| Objectives:In this research we used age-period-cohort model(APC model) to analysis the breast cancer incidence and mortality of Shanghai women. Based on quantitative description of the Shanghai female breast cancer incidence and mortality trends, we looked for possible causes of breast cancer through exploring factors, such as the way age and cohort impacts breast cancer incidence and mortality. By means of comprehensive comparison of effectives and negative effect of various population-based screening strategies, we put forward suitable breast cancer screening programme for Chinese people. This study provides scientific evidence for the etiology of breast cancer research and effective prevention and control measures, to reduce the disease burden of breast cancer, fatherly improve women’s health status. In the first part APC model was applied to the analysis of Shanghai women’s breast cancer incidence and mortality data. Effect of period and cohort factors were extracted from shanghai female breast cancer incidence and mortality trends, prompt breast cancer etiological clues. In the second part experience of Shanghai population-based breast cancer screening were analysised. Results of different breast cancer screening strategies were comparised to put forward breast cancer screening recommendations, in order to offer proposal for making breast cancer screening guidelines suitable for China’s population.Methods:Part one:We collected breast cancer incidence and mortality data in1973-2007from shanghai cancer registry(SCR). Data was stratified by age, period and cohort factors. Joinpoint model was used to calculate the annual percentage change(APC) of incidence and mortality. APC model was used to estimate model parameters, evaluate the impact of age, period and birth cohort factors in incidence and mortality trends.Results would bring up some clues about the etiology of breast cancer. Part two:Data of three population-based breast cancer screening project in Shanghai was collected. Breast cancer cases were detected through follow-up and review of the history case data. Data was also matched with SCR to seek out the interval cancer patients occurred in the screening population. Evaluate the quality of each screening program and analysis different screening strategies, respectively using clinical breast examination(CBE) for preliminary screening, combined with application of mammography and ultrasonography screening strategies and parallel application of mammography and ultrasonography screening strategies, breast cancer detection rate, proportion of early stage cancer, sensitivity and false positive rate were calculated, comparisons were made among different screening strategies.Results:Part one:Average annual crude incidence rate(CIR) of female breast cancer in Shanghai in1973-2007is38.53/100000, standardized incidence rate(SIR) is27.17/100000. Incidence rate showed a trend of steady increase. Average crude mortality rate(CMR) of female breast cancer in Shanghai from1973to2007is12.27/100000, standardized mortality rate(SMR) is8.07/100000. Mortality rate is also on the rise, but less than the rise in incidence rate. Joinpoint regression analysis results show that the standardized incidence and mortality rate of female breast cancer in Shanghai began to rise significantly since1980and1982, respectively. The main causes of the change of the breast cancer incidence and mortality are a combination of age, period and cohort factors. The influence factors of incidence are age, period and birth cohort in sequence, the influence factors of mortality are age, birth cohort, and period successively.Part two:CBE for preliminary screening, combined with application of mammography and ultrasonography screening strategies were used for24832people,14breast cancer cases were detected and the detection rate is52.38/100000. Serial application of CBE, ultrasonography and mammography screening strategies were used for24431people,19breast cancer cases were detected and the detection rate is77.77/100000. Parallel application of mammography and ultrasonography screening strategies were used for13483people,32breast cancer cases were detected and the detection rate is237.34/100000. Compared with the screening background incidence rates, Parallel application of mammography and ultrasonography screening strategies increased breast cancer detection rate as well as phase0-I cases ratio (p<0.05), applicate CBE for preliminary screening strategy only increased breast cancer detection rate (p<0.05). Compared with using mammography alone, Parallel application of mammography and ultrasonography screening strategies increased screening sensitivity (p>0.05) meanwhile reduced false-positive rate (p<0.05).Conclusions:Part one:CIR and SIR of female breast cancer in Shanghai increased rapidly. At the same time CMR and SMR were relatively stable, less than the increase magnitude of incidence. Shanghai women’s breast cancer incidence and mortality increases under the influence of age, period and birth cohort effects. The most significant effect were those of age factors, birth cohort secondly, the influence of period factors were relatively weak. The result suggested that breast cancer incidence trends may be related to changes in lifestyle, dietary structure and nutrition change, mortality trends may be related to diagnosis and treatment progress.Part two:The integated quality of screening program use mammography and ultrasonography parallal was better than the other two use CBE for preliminary screening. Quality of screening strategies in following screening was better than the initial screening. Parallel application of mammography and ultrasonography screening strategies would result in higher case detection rate and early stage cancer proportion. Screening strategies mainly rely on radiology examination were more valid than those using CBE for preliminary screening, combined with application of mammography and ultrasonography screening strategies. Assistant application of breast ultrasound examination on the basis of the mammography reduced the false positive rate, but the effect to improve the sensitivity was still not clear.Summary and recommendations:The incidence and mortality trends of breast cancer in shanghai women were possibly related to changes in lifestyle, dietary structure and nutrition change, diagnosis and treatment improvement. Key points of breast cancer prevention and control work were to carry out health education along with the popularization of population-based breast cancer screening program. To carry out population-based breast cancer screening program, priority should be given to screening strategy mainly rely on breast imaging examination in areas with enough health resources, assistant application of ultrasound screening on the basis of mammography may furtherly improve the screening effect. Through carrying out health education and improve population-based screening strategy we could reduce the disease burden of breast cancer. |
PDF Full Text Request