| Objective:Breast cancer has become the most common malignant tumor in Chinese women,which seriously threatens the health of Chinese women and brings heavy economic burden.Based on this study in Chongqing medical university medical institute big data platform,data of2010 to 2019,six hospitals in Chongqing breast cancer patients in our hospital onset age,clinical stage,pathological histology,molecular classification,and summarized the clinical pathological characteristics of operation way,and analyze the factors affecting the risk of breast cancer staging and trends,along with the change of s for Chongqing city and provide the accurate evidence-based medicine for the prevention and treatment of breast cancer.At the same time,this study from the perspective of the whole society,establish a Markov model of breast cancer screening program for Clinical breast examination(CBE),Mammography(MAM),Ultrasonography(US),CBE joint MAM,CBE joint US,MAM joint US,CBE joint MAM joint US and not health economics evaluation on the plan of eight kinds of screening for breast cancer screening.It provides a reliable theoretical basis for the allocation and optimization of medical and health resources in Chongqing and the formulation of breast cancer screening policies by health departments.Methods:collected 6 hospitals in Chongqing between January 2010and December 2019,confirmed for the first time and hospitalization of patients with primary breast cancer women clinical and pathological data,establishing database of breast cancer patients clinical pathological features,will be divided into 2010-2019,2010-2011,2012-2013,2014-2015,2016-2017,2018-2019 five periods,breast cancer were retrospectively analyzed the clinical pathological characteristics of distribution and trend along with the change of SPSS 25.0 statistical software was used for statistical description and analysis,and P<0.05 was considered statistically significant.Meanwhile,based on the natural history of breast cancer,a 1-year Markov model was established.Cohort analysis was adopted to simulate the cost and utility of eight screening schemes in100,000 female population.The starting age was set at 35 years old and the ending age was set at 85 years old,and the discount rate was 3%.Incremental cost-utility ratios(ICURs)were obtained by baselines of the costs of unscreened options,and single-factor sensitivity analysis,multi-factor sensitivity analysis and Monte Carlo analysis were used to investigate whether the model parameter fluctuations affected the simulation results,so as to verify the robustness of the model.Results:A total of 1921 patients with primary breast cancer who met the inclusion and exclusion criteria were included in this study.In recent 10years,the number of breast cancer inpatients admitted to 6 medical institutions in Chongqing presented an overall increasing trend.The age at onset of breast cancer ranged from 25 to 95 years,with a median age of 54years and a mean age of(55.24±10.38)years.The high incidence age group was 45 to 49 years old,393 cases(20.46%).The median ages of the five periods were 55,57,55,53,52 years old,respectively,and the difference was statistically significant(P<0.01).Different age groups(<45,45-49,50-54,55-59,60-64,≥65)were statistically significant in the five time periods(χ~2=25.49,P<0.01),the age of onset of breast cancer patients showed a decreasing trend with the change of time.The main pathological type were invasive ductal carcinoma(1378 cases,72.2%),followed by mixed type(235 cases,12.2%),carcinoma in situ(104 cases,5.4%),invasive lobular carcinoma(71 cases,3.7%),and other rare types(less than10%).Is given priority to withⅡperiod in patients with clinical stage(52.05%),zero phase patients(5.41%),Ⅰperiod patients(17.91%),Ⅲperiod patients(21.66%),Ⅳperiod patients accounted for 2.97%,five times no statistically significant differences in the distribution of clinical stage(χ~2=0.24,P=0.63).Luminal B type(49.40%),Luminal A type(17.39%),triple negative subtype(16.40%),and HER-2 overexpression type(15.20%)were the main types of molecular typing(χ~2=45.58,P<0.01),the proportion of HER-2 patients showed an upward trend,and the proportion of triple negative patients showed a downward trend.The main surgical methods were modified radical resection(72.25%),and the distribution of surgical methods in five time periods was statistically significant(χ~2=110.06,P<0.01),the traditional large-scale radical mastectomy of breast cancer showed a decreasing trend,while the rate of breast-conserving surgery showed an increasing trend,and the rate of breast-conserving surgery was about 12.9%in the past 5 years.The sentinel lymph node biopsy rate has been decreasing in recent 5 years.Multivariate Logistic regression analysis showed that there were significant correlations between positive HER-2,triple negative breast cancer and Ki-67 index and clinical stage at diagnosis(all P<0.05).At the same time,the health economics evaluation results of no screening and 7 breast cancer screening regimens in this study showed that compared with no screening regimens,the ICURs of CBE,US and CBE-US screening regimens were 21,725.08yuan/QALYs,115,715.67 yuan/QALYs and 215,201.97 yuan/QALYs,respectively,which were lower than the WTP threshold standard set in this study and had higher cost-effectiveness value.The results of univariate sensitivity analysis showed that the conclusion that CBE and US screening programs had cost-utility value was not sensitive to the fluctuation of model parameters,while CBE-US screening programs were on the contrary.Multivariate sensitivity analysis and results showed that the probability of cost-utility value of CBE screening regimen,US screening regimen and CBE-US screening regimen increased with the increase of WTP threshold.When the WTP threshold was higher than 30,000 yuan,US screening regimen had higher cost-utility value.Monte Carlo analysis results show that the cost probability and utility probability distribution of the three screening schemes tend to normal distribution,indicating that the simulation results of the model are stable.Conclusion:In recent 10 years,the number of female patients with breast cancer in 6 hospitals in Chongqing shows an increasing trend,the age of high incidence is 45～54 years old,and the age of diagnosis has a decreasing trend.The main pathological type was infiltrating ductal carcinoma.Patients with clinical stage toⅡprimarily and ratio has no obvious change;Luminal B was the main molecular type,the proportion of HER-2 patients showed an upward trend,and the proportion of triple negative patients showed a downward trend.Modified radical resection was the main surgical method,and the breast conserving surgery rate showed an increasing trend.Her-2 positive,triple negative breast cancer and Ki-67>were 14%risk factors for breast cancer staging.This study basically reflects the epidemiological characteristics of female breast cancer in Chongqing,clinicians should pay attention to these characteristics in the process of diagnosis and treatment.At the same time,compared with no screening,CBE,US and CBE-US screening programs are more cost-effective and worthy of promotion.Therefore,the Chongqing municipal government should strengthen the publicity of CBE and US screening and increase the participation rate of women in screening.In addition,breast cancer screening should be fully included in the medical insurance list and the out-of-pocket cost of patients should be reduced. |
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