Recently, The Lancet published an important report on breast cancer, stating that breast cancer has become one of the most detected cancer types globally. The report notes that by the end of 2020, over 7.8 million women worldwide were diagnosed with breast cancer in the past five years and are still in the chronic disease struggle phase.
In this context, we explored the current situation, prevention, and screening of breast cancer in China. Xu Binghe, an academician of the Chinese Academy of Engineering and also the director of the Breast Cancer Expert Committee of the National Cancer Quality Control Center, pointed out: “In the past 10 years, the incidence of breast cancer in China has shown five significant features.”
- The number of breast cancer cases is in a growth phase. According to the latest data from the National Cancer Center in 2022, there are about 357,200 new breast cancer cases in China each year, ranking second among all female cancers after lung cancer, accounting for 15.6%.
- There is a trend toward younger ages. The median age of Chinese patients diagnosed with breast cancer is 47 years, much lower than the 64 years in the United States.
- The proportion of late-stage breast cancer is higher in China. Specific data shows that about 31.8% of patients diagnosed with stage I breast cancer in China, about 44.1% with stage II, and the proportion of late-stage patients is about 24.1%.
- The proportion of breast cancer types with poor prognosis is higher in China. Although hormone receptor-positive breast cancers have a better prognosis, less than 70% of these cancer types in China fall into this category, compared to about 80% abroad.
- Significant regional differences exist. In China, the incidence of breast cancer is higher in economically developed areas, but as living standards improve, the incidence rates in economically weaker areas are also rising.
Regarding why the early diagnosis rate of breast cancer in China is far below that of developed countries, Xu Binghe believes the root cause is that breast cancer screening is not yet widespread or complete. He mentioned that breast cancer screening in China is divided into two models: one is the public health service project funded by central finance, including the early diagnosis and treatment project for rural cancers; the other is government-funded projects in some more developed cities, such as Beijing’s “two cancers” screening program.
Xu Binghe emphasized: “Overall, it is recommended that women over 40 should regularly participate in breast cancer screening.” However, the data shows that in 2015 only 18.9% of adult women in China participated in breast cancer screening. Between 2018 and 2019, the breast cancer screening coverage rate for women over 20 was 22.3%, and for women aged 35 to 64, it was 30.9%. In contrast, the screening coverage rate for women aged 50 to 74 in the United States reached 75.9% in 2021, and is estimated to further increase to 80.5% by 2030.
Currently, internationally, X-ray screening, commonly known as mammography, is the most important screening method for breast cancer.
Compared to the looser breast tissue of Western women, Chinese women’s breast cancer often occurs around the age of 47, when the breast tissue is typically denser. X-rays have weaker penetration in such tissue, making it difficult to detect small tumors and increasing the risk that 30% of patients may be missed by X-ray screening.
In China, the conventional screening methods for breast cancer include X-ray, ultrasound, and magnetic resonance imaging (MRI). Although MRI is not affected by the density of breast tissue, it is more costly, so X-ray and ultrasound are more widely used. For women of different age groups, Xu Binghe and his team suggest different combinations of screening methods: Women under 45 with denser breast tissue should primarily use ultrasound, supplemented by X-ray; for women over 45 with looser breast structure, it is advisable to use X-ray as the main method, supplemented by ultrasound.
Xu Binghe also emphasized the relationship between breast cancer and the Healthcare Access and Quality (HAQ) Index, noting that in regions with lower HAQ scores, breast cancer screening and treatment should be improved in various ways. This includes increasing the proportion of rural women screened for breast cancer, enhancing the diagnostic and treatment capabilities of doctors in primary care hospitals, improving the availability of medical examinations and treatment drugs, and extending the coverage of medical insurance.
The impact of breast cancer on patients is not only physical but also affects mental health and imposes economic burdens. Patients who undergo mastectomy may suffer from damage to their body image, a loss of personal confidence, and psychological issues such as anxiety and depression. To address these issues, Xu Binghe proposed several suggestions, including regular breast cancer screening, breast reconstruction surgery to boost the confidence of female patients, the importance of family support, and expanding the team of professional breast reconstruction surgeons. Although the proportion of breast reconstruction surgeries in China has increased, it still lags behind the United States.
In terms of breast cancer prevention, since the mechanism of the disease is not yet fully understood, prevention efforts focus on controlling known risk factors, such as maintaining a healthy lifestyle, reasonable diet, moderate exercise, and avoiding smoking and excessive drinking, etc.
Women’s health is greatly affected by lifestyle, in which dietary habits play a critical role. Excessive intake of high-fat, high-calorie foods, combined with potential smoking and drinking habits, can significantly alter the hormonal levels in women’s bodies, lead to hormonal disorders, and increase the risk of certain diseases.
Regarding weight management, it is recommended to keep the Body Mass Index (BMI) within the normal range to maintain a healthy weight status. This not only improves overall health but also reduces the likelihood of developing various diseases.
In terms of childbirth, completing the first childbirth before the age of 30 and breastfeeding can have a positive effect on lowering the incidence of breast cancer. The choice of the age of first childbirth and the number of births are associated with the incidence of breast cancer.
Women with a family history of breast cancer are at high risk and may consider taking endocrine drugs or undergoing ovarian removal as preventive measures to reduce the risk of the disease. However, which method to use should be decided after consulting with a specialist to ensure the most suitable prevention strategy for the individual.
