Study On The Trends In Incidence And Mortality, Early Diagnosis And Treatment Of Breast Cancer In Hubei Province

Objectives:(1)To identify the high-risk population of breast cancer mortality in Hubei Province by describing the mortality trend,age characteristics,regional distribution,and the disease burden from 2007 to 2015 to provide epidemiological evidence for prevention and control.(2)Cancer surveillance in Wuhan was started early in China,this study conducted a separate study on the trends in incidence and mortality of breast cancer in Wuhan.To comprehensively evaluate the long-term trends in the incidence and mortality of breast cancer in urban Wuhan from 1990 to 2015,as well as to predict for in the next decade.The high-risk population was further identified combined with breast cancer mortality in rural Wuhan during 2009-2015.(3)Based on the free breast cancer screening policy,we identified the high-risk population in Xiangyang.In addition,we further explored the acquire behavior of breast-related knowledge,as well as the underlying influence factors of screening participation and breast self-examination(BSE)behavior.(4)To understand the reasons and factors of treatment delay for breast cancer patients,and to provide new evidence for early diagnosis and treatment of breast cancer.Methods:(1)The mortality data of female breast cancer in Hubei Province were extracted from the Cause of Death Registry in Hubei Province.The incidence and mortality data of female breast cancer in Wuhan were derived from the Wuhan Cancer Registry.The age-standardized rates using China and the World tandard populations of breast cancer were used in this study.Joinpoint regression was used to analyze the trends in breast cancer incidence and mortality which evaluated by the average annual percentage change(AAPC)and annual percentage change(APC).The disability-adjusted life years(DALY),provided by the World Health Organization which including years of life loss(YLL)and years lived with disability(YLD),was used to evaluate the disease burden of breast cancer.The Nordpred prediction model was used to project the incidence and mortality trend of breast cancer in Wuhan from 2016 to 2025.The age-period-cohort analysis was applied to evaluate the age,period,and cohort effects on the trends of breast cancer incidence and mortality.(2)We further investigated the acquisition behavior of breast-related knowledge,screening,and BSE behavior among women.On the other hand,another survey was conducted to explore the treatment delay for breast cancer patients.According to previous studies,the time interval between breast cancer symptoms identified and visit a doctor for the symptom(≥3 months)is defined as treatment delay for breast cancer.Data analysis was conducted using the Chi-square analysis and Fisher’s exact test.Multivariate logistic regression was used to explore the underlying factors of screening participation and BSE behavior in healthy women,as well as the treatment delay for breast cancer patients.Results:(1)In 2015,the age-standardized mortality rate using China standard population(ASMRC)of breast cancer 5.33/100,000,and that using the World(ASMRW)was 5.32/100,000,of which the ASMRW in urban and rural areas were 6.82/100,000 and 4.74/100,000,respectively in Hubei Province.The first age peak of mortality during 2007-2015 was 50-54 age group(16.17/100,000).In addition,the trends in ASMRW of the 35-39 and 50-54 age groups increased significantly(AAPC=7.3%,95% CI: 2.1%,12.7%;AAPC=8.9%,95% CI: 2.4%,15.8%,respectively).The results also showed that Wuhan has the highest mortality rate in Hubei Province.In addition,the ASMRW of breast cancer in Huanggang increased significantly from 2007 to 2015(AAPC=14.4%,95% CI: 7.7%,21.6%),while that in Xiaogan decreased significantly(AAPC=-7.1%,95% CI:-13.7%,0).The YLL of breast cancer in Hubei Province was 65,417.69(1.55‰).(2)In 2015,the ASMRC of breast cancer was 6.13/100,000,and the ASMRW was 6.45/100,000 in Wuhan.In addition,the age-standardized incidence using China standard population(ASIRC)of breast cancer in urban Wuhan was 42.07/100,000,and that using the World(ASIRW)was 42.19/100,000.In addition,ASMRC and ASMRW of breast cancer in urban Wuhan were 6.83/100,000 and 7.20/100,000,respectively.In rural Wuhan,the ASMRW was 5.32/100,000 in 2015.In the past 26 years,the ASIRW of breast cancer in Wuhan has increased significantly(AAPC=3.3%,95% CI: 2.0%,4.7%).It is predicted that the incidence of breast cancer will continue to rise in the next 10 years.Meanwhile,the ASMRW was insignificantly increased(AAPC=0.4%,95% CI:-0.1%,0.9%).During 2011-2015 in urban Wuhan,the age group of 55-59 years has the highest incidence of breast cancer(123.88/100,000),and the first peak of age-specific mortality of breast cancer was 60-64 years(26.42/100,000).During 2009-2015 in rural Wuhan,the first peak of the age-specific mortality was 55-59 years old(19.29/100,000).Furthermore,from 1990 to 2015,the incidence of breast cancer in young women(<50 years)continued to increase(AAPC=3.5%,95% CI: 3.0%,4.1%),and the mortality of breast cancer in older women(≥50 years)continued to increase as well(AAPC=0.9%,95% CI: 0.2%,1.5%).Additionally,the DALY caused by breast cancer in urban Wuhan was 110,574.18(2.08‰)during the whole study period.In addition,the YLL of breast cancer in rural Wuhan was 13,839.47(1.31‰)from 2009 to 2015.Furthermore,the age,period,and cohort effects on breast cancer incidence and mortality trends showed significant statistical significance in both.(3)The results of free breast cancer screening provided in Xiangyang showed that women aged 45-49 and 60-64 years were at higher risk,with detection rates of 35.67/100,000 and 46.39/100,000,respectively.Women’s enthusiasm for acquiring breast-related knowledge was low(17.07%).Furthermore,television is the most practical way to acquire breast health knowledge,which accounted for 39.36%.The main factors associated with breast cancer screening participation were breast cancer-related knowledge(OR=1.84,95% CI: 1.52,2.22),economic factors(OR=1.39,95% CI: 1.03,1.86),time(OR=1.51,95% CI: 1.22,1.85),and inconvenience of breast cancer screening(OR=1.60,95% CI: 1.27,2.01).The main factors associated with BSE behavior were education(OR=4.69,95% CI: 2.25,9.80),breast-related knowledge(OR=2.49,95% CI: 1.83,3.39;OR=3.01,95% CI: 2.19,4.13,respectively),and work stress(OR=3.09,95% CI: 1.28,7.50).(4)The results of the survey on breast cancer patients showed that factors associated with patients’ screening behavior were education(OR=3.34,95% CI: 1.45,7.71),enthusiasm of to acquire breast-related knowledge(OR=0.32,95% CI: 0.15,0.70),and work pressure(OR=0.39,95% CI: 0.18,0.87).In addition,as mentioned previously,the enthusiasm for acquiring breast-related knowledge among breast cancer patients was also low(23.46%).The rate of treatment delay for breast cancer patients was as high as 50.28%.Most patients could seek medical treatment when the symptoms deteriorated(37.99%).The factor of “not worried about symptoms” comprised the highest proportion in all of the delayed patients(17.78%).In addition,the main factors associated with patients’ treatment delay were time cost(OR=2.34,95% CI: 1.18,4.64),and recognition of the severity of breast cancer symptoms(OR=4.58,95% CI: 2.31,9.07).Conclusions:(1)The breast cancer mortality in Hubei province is at the average level in China.The mortality rates of specific groups(women aged 35-39 years,or 50-54 years,or residents of Huanggang)showed significant upward trends.ASIRW in Wuhan was approaching those areas with highest breast cancer risk in China.Further,the incidence of breast cancer in urban Wuhan showed a rapid upward trend,which was predicted to continue in the next decade.And the evident increase of breast cancer incidence of younger women and mortality in older women suggested that prior strategies for breast cancer control should be adopted.The peaks of age-specific incidence or mortality of breast cancer in the selected areas showed a trend of retrogression.Which suggested that close attention should be paid to the dynamic changes of the high-risk population and take preventive and control measures timely.(2)The awareness of breast-related knowledge has a significant impact on women’s screening participation and BSE behavior.However,the prevalence of breast-related knowledge is poor,and women’s enthusiasm to acquire the knowledge is low.Therefore,strengthening television publicity to enhance women’s breast-related knowledge might help to improve breast cancer screening and BSE participation.In addition,reducing screening costs,and encouraging women to overcome difficulties to participate in screening regularly,which might increase the screening participation.Furthermore,raising women’s awareness of early diagnosis and treatment of breast cancer,and overcoming difficulties to timely diagnosis when breast abnormal occurs,which might also play an important role for reducing the adverse outcomes of breast cancer.