| Objective In last decade,the incidence of cancer was rising in China.The incidence of breast cancer dominated the first place among women with malignant tumor,while the mortality rate ranked the fourth(only after lung cancer,colorectal cancer,stomach cancer),which had terrible consequences for the women's life and health in our country.The incidence of breast cancer in urban was higher than that in rural,while the mortality of breast cancer in urban was lower than that in rural[1,2].Although there were many reports about the epidemiology of breast cancer[3-5],the epidemiological characteristics of breast cancer,such as age distribution,clinical stage,might have changed over time.There were two main factors for that change: the gradual development of screening,and the improvement of diagnostic techniques.There were few reports on the dynamic evolution trend of breast cancer epidemiology in China,and no relevant reports with large sample data.The aim of this study was to analyze the major epidemiological characteristics of primary female breast cancer in our hospital from January 1st,2000 to December 31 st,2015,which included the onset age,clinical stage and molecular typing,and provide more scientific basis for prevention and screening of breast cancer.Method This study had involved 2482 women primary breast cancer patients,who had initial treatment and surgery in the Military Medical Academy Affiliated Hospital(People's Liberation Army 307 Hospital)from January 1st,2000 to December 31 st,2015.Histological classification referenced to the 2003 World Health Organization(WHO)breast cancer histological classification.TNM staging referenced to the 2010 American Joint Committee on Cancer(AJCC)breast cancer TNM staging.Molecular typing classification referenced to ST Gallen consensus 2013: the luminal type(luminal A + luminal B);triple negative type;HER2 over-expression type.Excel 2013 was used to logging data and diagramming,establishing database,and retrospectively analyzing the distribution and the change trend along with time of onset age,clinical stage and molecular classification.Statistical analysis was carried out by SAS 9.2 software(p< 0.05 was considered statistically significant).All statistical tests were two-sided.Quantitative data was described using the mean ± standard deviation,the median(quartile spacing),and different years data was compared using the variance analysis or Kruskal-Wallis rank sum test.Qualitative data was described using the ratio or constituent ratio,different years data was compared using the chi-square test or Fisher' exact probability method.Result 1.2482 eligible patients with breast cancer mainly came from northern China.The number of breast cancer patients was increased in our hospital from 2000 to 2015.There were 302 cases from 2000 to 2005,1434 cases from 2006 to 2010,while 1434 cases from 2011 to 2015.The median age of the 2482 cases was 48(19 ~ 87)years old,and the peak age was 41 to 60 years old.Primary breast cancer patients aged 36 to 65 years old accounts for 81.43% of the total number of the patients.The median age of the patients was 48(23 ~ 85)years old from 2000 to 2005,48(19 ~ 82)years old from 2005 to 2010,49(20 ~ 87)years old from 2011 to 2015.There was no statistically significant difference in this trend(P = 0.0679).2.There were 193 cases of Early-onset breast cancer patients(< 35 years),accounting for 7.78% of the total number of the patients(193/2482).The rate of early-onset breast cancer was 7.95%(24/302)from 2000 to 2005,7.10%(53/746)from 2006 to 2010,8.09%(116/1434)from 2011 to 2015.There was no statistically significant difference in this trend(P = 0.7127).3.There were 2446 cases(98.5%)of primary breast cancer patients had histological classification in this study,including 203 cases(8.30%)of breast carcinoma in situ,2243 cases(91.70%)of invasive breast cancer.The rate of breast carcinoma in situ was 2.43%(7/288)from 2000 to 2005,6.77%(50/739)from 2006 to 2010,10.29%(146/1419)from 2011 to 2015.The rate of breast carcinoma in situ was rising significantly,and there was statistically significant difference in this trend(P <0.0001).4.There were 2446 cases(98.55%)of primary breast cancer patients had histological classification in this study,including 203 cases(8.30%)of breast carcinoma in situ,2243 cases(91.70%)of invasive breast cancer.The rate of breast carcinoma in situ was 2.43%(7/288)from 2000 to 2005,6.77%(50/739)from 2006 to 2010,10.29%(146/1419)from 2011 to 2015.The rate of breast carcinoma in situ was rising significantly,and the difference was statistically significant(P < 0.0001).5.There were 2403 cases(96.81%)of patients had TNM staging in this study.Of those,203 cases of stage 0 breast cancer,accounted for 8.45%(203/2403).There were 636 cases of stage ? breast cancer,and the rate of stage ? breast cancer was 22.30%(64/287)from 2000 to 2005,23.55%(171/726)from 2006 to 2010,28.83%(401/1391)from 2011 to 2015.There were 1025 cases of stage ? breast cancer,and the rate of stage ? breast cancer was 45.30%(130/287)from 2000 to 2005,47.52%(345/726)from 2006 to 2010,39.54%(550/1391)from 2011 to 2015.There were 449 cases of stage ? breast cancer,and the rate of stage ? breast cancer was 26.83%(77/287)from 2000 to 2005,18.04%(131/726)from 2006 to 2010,17.33%(241/1391)from 2011 to 2015.There were 90 cases of stage ? breast cancer,and the rate of stage ? breast cancer was 3.14%(9/287)from 2000 to 2005,3.99%(29/726)from 2006 to 2010,3.74%(52/1391)from 2011 to 2015.The difference was statistically significant(P < 0.0001).6.There were 1904 cases of early breast cancer which could accept surgery(0 ~? + T3N1M0),accounting for 79.23%(1904/2403)of the breast cancer with TNM staging.The rate of early breast cancer which could accept surgery was 73.52%(211/287)from 2000 to 2005,80.30%(583/726)from 2006 to 2010,79.86%(1110/1390)from 2011 to 2015.The trend was statistically significant(P = 0.0379).7.There were 2238 cases(90.17%)of breast cancer patients who had immunohistochemistry(ER,RP,HER2,Ki-67)in this study,including 171 cases of carcinoma in situ and 2067 cases of invasive carcinoma.Of the invasive carcinoma patients,the rate of Luminal type(including Luminal A and Luminal B)was 73.73%(1524/2067),the rate of triple negative type was 17.42%(360/2067),the rate of HER2 over-expression type was 8.85%(183/2067).The rate of Luminal type was 70.19%(146/208)from 2000 to 2005,72.13%(458/635)from 2006 to 2010,75.16%(920/1224)from 2011 to 2015,which showed a rising trend over time.The rate of HER2 over-expression type was 4.33%(9/208)from 2000 to 2005,8.50%(54/635)from 2006 to 2010,9.80%(120/1224)from 2011 to 2015,which showed a rising trend over time.The rate of triple negative type was 25.48%(53/208)from 2000 to 2005,19.37%(123/635)from 2006 to 2010,15.03%(184/1224)from 2011 to 2015,which showed a decreasing trend over time.The overall frequency distribution was statistically significant(P = 0.0005).Conclusion 1.The median onset age of breast cancer in our hospital was slightly increased in the last five years,but there was no statistically significant difference in this trend.The peak onset age of breast cancer was 41 ~ 60 years old,and the median age was 48 years old from 2000 to 2015.Of this.The patients aged from 36 to 65 years accounted for 81.43%,which should be considered for the focus of breast cancer screening.2.The incidence of Early-onset breast cancer(< 35 years old)was stable,accounting for 8% of the breast cancer.3.The rate of early breast cancer which could accept surgery(0~?+T3N1M0),especially the carcinoma in situ(0 period)and stage ? breast cancer,had significantly increased in recent years,while the rate of local advanced breast cancer had a tendency to decreasing.And the rate of stage ? breast cancer was not significantly changed.4.Molecular classification of invasive breast cancer was not changed much over time.This study found that the rate of Luminal type and HER2 over-expression type breast cancer had a tendency to increase.The Luminal type was one of the main molecular subtypes,with a high rate more than 75% in recent 5 years. |
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