Risk factors for breast cancer among Chinese women: a 10-year nationwide multicenter cross-sectional study.

BACKGROUND: The characteristics of established risk factors for breast cancer may vary among countries. A better understanding of local characteristics of risk factors may help in devising effective prevention strategies for breast cancer. METHODS: Information on exposures to risk factors was collected from the medical charts of 4211 women with breast cancer diagnosed during 1999-2008. The distributions of these exposures among regions, and by menopausal status and birth period, were compared with the χ(2) test. Crude associations between the selected factors and breast cancer were estimated using the cases in the present study and a representative control population, which was selected from qualified published studies. RESULTS: As compared with cases from less developed regions, those from more developed regions were significantly more likely to be nulliparous, had fewer childbirths (P < 0.05), and were less likely to have breastfed (P = 0.08). As compared with premenopausal cases, postmenopausal cases were more likely to be overweight and to have breastfed and had more childbirths (P < 0.05). The number of live births and rate of breastfeeding decreased in relation to birth period (P for trends <0.001). Overweight, late menopause, and family history of breast cancer were significantly associated with breast cancer among Chinese women. CONCLUSIONS: Breast cancer incidence was associated with nulliparity and history of breastfeeding. Population attributable risks should be assessed, especially for more developed areas and young women. The effects of body mass index, age at menopause, and family history of breast cancer should be given priority during assessment of breast cancer risk among Chinese women.

Application of intraoperative frozen section examination in the management of female breast cancer in China: a nationwide, multicenter 10-year epidemiological study.

BACKGROUND: Intraoperative frozen section examination (IFSE) during breast cancer surgery can partly reflect the status of surgical treatment since the surgical method used directly determines the purpose of IFSE use in disease management. This study aims to investigate the application of, changing trends in, and factors influencing IFSE in the management of female breast cancer in China. METHODS: We collected the sociodemographic and clinical data of 4,211 breast cancer patients between 1999 and 2008 and statistically analyzed these data using χ2 or Fisher's exact tests. RESULTS: A total of 2,283 (54.22%) patients with breast cancer underwent IFSE. During the 10-year study period, IFSE use was associated with an increase in the number of sentinel lymph node biopsies (SLNB) and breast-conserving surgeries (BS) performed, with significant regional differences noted in this trend (P < 0.05). Patients' education, occupation, age, tumor size estimated by preoperative palpation, and the use of imaging examinations affected the purpose of IFSE use (P < 0.05). CONCLUSIONS: Our results show that the purpose of IFSE in the surgical treatment of breast cancer in China is gradually approaching that in developed countries. We believe that policymakers must address the differences in breast cancer treatment based on the socioeconomic status of patients. Lastly, the use of IFSE for determining tumor characteristics should be avoided as far as possible, and patient education and breast cancer screening programs tailored to the Chinese population should be established. Our findings may guide the formulation of breast cancer control strategies in China and other low-income countries.

Breast cancer stage at diagnosis and area-based socioeconomic status: a multicenter 10-year retrospective clinical epidemiological study in China.

BACKGROUND: Although socioeconomic status (SES) has been focused on as a key determinant of cancer stage at diagosis in western countries, there has been no systemic study on the relationship of SES and breast cancer stage at diagnosis in China. METHODS: The medical charts of 4,211 eligible breast cancer patients from 7 areas across China who were diagnosed between 1999 and 2008 were reviewed. Four area-based socioeconomic indicators were used to calculate area-based SES by cluster analysis. The associations between area-based SES and stage at diagnosis were analyzed by trend chi-square tests. Binary logistic regression was performed to estimate odds ratios for individual demographic characteristics' effects on cancer stages, stratified by area-based SES. RESULTS: The individual demographic and pathologic characteristics of breast cancer cases were significantly different among the seven areas studied. More breast cancer cases in low SES areas (25.5%) were diagnosed later (stages III & IV) than those in high (20.4%) or highest (14.8%) SES areas (χ² for trend = 80.79, P < 0.001). When area-based SES is controlled for, in high SES areas, cases with less education were more likely to be diagnosed at later stages compared with more educated cases. In low SES areas, working women appeared to be diagnosed at earlier breast cancer stages than were homemakers (OR: 0.18-0.26). CONCLUSIONS: In China, women in low SES areas are more likely to be diagnosed at later breast cancer stages than those in high SES areas.

[10-year changes and development of surgical treatment for breast cancer in China].

OBJECTIVE: To investigate the changes and development of surgical treatment for breast cancer from 1999 to 2008 in China, and compare the differences between the surgical methods used in high-resource and low-resource areas. METHODS: Clinicopathological data of surgical treatment for female primary breast cancer was collected via medical chart review at hospitals in seven geographic areas in China. Chi-square test and chisqure test for linear trends were used to analyze the changes and development of the surgical methods used for breast cancer in the 10 years. RESULTS: A total of 4211 primary breast cancer patients were selected from the 10-year database, including 4078 women (97.5%) treated by surgical operation. Among 3271 women (80.21%) treated with modified radical mastectomy, the surgical rate was rising from 68.89% in 1999 to 80.17% in 2008, ascending by 11.28% (χ(2) = 31.143, P < 0.001). In high-resource areas, the surgical rate of modified radical mastectomy was rising from 45.64% in 1999 to 76.13% in 2008, ascending by 30.49% (χ(2) = 89.393, P < 0.001), while in low-resource areas it kept a steady rate at 80% in the ten years (χ(2) = 2.113,P = 0.146). Among 231 women (5.66%) treated with breast-conserving surgery, the surgical rate was rising from 1.29% in 1999 to 11.57% in 2008, ascending by 10.28% (χ(2) = 102.835, P < 0.001). In high-resource areas, the surgical rate of breast-conserving surgery was rising from 2.68% in 1999 to 16.87% in 2008, ascending by 14.19% (χ(2) = 69.544, P < 0.001), while in low-resource areas it was rising from 0.42% in 1999 to 6.22% in 2008, ascending by 5.80% (χ(2) = 30.003, P < 0.001). Among 469 women (11.50%) treated with Halsted radical mastectomy, the surgical rate was declining from 28.28% in 1999 to 4.96% in 2008, descending by 23.32% (χ(2) = 206.202, P < 0.001). In high-resource areas, the surgical rate of Halsted radical mastectomy was declining from 50.34% in 1999 to 3.29% in 2008, descending by 47.05% (χ(2) = 274.830, P < 0.001), while in low-resource areas it was declining from 14.58% in 1999 to 6.64% in 2008, descending by 7.94% (χ(2) = 8.166, P = 0.004). Among 3786 women treated with breast mastectomy (including modified radical mastectomy and Halsted radical mastectomy), the surgical rate was declining from 98.46% in 1999 to 86.36% in 2008, descending by 12.10% (χ(2) = 95.744, P < 0.001). In high-resource areas, the surgical rate of breast mastectomy was declining from 96.64% in 1999 to 80.66% in 2008, descending by 15.98% (χ(2) = 53.446, P < 0.001), while in low-resource areas it was declining from 99.58% in 1999 to 92.12% in 2008, descending by 7.46% (χ(2) = 36.758,P < 0.001). CONCLUSIONS: The main primary surgical treatment for breast cancer is modified radical mastectomy during the period 1999 - 2008. Halsted radical mastectomy is gradually replaced by modified radical mastectomy and breast-conserving surgery. The rate of changes for breast-conserving surgery and mastectomy is higher in high-resource areas than that in low-resource areas. Breast-conserving surgery will become the main treatment for early-stage breast cancer.

A nation-wide multicenter 10-year (1999-2008) retrospective clinical epidemiological study of female breast cancer in China.

BACKGROUND: According to the very limited cancer registry, incidence and mortality rates for female breast cancer in China are regarded to be increasing especially in the metropolitan areas. Representative data on the breast cancer profile of Chinese women and its time trend over years are relatively rare. The aims of the current study are to illustrate the breast cancer profile of Chinese women in time span and to explore the current treatment approaches to female breast cancer. METHODS: This was a hospital-based nation-wide and multi-center retrospective study of female primary breast cancer cases. China was divided into 7 regions according to the geographic distribution; from each region, one tertiary hospital was selected. With the exception of January and February, one month was randomly selected to represent each year from year 1999 to 2008 at every hospital. All inpatient cases within the selected month were reviewed and related information was collected based on the designed case report form (CRF). The Cancer Hospital/Institute, Chinese Academy of Medical Sciences (CICAMS) was the leading hospital in this study. RESULTS: Four-thousand two-hundred and eleven cases were randomly selected from the total pool of 45,200 patients and were included in the analysis. The mean age at diagnosis was 48.7 years (s.d. = 10.5 yrs) and breast cancer peaked in age group 40-49 yrs (38.6%). The most common subtype was infiltrating ductal carcinoma (86.5%). Clinical stage I & II accounted for 60.6% of 4,211 patients. Three-thousand five-hundred and thirty-four cases had estrogen receptor (ER) and progestin receptor (PR) tests, among them, 47.9% were positive for both. Two-thousand eight-hundred and forty-nine cases had human epidermal growth factor receptor 2(HER-2) tests, 25.8% of them were HER-2 positive. Among all treatment options, surgery (96.9% (4,078/4,211)) was predominant, followed by chemotherapy (81.4% (3,428/4,211). Much less patients underwent radiotherapy (22.6% (952/4,211)) and endocrine therapy (38.0% (1,599/4,211)). CONCLUSIONS: The younger age of breast cancer onset among Chinese women and more advanced tumor stages pose a great challenge. Adjuvant therapy, especially radiotherapy and endocrine therapy are of great unmet needs.

[Comparison of touch imprint cytology of core needle biopsy and section histopathology in breast cancer diagnosis].

OBJECTIVE: To evaluate the sensitivity, specificity of touch imprint cytology (TIC), and to compare its conformity rate with histopathology, to observe the consistence of immunocytochemistry (ICC) with immunohistochemistry (IHC), and to assess the diagnostic value of TIC prior to neoadjuvant chemotherapy for breast cancer. METHODS: 289 cases of TIC and 287 cases with core needle biopsy (CNB) histopathology accumulated from October 2005 to October 2008 in our hospital were included in this study. One hundred ninety cases TIC results were compared with that of final histopathology. 64 cases were tested for ER, PR, HER-2 by immunocytochemistry. RESULTS: Twenty-four benign cases and 263 malignant cases were diagnosed. 4 specimens were unsatisfactory. False negative rate and unsatisfactory rate were 1.4%, both, and false positive rate was 0.35%. The accuracy rate of TIC and CNB was 95.8% and 95.3%, respectively (P = 0.804). The sensitivity of TIC and CNB was 96.2% and 95.0% (P = 0.601), specificity 87.5% and 100% (P = 0.471) were found, when compared with the results of routine histopathology. 52 cases had a control with IHC of CNB in 64 ICC, and 43 cases had a final histopathology IHC. The ICC conformity rate of ER, PR, HER-2 with IHC of CNB was 86.5%, 75.0%, 78.8%, and that with IHC of final histopathology was 88.4%, 74.4%, 75.6%, respectively. The conformity rate of IHC between CNB and final histopathology was 83.7%, 74.4%, 76.5%, respectively. There was no significant statistical difference between them. CONCLUSION: Compared with routine CNB histopathology, TIC has a high accuracy and sensitivity, and can provide a rapid and reliable cytological diagnosis to complement CNB for breast lesions. The conformity rates are high in ER, PR, HER-2 expression between ICC and IHC. ICC of TIC can be used to determine the estrogen and progesterone receptor levels in breast cancer before neoadjuvant chemotherapy.

[Clinical characteristics and survival in the operable breast cancer patients with different molecular subtypes].

OBJECTIVE: According to the immunohistochemical (IHC) test of ER, PR and HER-2, breast cancer can be divided into 4 different molecular subtypes: Luminal A subtype (ER or PR positive and HER-2 negative), Luminal B subtype (ER or PR positive and HER-2 positive), HER-2 subtype (ER and PR negative, HER-2 positive) and Basal-like subtype (ER, PR and HER-2 negative). This study was to analyze the clinical features of different breast cancer subtypes, and try to find the evidence of combined and individualized treatment for patients with breast cancer. METHODS: The data of 408 surgically treated breast cancer patients in the Cancer Hospital of Chinese Academy of Medical Sciences from January 1, 2002 to December 31, 2002 were collected and retrospectively analyzed. The clinicopathological features and recurrence, metastasis as well as survival of these four subtypes were compared. RESULTS: Of the 408 cases, Luminal A subtype accounted for 60.8% (248/408), Luminal B subtype 7.8% (32/408), HER-2 subtype 12.5% (51/408), and Basal-like subtype 18.9% (77/408). Basal-like subtype had less lymph node metastases than other subtypes (P<0.05). HER-2 subtypes consisted of less patients aged 45 years or younger than other subtypes (P<0.05). Luminal B subtype contained less advanced cases than other subtypes (P<0.01). By August 2008, the median time of follow-up was 64 months (range, 3-79 months). Fifty-eight cases presented local recurrence or metastasis, and 51 of them died of the disease. The 5-year overall survival rates (OS) for patients with Luminal A, Luminal B, Basal-like and HER-2 subtype were 89.83%, 86.15%, 79.85% and 86.70% , respectively. The 5-year disease-free survival (DFS) rates of the four subtypes were 83.52%, 68.88%, 71.66% and 75.83%, respectively. The rate of local recurrence or metastasis in Luminal A subtype was significantly lower than that in Luminal B and Basal-like subtypes (P<0.05). The DFS time in Luminal B subtype was shorter than that in Luminal A subtype (P=0.0481). The OS and DFS time in Basal-like subtype were all shorter than that in Luminal A subtype (P=0.0077 and P=0.0306, respectively). CONCLUSION: The distribution of each subtype in Chinese breast cancer patients is similar to that in European and American breast cancer patients. Luminal A is the most common subtype in Chinese breast cancer patients, and has a good prognosis. While Basal-like and Luminal B subtype have a poor prognosis.

[Clinicopathological characteristics and prognosis of patients with breast cancer over 65 years of age].

OBJECTIVE: To study clinicopathological characteristics and prognosis of elderly women with breast cancer. METHODS: The data of 399 patients with breast cancer over 65 years of age was analyzed retrospectively in the Cancer Hospital of Chinese Academy of Medical Sciences from January 1989 to December 2003. RESULTS: Curative resection was performed for all patients, including modified radical mastectomy 277 (69.4%), radical mastectomy 12 (3.0%), breast-conserving therapy 59 (15.8%), mammectomy 24 (6.0%), breast segmentectomy 25 (6.3%) and breast segmentectomy with sentinel node biopsy 2 (0.5%). Major pathological type was invasive ductal carcinoma (337/399, 85.5%). The positive rates of estrogen receptor (ER) and progesterone receptor (PR) were 71.4% and 69.6%, respectively. The overall 5-and 10- year survival rates were 78.9% and 56.3%, respectively. Univariate analysis showed that ER status, PR status, T stage, lymph node status and histological grade were significant statistically (P < 0.05). The multivariate analysis showed ER status, lymph node status and histological grade were the independent prognostic factors. CONCLUSION: Elderly women with breast cancer should be given multimodality therapy. Surgery and endocrine therapy are crucial, but the surgical style should be individuation. ER status, lymph node status and histological grade were the independent prognostic factors.

[Clinical characteristics comparison between triple-negative and non-triple-negative breast cancer].

OBJECTIVE: To compare the clinical characteristics of triple-negative (TN) breast cancer and non-triple-negative (NTN) breast cancer, enrich the information of TN patients, and provide evidences for individualized combined treatment. METHODS: The data of 408 cases received operation in the year of 2002 was enrolled in this study. TN patients were confirmed according to the immunohistochemical (IHC) test of estrogen receptor (ER), progesterone receptor (PR) and HER-2/neu. The clinical characteristics, recurrence, metastasis and survival were compared between the two groups. RESULTS: Seventy-seven patients (18.9%) were confirmed TN cases. The median follow-up was 64 months (range, 3-79 months). Of all the cases, 58 occurred local recurrence or metastasis and 51 died, it was 19 and 12 in TN group. Compared with the NTN group, the TN patient tended to be younger and the tumor mass larger (P=0.015 and 0.011). However, axillary lymph nodes metastasis occurred more often in NTN patients than in TN patients (P=0.001). The rate of local recurrence and metastasis in TN group was significantly higher than in NTN group (P=0.005 and 0.025), and TN cases were more likely to develop lung metastasis than NTN patients (P<0.01). The 3-year and 5-year overall survival rate in TN group were significantly lower than in NTN group (86.4% vs. 93.4%, P=0.0205; 77.7% vs. 87.9%, P=0.0215). The 3-year and 5-year disease-free survival rate in TN group were also significantly lower than in NTN group (78.4% vs. 92.4%, P=0.0038; 72.8% vs. 85.8%, P=0.0041). Tumor size, lymph node status and triple-negative were the most important factors influencing the prognosis on multivariate Cox regression analysis. CONCLUSIONS: TN breast cancer haa some specific clinical characteristics. The prognosis of TN patients is worse than that of NTN patients. Further study is needed to find individualized treatment for TN breast cancer patients.

[A comparison of localization by ductoscopy-guided wire and conventional methods in terminal duct excision for women with pathological nipple discharge].

OBJECTIVE: To evaluate and compare localization by ductoscopy-guided wire with localization by conventional methods in the terminal duct excision for women with pathological nipple discharge. METHODS: Breast terminal duct excision were performed in 174 consecutive patients with intraductal lesions diagnosed by mammary ductoscopy. Sixty-eight of those underwent ductoscopy-guided wire localization for more accurate ductal excision. The patients received mammary ductoscopy and a hooked wire was anchored at the intraductal lesions under endoscopic surveillance just before the operation. Then a biopsy resection of wire-guided terminal duct and frozen section were done. Tbe other 106 patients received terminal duct excision under localization with conventional methods without ductoscopy either by puncturing a needle or injection of blue dye through the duct with pathological discharge. RESULTS: Of the 68 patients with ductoscopy-guided duct excision, 64 had intraductal papillomas and 4 duct carcinoma in situ proved by pathology. All the lesions in these 68 patients were completely resected during biopsy without extra extended resection, and the concordance rate of the pathological result with ductoscopic diagnosis was 100.0%. None of them developed a postoperative breast distortion. In the conventional method localization group, there were 96 intraductal papilloma, 6 duct carcinoma in situ and 4 adenosis. Only 77.4% of the lesions were excised in the primary biopsy, and 22.6% needed extended resection. The concordance rate of the pathological diagnosis with ductoscopic diagnosis was 96.2%. Twenty-six patients had a deformed breast postoperatively. CONCLUSION: Ductoscopy-guided wire localization is superior to the conventional localization method in the surgical terminal duct excision for women with spontaneous nipple discharge. It is not only helpful for more accurate localization and resection as well as pathologic sampling, but also is minimally invasive. Further studies are still required and this method may deserve to be popularized.

[The clinical detection of breast cancer by spectrum method].

Breast cancer is one of the most frequently encountered malignant tumors of women. Early detection can save lives successfully. A safe, effective detection method is needed. The detection of breast cancer based on the laser-tissue interactions is an international research focus. The prototype of the detection system in the authors' lab uses a 780 nm low frequency modulated laser to penetrate breast tissue. Two-dimensional scan is processed under the control of computer. A photomultiplier tube (PMT) is used to get the penetrated light and convert it to electrical signal. The signal of light intensity is sampled by the system and used to get the near infrared penetrating image of breast after data processing. In the present paper the signal processing method is discussed and the data processing results in the lab experiments are given. Clinical trials were carried out in the Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, using NIR (near infrared light) breast scanner developed by the authors' lab. The investigations were performed after approval by the ethic committee of Cancer Institute and Hospital, Chinese Academy of Medical Sciences. Written informed consent was obtained from each subject. None of the patients' names, initials, or hospital numbers was used in this paper. Fifty patients underwent the examination. Thirty four of them were malignant, and 13 were benign. The other 3 lacked pathology results. Analysis and comparison were executed to evaluate the result. NIR images, mammographs, and the ultrasound images were compared with both the pathology results and each other. The accuracy percentage of NIR image reaches 72.5%, which is between the accuracy percentage of ultrasound (77.50%) and that of mammography (71.88%). In this paper, the characteristics of different breast diseases were found in NIR images, which offers criterion for NIR diagnosis method in detail. The typical NIR images of different diseases, such as papillomatosis with local cancer and cancer, were shown. The clinical trial verified the validity of tumor diagnosis with the special absorption of NIR light by hemoglobin. Both the position and the benign/malignant property of tumor can be detected by NIR method. The improving aspects of the prototype were proposed. A new approach was put forward to the optical method.

[Detection of micrometastases in sentinel lymph nodes of breast cancer].

OBJECTIVE: To investigate an optimal examination method to detect micrometastases in sentinel lymph nodes (SLNs) of breast cancer. METHODS: Firstly, the SLNs of breast cancer were found by 99mTc-DX isotope method. Secondly, all the SLNs which were negative by routine HE examination were serially sectioned at a 100 microm interval and stained by both HE and immunohistochemistry for detecting micrometastases. All tumor tissue paraffin blocks were also sectioned and stained with HE and immunohistochemistry as control. RESULTS: Totally, 121 SLNs and 44 tumors of 59 patients were examined. Micrometastasis was found to be positive in 17 SLNs (14.0%) of 14 patients (23.7%). When examined number of sections was increased from one to three, more positive micrometastatic SLNs were detected by HE staining only (3, 7, 10 for 1, 2, 3 sections, respectively). When HE staining was combined with immunohistochemical staining for AE1/3 or CK19 or muc1, much more positive micrometastatic SLNs were found (14, 12, 16 for 1, 2, 3 sections, respectively). The more sections were examined, the more micrometastases in SLNs were found. Furthermore, micrometastasis was also found to be positively correlated with the tumor size and the expression of c-erbB2, MMP-2, VEGF. The larger the tumor size was or the stronger expression of the above mentioned biomarkers, the more micrometastases in SLNs could be found. CONCLUSION: Serially sections at a 100 microm interval and staining with both HE and immunohistochemical technique using muc1 antibody may be the best way to detect micrometastases in sentinel lymph nodes in breast cancer patients.

A nomogram to predict the probability of axillary lymph node metastasis in female patients with breast cancer in China: A nationwide, multicenter, 10-year epidemiological study.

Axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) alone may lead to postoperative complications. Among patients with positive ALN in the preoperative examination, approximately 40% patients do not have SLN metastasis. Herein, we aimed to develop a model to predict the probability of ALN metastasis as a preoperative tool to support clinical decision-making. We retrospectively analyzed the clinicopathological features of 4211 female patients with breast cancer who were diagnosed in seven breast cancer centers representing entire China, over 10 years (1999-2008). The patients were randomly categorized into a training cohort or validation cohort (3:1 ratio). Multivariate logistic regression analysis was performed for 1869 patients with complete information on the study variables. Age at diagnosis, tumor size, tumor quadrant, clinical nodal status, local invasion status, pathological type, and molecular subtypes were the independent predictors of ALN metastasis. The nomogram was then developed using the seven variables. Further, it was subsequently validated in 642 patients with complete data on variables in the validation cohort. Coefficient of determination (R²) and the area under the receiver-operating characteristic (ROC) curve (AUC) were calculated to be 0.979 and 0.7007, showing good calibration and discrimination of the model, respectively. The false-negative rates of the nomogram were 0 and 6.9% for the predicted risk cut-off values of 14.03% and 20%, respectively. Therefore, when the predicted risk is less than 20%, SLNB may be avoided. After further validation in various patient populations, this model may support increasingly limited axillary surgery in breast cancer.

Influence of occupation and education level on breast cancer stage at diagnosis, and treatment options in China: A nationwide, multicenter 10-year epidemiological study.

The objective of this study was to evaluate the impact of occupation and education level of Chinese female breast cancer patients on their cancer staging at diagnosis, clinical and pathological features, rate of implementation, and selection of treatment.The medical charts of 4211 confirmed female breast cancer cases diagnosed between 1999 and 2008, from 7 breast cancer centers spread across the whole of China, were reviewed. Data including information on the patient's sociodemographic status, clinical and pathological characteristics, implementation of clinical examination and treatment modalities were analyzed. In parallel, the associations between different occupations and level of educational attainment were analyzed in relation to tumor stage through TNM staging, clinical and pathological characteristics, implementation of clinical examination, and treatment patterns. Multivariate logistic regression was used to identify whether the occupation and education level of patients are independent factors of TNM staging at diagnosis.There were significant differences among different occupation groups and the education level of patients in regards to pathological characteristics and treatment choice. Both the occupation and education level of patients were independent factors of TNM staging at diagnosis. For patients within the lower-income occupation or lower educational attainment group, the tumor stage was later, the rates of implementation of relevant investigations were lower, as were the rates of radiotherapy, chemotherapy, and endocrine therapy.This study suggests that strategies should work toward developing more accurate and effective breast cancer prevention and treatment strategies aimed specifically at patients with lower educational attainment levels and at specific occupation groups.

[A prospective multicenter clinical trial of breast conserving therapy for early breast cancer in China].

OBJECTIVE: To demonstrate the feasibility of breast conserving therapy (BCT) and establish a multimodality BCT model for early breast cancer in China. METHODS: A prospective multicenter case control study consisting of 4461 patients was carried out by the Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and nine other hospitals across China from November, 2001 to November, 2004, the result of BCT and mastectomy on early stage breast cancer were compared. Patients entry-primary tumor < or = 3 cm, primary tumor in periphery quadrant, pathology showed infiltrating carcinoma and clinical absence of locoregional lymphatic or distant metastasis. Patients rejection-multiple center cancer or diffused malignant calcified spots, previous radical radiation therapy in the chest, accompanying collogenolytic vascular granuloma and simultaneous pregnancy. RESULTS: Of these 4461 patients, breast conserving surgery was performed in 872 (19.5%) patients who were eligible for BCT, accounting for 9.0% of all operated breast cancer patients during the same period. The rates of local recurrence, metastasis and death were 1.0% (9/872), 1.3% (11/872) and 0.1% (1/872) in BCT group, versus 0.5% (18/3589), 1.4% (49/3589) and 0.1% (4/3589) in the mastectomy group. No statistical significant difference was found between these two groups (P > 0.05). Cosmetic evaluation of breast in BCT group was carried out postoperatively at points of six months, one year and two years with 89.7%, 91.1% and 86.6% of the patients assessed as excellent or fine cosmetic state respectively. CONCLUSION: Breast conserving therapy for early stage breast cancer is feasible in China, with no ominous effect on the survival and recurrence rate. Breast conserving therapy is able to improve not only the quality of life but also enhance the confidence of the patients, in addition to quasi-perfect cosmetic results. Standard comprehensive BCT involving multi-centers all concentrating on combination treatment should be widely adopted in China in the future. However, breast conserving surgery should selectively be used only for early stage breast cancer, and should be combined with postoperative radiotherapy, chemotherapy and hormone therapy in order to guarantee success.

[Bilateral primary breast cancer: a report of 217 cases].

OBJECTIVE: To report the clinical and pathological characteristics of bilateral primary breast cancer (BPBC) in comparison with unilateral primary breast cancer (UPBC). METHODS: A retrospect database of primary breast cancer patients admitted to the Cancer Hospital from March 1967 through May 2003 was analyzed. RESULTS: A total of 10,470 primary breast cancer patients were treated, among which 271 patients had bilateral primary tumors with an incidence of 2.1%. Most of the BPBC, developed both synchronously (sBPBC, incidence rate: 0.6%) and metachronously (mBPBC, incidence rate: 1.5%), were diagnosed in premenopausal women with an average age of 48. In the latter cases, the median time interval between their occurrences was 57.6 months. The median survival time for patients with sBPBC and mBPBC was 29.6 months and 27.8 months, respectively. There was no statistical difference in survival rate between the 2 groups of patients. Nor was menopausal status related to survival. In mBPBC patients, when the occurrence of the second breast cancer was taken as the beginning of prognostic analysis, the prognosis of BPBC patients was worse than those with unilateral involvement. CONCLUSION: Prognosis of patients with bilateral primary breast cancer is poor. In mBPBC patients whose breast cancers appear one after the other, meticulous follow-up is needed after resection of tumor on one side to early detect development of cancer of the countralateral breast especially within 5 years.

[Clinicopathologic analysis of primary pure squamous cell carcinoma of the breast].

OBJECTIVE: To analyze the clinicopathologic characteristics and treatment method for primary pure squamous cell carcinoma of the breast. METHODS: Twelve patients with primary squamous cell carcinoma of the breast pathologically confirmed were retrospectively reviewed. The clinical characteristics, diagnosis, treatment and prognosis were analyzed. RESULTS: All 12 patients were women with median age of 50 years (44-76 years). The patients all presented a single mass in the breast on presentation. The diameter ranged from 2.5 cm to 10.0 cm in diameter. All of the patients had undergone surgical resection. There were 6 cases in stage IIa, 2 in IIb, 2 in IIIa and 2 in IIIb according to the TNM staging system of AJCC and UICC. Ten of the 12 cases were followed-up from 4 months to 189 months. CONCLUSION: Primary squamous cell carcinoma of the breast is often in need of diagnosis by exclusion, but can be initially confirmed by fine needle aspiration. Presently, no standard therapy can be recommended in practice. The prognosis is controversial.

The characteristics of breast cancer subtypes: implications for treatment guidelines and individualized treatment strategies in China.

This study aimed at investigating the characteristics of invasive breast cancer among molecular subtypes. Patients with invasive breast cancer, with complete information on the expressions of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 (HER2), were recruited. χ tests and an unconditional logistic regression model were used for statistical analysis. The percentages of luminal A, luminal B, HER2/neu, and triple-negative subtypes were 54.2% (1639/3021), 14.0% (422/3021), 8.9% (269/3021), and 22.9% (691/3021), respectively. Differences among molecular subtypes (P<0.05) in tumor size, stage, pathologic type, and lymph node status were observed. The HER2/neu, luminal B, and triple-negative subtypes were more aggressive compared with the luminal A subtype in tumor stage, lymph node status, or pathologic type (P<0.05), when the findings were adjusted for age. Molecular subtypes were distributed differently between both age groups and regional groups on the basis of the socioeconomic status (P<0.05). In conclusion, luminal A and triple-negative subtypes were the 2 main subtypes of invasive breast cancer in China. The variations of molecular subtypes in pathology, age, and regional distribution may give some suggestions for updating treatment guidelines and individualized treatment strategies in China.

Body mass index and breast cancer defined by biological receptor status in pre-menopausal and post-menopausal women: a multicenter study in China.

BACKGROUND: Few studies have investigated the association between body mass index (BMI) and breast cancer with consideration to estrogen/progesterone/human epidermal growth factor type 2 receptor status (ER/PR/HER2) in the breast tissue among Chinese pre- and post-menopausal women. METHODS: Four thousand two hundred and eleven breast cancer patients were selected randomly from seven geographic regions of China from 1999 to 2008. Demographic data, risk factors, pathologic features, and biological receptor status of cases were collected from the medical charts. Chi-square test, fisher exact test, rank-correlation analysis, and multivariate logistic regression model were adopted to explore whether BMI differed according to biological receptor status in pre- and post-menopausal women. RESULTS: Three thousand two hundred and eighty one eligible cases with BMI data were included. No statistically significant differences in demographic characteristics were found between the cases with BMI data and those without. In the rank-correlation analysis, the rates of PR+ and HER2+ were positively correlated with increasing BMI among post-menopausal women (rs BMI, PR+=0.867, P=0.001; rs BMI, HER2+ =0.636, P=0.048), but the ER+ rates did not vary by increasing BMI. Controlling for confounding factors, multivariate logistic regression models with BMI<24 kg/m(2) as the reference group were performed and found that BMI ≥ 24 kg/m(2) was only positively correlated with PR+ status among post-menopausal breast cancer cases (adjusted OR=1.420, 95% CI: 1.116-1.808, Wald=8.116, P=0.004). CONCLUSIONS: Post-menopausal women with high BMI (≥ 24 kg/m(2)) have a higher proportion of PR+ breast cancer. In addition to effects mediated via the estrogen metabolism pathway, high BMI might increase the risk of breast cancer by other routes, which should be examined further in future etiological mechanism studies.

Age of diagnosis of breast cancer in china: almost 10 years earlier than in the United States and the European union.

BACKGROUND: The study aimed to describe the age distribution of breast cancer diagnosis among Chinese females for comparison with the United States and the European Union, and provide evidence for the screening target population in China. MATERIALS AND METHODS: Median age was estimated from hospital databases from 7 tertiary hospitals in China. Population-based data in China, United States and European Union was extracted from the National Central Cancer Registry, SEER program and GLOBOCAN 2008, respectively. Age-standardized distribution of breast cancer at diagnosis in the 3 areas was estimated based on the World Standard Population 2000. RESULTS: The median age of breast cancer at diagnosis was around 50 in China, nearly 10 years earlier than United States and European Union. The diagnosis age in China did not vary between subgroups of calendar year, region and pathological characteristics. With adjustment for population structure, median age of breast cancer at diagnosis was 50~54 in China, but 55~59 in United States and European Union. CONCLUSIONS: The median diagnosis age of female breast cancer is much earlier in China than in the United States and the European Union pointing to racial differences in genetics and lifestyle. Screening programs should start at an earlier age for Chinese women and age disparities between Chinese and Western women warrant further studies.