivery of doxorubicin to breast cancer cells by aptamer functionalized DOTAP/DOPE liposomes. Oncol Rep 2015; 34:1953-60. [DOI: 10.3892/or.2015.4136] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/06/2015] [Indexed: 11/06/2022] Open
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Wang B, He M, Chao A, Engelgau MM, Saraiya M, Wang L, Wang L. Cervical Cancer Screening Among Adult Women in China, 2010. Oncologist 2015; 20:627-34. [PMID: 25956407 PMCID: PMC4571778 DOI: 10.1634/theoncologist.2014-0303] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 02/06/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cervical cancer is one of the most commonly diagnosed cancers among women in China. The World Health Organization (WHO) recommends routine screening for cervical cancer, and the WHO Global Monitoring Framework suggests that every nation monitors cervical cancer screening. However, little information is available on cervical cancer screening behavior among women in China. METHODS We used data from the 2010 China Chronic Disease and Risk Factor Surveillance System that included 51,989 women aged 18 years and older. We report the proportion of women who reported ever having had a Papanicolaou (Pap) test, stratified by sociodemographic characteristics and geographic region. Multivariable logistic regression modeling was performed to adjust for potential confounders. RESULTS Overall, 21% of 51,989 women reported having ever had a Pap test. The highest proportion was reported among women aged 30-39 years (30.1%, 95% confidence interval, 26.8%-33.4%). In all geographic regions, women in rural areas were consistently less likely than women in urban areas to report having had a Pap test. Among women who reported ever having a Pap test, 82% reported having the most recent test in the past 3 years. Factors associated with reporting ever having a test were being aged 30-49 years, higher education, being married, and having urban health insurance. CONCLUSION Our results indicate that screening programs need to be strengthened along with a more intense focus on specific demographic groups. National cervical cancer screening guidelines and comprehensive implementation strategies are needed to make screening services available and accessible to all women. IMPLICATIONS FOR PRACTICE This study is the largest nationwide and population-based assessment of self-reported history of Pap test for cervical cancer screening in China. This article describes cervical cancer screening behavior among women and examines key demographic and geographic factors. Only one fifth of Chinese women reported having ever had a Pap test for cervical cancer screening. The results highlight the urgent need to develop national cervical cancer screening guidelines and strategies that make screening services widely available, accessible, and acceptable to all women, especially to those who reside in rural areas and those with no health insurance.
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Affiliation(s)
- Baohua Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Minfu He
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ann Chao
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael M Engelgau
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mona Saraiya
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China; Center for Global Health, U.S. National Cancer Institute, Rockville, Maryland, USA; Center for Global Health and Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Control and Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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34
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Fei X, Wu J, Kong Z, Christakos G. Urban-rural disparity of breast cancer and socioeconomic risk factors in China. PLoS One 2015; 10:e0117572. [PMID: 25688556 PMCID: PMC4331531 DOI: 10.1371/journal.pone.0117572] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/28/2014] [Indexed: 01/24/2023] Open
Abstract
Breast cancer is one of the most commonly diagnosed cancers worldwide. The primary aim of this work is the study of breast cancer disparity among Chinese women in urban vs. rural regions and its associations with socioeconomic factors. Data on breast cancer incidence were obtained from the Chinese cancer registry annual report (2005–2009). The ten socioeconomic factors considered in this study were obtained from the national population 2000 census and the Chinese city/county statistical yearbooks. Student’s T test was used to assess disparities of female breast cancer and socioeconomic factors in urban vs. rural regions. Pearson correlation and ordinary least squares (OLS) models were employed to analyze the relationships between socioeconomic factors and cancer incidence. It was found that the breast cancer incidence was significantly higher in urban than in rural regions. Moreover, in urban regions, breast cancer incidence remained relatively stable, whereas in rural regions it displayed an annual percentage change (APC) of 8.55. Among the various socioeconomic factors considered, breast cancer incidence exhibited higher positive correlations with population density, percentage of non-agriculture population, and second industry output. On the other hand, the incidence was negatively correlated with the percentage of population employed in primary industry. Overall, it was observed that higher socioeconomic status would lead to a higher breast cancer incidence in China. When studying breast cancer etiology, special attention should be paid to environmental pollutants, especially endocrine disruptors produced during industrial activities. Lastly, the present work’s findings strongly recommend giving high priority to the development of a systematic nationwide breast cancer screening program for women in China; with sufficient participation, mammography screening can considerably reduce mortality among women.
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Affiliation(s)
- Xufeng Fei
- College of Environment and Resource Sciences, Zhejiang University, Hangzhou, China
| | - Jiaping Wu
- Institute of Islands and Coastal Ecosystems, Zhejiang University, Hangzhou, China
- * E-mail:
| | - Zhe Kong
- College of Environment and Resource Sciences, Zhejiang University, Hangzhou, China
| | - George Christakos
- Institute of Islands and Coastal Ecosystems, Zhejiang University, Hangzhou, China
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35
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Liu S, Wang H, Zhang L, Tang C, Jones L, Ye H, Ban L, Wang A, Liu Z, Lou F, Zhang D, Sun H, Dong H, Zhang G, Dong Z, Guo B, Yan H, Yan C, Wang L, Su Z, Li Y, Huang XF, Chen SY, Zhou T. Rapid detection of genetic mutations in individual breast cancer patients by next-generation DNA sequencing. Hum Genomics 2015; 9:2. [PMID: 25757876 PMCID: PMC4348109 DOI: 10.1186/s40246-015-0024-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 01/18/2015] [Indexed: 12/18/2022] Open
Abstract
Breast cancer is the most common malignancy in women and the leading cause of cancer deaths in women worldwide. Breast cancers are heterogenous and exist in many different subtypes (luminal A, luminal B, triple negative, and human epidermal growth factor receptor 2 (HER2) overexpressing), and each subtype displays distinct characteristics, responses to treatment, and patient outcomes. In addition to varying immunohistochemical properties, each subtype contains a distinct gene mutation profile which has yet to be fully defined. Patient treatment is currently guided by hormone receptor status and HER2 expression, but accumulating evidence suggests that genetic mutations also influence drug responses and patient survival. Thus, identifying the unique gene mutation pattern in each breast cancer subtype will further improve personalized treatment and outcomes for breast cancer patients. In this study, we used the Ion Personal Genome Machine (PGM) and Ion Torrent AmpliSeq Cancer Panel to sequence 737 mutational hotspot regions from 45 cancer-related genes to identify genetic mutations in 80 breast cancer samples of various subtypes from Chinese patients. Analysis revealed frequent missense and combination mutations in PIK3CA and TP53, infrequent mutations in PTEN, and uncommon combination mutations in luminal-type cancers in other genes including BRAF, GNAS, IDH1, and KRAS. This study demonstrates the feasibility of using Ion Torrent sequencing technology to reliably detect gene mutations in a clinical setting in order to guide personalized drug treatments or combination therapies to ultimately target individual, breast cancer-specific mutations.
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Affiliation(s)
- Suqin Liu
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Hongjiang Wang
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Lizhi Zhang
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | | | - Lindsey Jones
- Norris Comprehensive Cancer Center, Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Hua Ye
- San Valley Biotechnology Incorporated, Beijing, China.
| | - Liying Ban
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Aman Wang
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Zhiyuan Liu
- San Valley Biotechnology Incorporated, Beijing, China.
| | - Feng Lou
- San Valley Biotechnology Incorporated, Beijing, China.
| | - Dandan Zhang
- San Valley Biotechnology Incorporated, Beijing, China.
| | - Hong Sun
- San Valley Biotechnology Incorporated, Beijing, China.
| | - Haichao Dong
- San Valley Biotechnology Incorporated, Beijing, China.
| | | | - Zhishou Dong
- San Valley Biotechnology Incorporated, Beijing, China.
| | - Baishuai Guo
- San Valley Biotechnology Incorporated, Beijing, China.
| | - He Yan
- San Valley Biotechnology Incorporated, Beijing, China.
| | - Chaowei Yan
- San Valley Biotechnology Incorporated, Beijing, China.
| | - Lu Wang
- San Valley Biotechnology Incorporated, Beijing, China.
| | - Ziyi Su
- San Valley Biotechnology Incorporated, Beijing, China.
| | - Yangyang Li
- San Valley Biotechnology Incorporated, Beijing, China.
| | - Xue F Huang
- Norris Comprehensive Cancer Center, Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Si-Yi Chen
- Norris Comprehensive Cancer Center, Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Tao Zhou
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
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36
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Fox JB, Shaw FE. Clinical Preventive Services Coverage and the Affordable Care Act. Am J Public Health 2015; 105:e7-e10. [PMID: 25393173 DOI: 10.2105/ajph.2014.302289] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Affordable Care Act requires many health plans to provide coverage for certain recommended clinical preventive services without charging copays or deductible payments. This provision could lead to greater uptake of many services that can improve health and save lives. Although the coverage provision is broad, there are many caveats that also apply. It is important for providers and public health professionals to understand the nuances of the coverage rules to help maximize their potential to improve population health.
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Affiliation(s)
- Jared B Fox
- Jared B. Fox and Frederic E. Shaw are with the Office of the Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, GA
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37
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Simon MA, Li Y, Dong X. Preventive care service usage among Chinese older adults in the Greater Chicago area. J Gerontol A Biol Sci Med Sci 2014; 69 Suppl 2:S7-14. [PMID: 25378452 PMCID: PMC4453748 DOI: 10.1093/gerona/glu143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Preventive care is important for reducing morbidity and mortality among the elderly, but racial/ethnic disparities exist in use of preventive care services. We aimed to develop a better understanding of preventive care service utilization among Chinese older adults in the Greater Chicago area. METHODS We used data collected from the Population Study of Chinese Elderly in Chicago study, a population-based survey of 3,159 community-dwelling Chinese older adults in the Greater Chicago area. Preventive care services assessed include use of flu, pneumonia, and hepatitis B vaccines as well as colon, breast, cervical and prostate cancer screening. We also examined sociodemographic, health and quality of life correlates for preventive care service use. RESULTS We found that although Chinese older adults had lower utilization rates for the pneumonia vaccine and cancer screening, their utilization of the flu shot was consistent with national utilization rates. No sociodemographic, self-reported health, or quality of life characteristics were associated with all nine of the preventive care services. CONCLUSION Use of preventive care services except flu vaccination was low among Chinese older adults in the Greater Chicago area. However, future longitudinal studies may be necessary to further elucidate preventive care service utilization patterns among Chinese older adults.
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Affiliation(s)
| | - Yu Li
- Northwestern University Medical Center, Chicago, Illinois
| | - XinQi Dong
- Rush University Medical Center, Chicago, Illinois
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38
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Abstract
Standard treatment options for breast cancer include surgery, chemotherapy, radiation, and targeted therapies, such as adjuvant hormonal therapy and monoclonal antibodies. Recently, the recognition that chronic inflammation in the tumor microenvironment promotes tumor growth and survival during different stages of breast cancer development has led to the development of novel immunotherapies. Several immunotherapeutic strategies have been studied both preclinically and clinically and already have been shown to enhance the efficacy of conventional treatment modalities. Therefore, therapies targeting the immune system may represent a promising next-generation approach for the treatment of breast cancers. This review will discuss recent findings that elucidate the roles of suppressive immune cells and proinflammatory cytokines and chemokines in the tumor-promoting microenvironment, and the most current immunotherapeutic strategies in breast cancer.
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Affiliation(s)
- Xinguo Jiang
- Department of Medicine, VA Palo Alto Health Care System/Stanford University School of Medicine, Stanford, CA 94305, USA
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39
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Moore MA. Cancer control programs in East Asia: evidence from the international literature. J Prev Med Public Health 2014; 47:183-200. [PMID: 25139165 PMCID: PMC4162122 DOI: 10.3961/jpmph.2014.47.4.183] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/23/2014] [Indexed: 12/31/2022] Open
Abstract
Cancer is a major cause of mortality and morbidity throughout the world, including the countries of North-East and South-East Asia. Assessment of burden through cancer registration, determination of risk and protective factors, early detection and screening, clinical practice, interventions for example in vaccination, tobacco cessation efforts and palliative care all should be included in comprehensive cancer control programs. The degree to which this is possible naturally depends on the resources available at local, national and international levels. The present review concerns elements of cancer control programs established in China, Taiwan, Korea, and Japan in North-East Asia, Viet Nam, Thailand, Malaysia, and Indonesia as representative larger countries of South-East Asia for comparison, using the published literature as a guide. While major advances have been made, there are still areas which need more attention, especially in South-East Asia, and international cooperation is essential if standard guidelines are to be generated to allow effective cancer control efforts throughout the Far East. Cancer is a major cause of mortality and morbidity throughout the world, including the countries of North-East and South-East Asia. Assessment of burden through cancer registration, determination of risk and protective factors, early detection and screening, clinical practice, interventions for example in vaccination, tobacco cessation efforts and palliative care all should be included in comprehensive cancer control programs. The degree to which this is possible naturally depends on the resources available at local, national and international levels. The present review concerns elements of cancer control programs established in China, Taiwan, Korea, and Japan in North-East Asia, Viet Nam, Thailand, Malaysia, and Indonesia as representative larger countries of South-East Asia for comparison, using the published literature as a guide. While major advances have been made, there are still areas which need more attention, especially in South-East Asia, and international cooperation is essential if standard guidelines are to be generated to allow effective cancer control efforts throughout the Far East.
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Affiliation(s)
- Malcolm A. Moore
- Chief Editor, Asian Pacific Journal of Cancer Prevention, Bangkok, Thailand
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