Background and objective: Incidence of and mortality rates for breast cancer continue to rise in the People's Republic of China. The purpose of this study was to analyze differences in characteristics of breast malignancies between China and the U.S.
Methods: Data from 384,262 breast cancer patients registered in the U.S. Surveillance, Epidemiology, and End Results (SEER) program from 2000 to 2010 were compared with 4,211 Chinese breast cancer patients registered in a Chinese database from 1999 to 2008. Outcomes included age, race, histology, tumor and node staging, laterality, surgical treatment method, and reconstruction. The Pearson chi-square and Fisher's exact tests were used to compare rates.
Results: Infiltrating ductal carcinoma was the most common type of malignancy in the U.S. and China. The mean number of positive lymph nodes was higher in China (2.59 vs. 1.31, p < .001). Stage at diagnosis was higher in China (stage IIA vs. I, p < .001). Mean size of tumor at diagnosis was higher in China (32.63 vs. 21.57 mm). Mean age at diagnosis was lower in China (48.28 vs. 61.29 years, p < .001). Moreover, 2.0% of U.S. women underwent radical mastectomy compared with 12.5% in China, and 0.02% in China underwent reconstructive surgery.
Conclusion: Chinese women were diagnosed at younger ages with higher stage and larger tumors and underwent more aggressive surgical treatment. Prospective trials should be conducted to address screening, surgical, and tumor discrepancies between China and the U.S.
Implications for practice: Breast cancer patients in China are diagnosed at later stages than those in America, which might contribute to different clinical management and lower 5-year survival rate. This phenomenon suggests that an earlier detection and treatment program should be widely implemented in China. By comparing the characteristics of Chinese and Chinese-American patients, we found significant differences in tumor size, lymph nodes metastasis, and age at diagnosis. These consequences indicated that patients with similar genetic backgrounds may have different prognoses due to the influence of environment and social economic determinates.
摘要
背景与目的. 中华人民共和国的乳腺癌发病率和死亡率正在持续升高。本研究旨在分析中国与美国乳腺癌特征的差异。
方法. 对2000 – 2010年期间美国监测、流行病学与最终结果(SEER)项目中登记的384 262例乳腺癌患者数据与1999 – 2008年间中国数据库中登记的4 211例中国乳腺癌患者数据进行比较。结果包括年龄、种族、组织学、肿瘤与淋巴结分期、发病侧、手术方案,以及乳房再造术。使用Pearson卡方检验和Fisher精确检验对比率进行比较。
结果. 浸润性导管癌是美国和中国乳腺癌最常见的类型。中国患者平均阳性淋巴结数目较多(2.59 vs. 1.31,P < 0.001),诊断时分期较高(IIA vs. I期,P < 0.001)、平均肿瘤体积较大(32.63 vs. 21.57 mm)且平均年龄较低(48.28 vs. 61.29岁,P < 0.001)。此外,美国女性患者中有2.0%接受乳腺癌根治术治疗,而中国的比例为12.5%,中国有0.02%的患者接受了乳房再造术。
结论. 中国女性诊断时较为年轻、分期较高、肿瘤体积较大,且更多接受较激进的手术治疗。应开展前瞻性临床研究来阐明中国和美国之间筛查、手术和肿瘤差异的问题。The Oncologist 2015;20:1044–1050
对临床实践的提示:中国乳腺癌患者诊断时分期晚于美国患者,这可能导致临床管理的差异和5年生存率较低。这一现象提示中国应广泛开展早期诊断和治疗方案。通过对中国患者和美籍华人患者的特征进行比较,我们发现肿瘤体积、淋巴结转移和诊断年龄存在显著差异。这些结果提示由于环境和社会经济学决定因素的影响,遗传背景相似的患者可能具有不同的预后。
Keywords: Breast cancer; China; Disparities.
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