Monday, 2 June 2014

Breast cancer with Chinese characteristics

by Michael Woodhead
Breast cancer rates in Chinese women are only one sixth those of their American counterparts, but China is catching up quickly, a new report says.
A review of breast cancer in China published in the Lancet Oncology this week shows that breast cancer has traditionally been an uncommon disease in China but rates are increasingly rapidly as the country adopts more affluent lifestyles.
The report by researchers at the National Office for Cancer Prevention and Control, Chinese Academy of Medical Sciences, Beijing shows that more than 1·6 million Chinese people are diagnosed with breast cancer and 1·2 million die of the disease each year. Breast cancer is now the most common cancer in Chinese women, accounting for cases 12% of all newly diagnosed breast cancers. Annual incidence rates are about 22 per 100,000, compared to rates of around 120 per 100,000 in the US.
The reviewers say breast cancer occurs at a younger age in Chinese women compared to their western counterparts, and for this reason screening programs such as mammography would probably not be appropriate. Rates have increased in recent years due to reproductive factors such as the single child policy and later age of first birth increasing exposure to sex hormones.
For these reasons, and because of the low awareness and delays in diagnosis, Chinese women with breast cancer tend to have more advanced stages of disease when diagnosed.
Another major disparity with breast cancer in China is the lack of adequate treatment. Most women cannot afford the more expensive advanced drugs for breast cancer now recommended in international guidelines. Paradoxically, treatment of breast cancer by Chinese doctors tends to be over-aggressive, with excessive surgery and chemotherapy. Many women have unnecessary mastectomy and axillary lymph node dissection and also chemotherapy. Under-treatment is also common, with some women receiving inadequate therapy for treatable cancers. The reviewers say palliative-care programs probably represent the best way forward to manage quality of life for patients with advanced disease and their families.
They conclude by saying there is a need for more public  awareness of breast cancer and promotion of early detection.
"Because the disparity of access to treatment for breast cancer will remain for some time, great effort is needed to expand insurance benefits and cancer-care infrastructure to underserved women in China," they conclude.

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