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Comparison of data from China and the United States
According to cancer burden data from the World Health Organization's International Agency for Research on Cancer (IARC), it is estimated that 430,000 women in China will be diagnosed with breast cancer in 2022; 120,000 deaths[1].
Recently, Shenjian CA released the "American Women's Breast Cancer Statistical Yearbook" [2], which counted the incidence, death, survival and mammography screening data
of breast cancer.
Today, the Medical Oncology Channel takes you to savor this blockbuster data
.
Screenshot of the first page of the report
In 30 years, breast cancer mortality has dropped by 43%!
1Estimated new cases and deaths in 2022
The report predicts that in 2022, there will be about 287,850 newly diagnosed invasive breast cancers and 51,400 newly diagnosed ductal carcinoma in situ (DCIS) in the United States, and 43,250 women will die of breast cancer
.
83% of invasive breast cancers are diagnosed in women aged 50 years and older, and 91% of breast cancer deaths occur in this age group; Half of breast cancer deaths occur in
women aged 70 years or older.
The median age at breast cancer diagnosis in women was 62 years and the median age at death was 69 years
.
Age-specific female breast cancer incidence (2015–2019) and mortality rate (2016–2020)
by race/ethnicity Although breast cancer is predominantly female, it is estimated that in 2022, there will be about 2710 new cases and 530 deaths among men, accounting for about 1% of all new breast cancer cases and deaths.
。
2Estimated number of breast cancer survivors in 2022
As of January 1, 2022, approximately 4.
1 million women in the United States have a history of
breast cancer.
About 4% have metastatic disease, and more than half of them are initially diagnosed with early-stage (stage I-III) cancer
.
3Current 5-year survival rate for breast cancer
Survival rates for different stages of breast cancer at diagnosis vary widely
.
The 5-year relative survival rate for patients diagnosed with stage I was 99%, 93% for stage II, 75% for stage III, and 29%
for stage IV patients diagnosed between 2012 and 2018.
5-year relative survival (%)
for breast cancer in the United States by stage at diagnosis and race/ethnicity, 2012-2018.
Note: Survival is based on patients diagnosed between 2012 and 2018 and followed up to 2019
How does the world's high 5-year survival rate result?
1Morbidity and mortality "drifting away"
Breast cancer rates in the United States have been on the rise for most of the past 40 years:
in the '80s and '90s, largely due to increased
detection rates of asymptomatic disease during the rapid adoption of mammography screening.
In women aged 50 years and older, the incidence of DCIS increased more than 10-fold; The incidence of invasive breast cancer has increased by 40%.
Age-specific incidence trends in breast ductal carcinoma in situ and invasive breast cancer in women in the United States, 1975-2019 From 2001 to 2004, the incidence of invasive breast cancer decreased sharply, mainly due to a decrease in hormone use after the publication of postmenopausal studies on the risk associated with breast cancer and heart
disease.
Since 2004, the incidence of invasive breast cancer has slowly increased at a rate of 0.
5% per year, which has been attributed to rising body mass index and continued decline
in fertility.
The increase in the incidence of breast cancer in recent years mainly reflects the increase in localized disease, from 75 cases per 100,000 people in 2004 to 86 cases
per 100,000 people in 2019.
From 2015 to 2019, the incidence of local-stage diseases increased by 0.
9% per year, and the incidence of regional diseases decreased by 0.
7% per year, which may reflect a shift towards an early stage
in breast cancer diagnosis.
In contrast to trends in breast cancer incidence
in women by stage and ethnicity in the U.
S.
from 2004 to 2019, breast cancer mortality has declined steadily since its peak in 1989:
From 1975 to 1989, the total breast cancer mortality rate increased by 0.
4 percent per year.
grew but fell by 43%
between then and 2020.
As a result of this decline, 460,000 breast cancer deaths
were averted among American women from 1989 to 2020.
The decline in breast cancer mortality is attributed to better, more targeted treatment and early detection
from mammography screening.
However, the recent rate of decline in mortality has slowed from 1.
9% in 1998-2011 to 1.
3% in 2011-2020, which may reflect a steady increase in breast cancer incidence and a stabilization
of mammography screening rates.
Fig.
9 Trends in female breast cancer mortality by race/ethnicity in the United States, 1975-2020 1
The treatment threshold continues to move forward
In 2018, 63% of stage I or II patients underwent breast-conserving surgery with or without adjuvant radiotherapy, and 33% underwent mastectomy
.
Although most patients receive chemotherapy postoperatively, the use of neoadjuvant therapy is increasing, especially in patients with
HER2-positive and triple-negative breast cancer.
Most patients with stage IV breast cancer (60%) received noncurative radiation and/or chemotherapy
.
Breast cancer treatment patterns by stage and ethnicity, 2018 (%)
From the gap of tertiary prevention, how China's breast cancer prevention and treatment is in line with "international standards"
Compared with the overall 5-year survival rate of breast cancer patients in the United States of more than 90% and stage I patients close to 100%, the 5-year survival rate of breast cancer patients in China is 82.
8%, which is still at the level of the last century in the United States [3,4].
It can be seen that China's breast cancer prevention and control road has a long
way to go.
For this annual report on breast cancer statistics, we may wish to compare the current situation of breast cancer prevention and treatment in China and the United States from the three levels of prevention, and take a look at the successful experience
of breast cancer prevention and treatment in the United States.
1Primary prevention
That is, etiology prevention, preventing the occurrence of breast cancer by controlling the cause or risk factors, is the most active and fundamental prevention means
.
The associated risks of breast cancer can be divided into 3 categories: non-modifiable (e.
g.
, age), potentially modifiable (e.
g.
, estrogen exposure, fertility), and modifiable (e.
g.
, overweight, alcohol consumption) risk factors
.
Age is an irremovable risk factor
associated with breast cancer.
In the United States, the median age of onset of breast cancer in women is 62 years and continues to increase
.
The trend of onset age in Chinese women shows two characteristics: the median age of onset is 10-20 years earlier, and it is bimodal [5].
Among the potential modifiable factors in the age
of onset of breast cancer in Chinese women, the reduction in the use of hormone replacement therapy (HRT) among American women led to a sharp decline in breast cancer incidence from 2001 to 2004; The continued rise in nullifiability and late childbearing rates may be related to
the climb in breast cancer rates since 2004.
China's aging and declining fertility rate will undoubtedly "help" the incidence
of breast cancer.
Modifiable risk factors support half the sky for cancer onset [6], and 30% of breast cancer cases can be attributed to modifiable risk factors such as overweight, physical inactivity, and alcohol consumption
.
This report directly pointed out that the slow rise in breast cancer incidence in the United States since 2004 has a "military merit medal" of "overweight"
.
In China, modifiable risk factors attributable to cancer deaths account for more than 40%, and also account for 23.
2% of breast cancer, of which obesity (16.
4%) ranks first [7].
See this, everyone, put down the milk tea in your hand, okay? (Dog head)
2Secondary prevention
It is the "early detection, early diagnosis, and early treatment"
that we most often emphasize.
Undoubtedly, in terms of early diagnosis and screening of breast cancer, the United States is at the forefront
of the world.
Since the 80s of the 20th century, mammography screening for breast cancer has been widely used
in the United States.
At present, European and American countries have increased the early detection rate to 80% through the extensive implementation of standardized and standard breast cancer screening programs, of which more than 20% are detected through screening [8].
In contrast, large-scale breast cancer screening for women in rural and urban areas only began in 2008 and 2012, nearly 30 years
later than in the United States.
However, with the gradual deepening of Chinese women's understanding of breast cancer and the further popularization of screening, early diagnosis and early treatment are undoubtedly a major score point
in the decline of breast cancer deaths in China.
3Tertiary prevention
In order to prevent rehabilitation, it mainly provides various treatment methods for diagnosed patients to improve survival and recovery rate, including preventing tumor recurrence and metastasis, reducing postoperative pain and other complications
.
In the progress of breast cancer treatment in the United States, "precision" is undoubtedly the best footnote
in recent years.
Lymph node localization and sentinel lymph node biopsy techniques have largely replaced axillary lymph node dissection as the basis
for the staging of breast cancer.
Especially women over the age of 70 with ER-positive and HER2-negative small (T1) tumors are considered safe to avoid any axillary staging surgery
.
The 21-gene recurrence score assay Oncotype DX can be used to predict the efficacy of
chemotherapy in patients with HR-positive/HER2-negative lymphaden-negative breast cancer.
Recently, the TAILORx clinical trial also found that chemotherapy was only beneficial for women under 50 years of age, and the "chemotherapy-de-chemotherapy" process was +1
again.
Although treatment progress for triple-negative breast cancer (TNBC) lags behind other subtypes, recent clinical trials have shown encouraging results
with some targeted and immunotherapy drugs.
For example, the combination of pembrolizumab with standard chemotherapy prolongs progression-free survival in women with early TNBC and improves pathologic complete response rates
.
The targeted blockbuster drug DS-8201 significantly improved overall survival in
patients with drug-resistant, metastatic, HER2-positive and low-HER2-expressing breast cancer.
In China, the concept of breast cancer classification and treatment is deeply rooted in the hearts of the people, the pace of foreign new drugs has accelerated, and after domestic independent research and development is unwilling, the treatment end is progressing with each passing day, and breakthroughs
have been made for the survival of Chinese patients.
But it is true that "the upper heals the disease, the Chinese medicine cures the desire disease, and the lower heals the disease"
.
In the prevention and treatment of breast cancer, the "best doctor" has to be ourselves
.
References:
[1] Xia,et al,2022:profiles,trends,and determinants.
Chinese Medical Journal:March 5,2022-Volume 135-Issue 5-p 584-590
doi:10.
1097/CM9.
0000000000002108
[2]https://acsjournals.
onlinelibrary.
wiley.
com/doi/full/10.
3322/caac.
21754
[3] Miller KD,Nogueira L,Devasia T,Mariotto AB,Yabroff KR,Jemal A,Kramer J,Siegel RL.
Cancer treatment and survivorship statistics,2022.
CA Cancer J Clin.
2022 Jun 23.
doi:10.
3322/caac.
21731.
Epub ahead of print.
PMID:35736631.
[4] Zeng H,Chen W,Zheng R,Zhang S,Ji JS,Zou X,Xia C,Sun K,Yang Z,Li H,Wang N,Han R,Liu S,Li H,Mu H,He Y,Xu Y,Fu Z,Zhou Y,Jiang J,Yang Y,Chen J,Wei K, Fan D,Wang J,Fu F,Zhao D,Song G,Chen J,Jiang C,Zhou X,Gu X,Jin F,Li Q,Li Y,Wu T,Yan C,Dong J,Hua Z,Baade P,Bray F,Jemal A,Yu XQ,He J.
Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries.
Lancet Glob Health.
2018 May; 6(5):e555-e567.
doi:10.
1016/S2214-109X(18)30127-X.
PMID:29653628.
[5] Lei Fan,Kathrin Strasser-Weippl,Jun-Jie Li,Jessica St Louis,Dianne M Finkelstein,Ke-Da Yu,Wan-Qing Chen,Zhi-Ming Shao,Paul E Goss,Breast cancer in China,The Lancet Oncology,Volume 15, Issue 7,2014,Pages e279-e289,ISSN 1470-2045,https://doi.
org/10.
1016/S1470-2045(13)70567-9.
[6] GBD 2019 Cancer Risk Factors Collaborators.
The global burden of cancer attributable to risk factors,2010-19:a systematic analysis for the Global Burden of Disease Study 2019.
Lancet.
2022 Aug 20; 400(10352):563-591.
doi:10.
1016/S0140-6736(22)01438-6.
PMID:35988567.
[7] Chen W,Xia C,Zheng R,Zhou M,Lin C,Zeng H,Zhang S,Wang L,Yang Z,Sun K,Li H,Brown MD,Islami F,Bray F,Jemal A,He J.
Disparities by province,age,and sex in site-specific cancer burden attributable to 23 potentially modifiable risk factors in China:a comparative risk assessment.
Lancet Glob Health.
2019 Feb; 7(2):e257-e269.
doi:10.
1016/S2214-109X(18)30488-1.
PMID:30683243.
[8] Expert Group on the Development of Guidelines for Breast Cancer Screening Guidelines for Chinese Women of the Breast Professional Committee of the Chinese Association of Research Hospitals.
Guidelines for breast cancer screening for women in China (2022 edition)[J].
China Research Hospital,2022,09(2):6-13.
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