Breast Cancer Challenges and Screening in China: Lessons From Current Registry Data and Population Screening Studies

Abstract

Background. As one of its responses to the increasing global burden ofbreast cancer (BC), China has deployed a national registration and BCscreening campaign. The present report describes these programs and theinitial results of these national BC control strategies, highlightingthe challenges to be considered.Materials and Methods. The primary BC incidence and prevalence data wereobtained from the Chinese National Central Cancer Registry. MapInfosoftware was used to map the geographic distribution and variation. Thetime trends were estimated by the annual percentage of change from 2003to 2009. The description of the screening plans and preliminary resultswere provided by the Ministry of Health.Results. Chinese cancer registries were primarily developed andactivated in the Eastand Coastal regions of China, with only 12.5% ofthe registries located in West China. Geographic variation was noted,with the incidence of BC higher in North China than in South China andin urban areas compared with rural areas. Of great interest, theseregistries reported that the overall BC incidence has been increasing inChina, with an earlier age of onset compared with Western countries anda peak incidence rate at age 50. In response to this increasingincidence and early age of onset, BC screening programs assessed 1.46million women aged 35-59 years, using clinical breast examinations andultrasound as primary screening tools between 2009 and 2011. Thediagnostic rate for this screening program was only 48.0/10(5) with 440cases of early stage BC. Early stage BC was detected in nearly 70% ofscreened patients. Subsequently, a second-generation screening programwas conducted that included older women aged 35-64 years and anadditional 6 million women were screened.Conclusion. The cancer registration system in China has been uneven,witha greater focus on East rather than West China. The data from theseregistries demonstrate regional variation, an increasing BC incidence,and an early age of onset. The 2009 to 2011 BC screening programtargeting women aged 35-59 years had a low detection rate that resultedin a second-generation screening program that extended the cohort sizeand ages screened to 35-64 years.