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Comparison of data from China and the United States
According to the cancer burden data of the World Health Organization International Cancer Research Institute (IARC), it is estimated that 430,000 women in China will be diagnosed with breast cancer in 2022; 120,000 deaths [1].
Recently, the God-made magazine CA released the "Annual Report on Breast Cancer Statistics of American Women" [2], which counted breast cancer incidence, death, survival and mammogram screening data. Today, the Medical Cancer Channel will take you to savor this important data.
report homepage screenshot
30 years, the mortality rate of breast cancer has dropped by 43%!
1 Estimated new and deaths in 2022
Report predicts that in 2022 there will be about 287,850 newly diagnosed invasive breast cancer in the United States and 51,400 newly diagnosed ductal carcinoma in situ (DCIS), and 43,250 women will die of breast cancer.
83% of invasive breast cancers are diagnosed in women aged 50 and older, 91% of breast cancer deaths occur in this age group; half of breast cancer deaths occur in women aged 70 and older. The median age for diagnosis of breast cancer in women was 62 years old and the median age for death was 69 years old.
Breast cancer incidence and mortality rates for women of specific ages by race/ethnicity (2015–2019) and mortality rates (2016–2020)
Although breast cancer is mainly a female disease, 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 cases and deaths in all breast cancers.
2 Estimated number of breast cancer survivors in 2022
As of January 1, 2022, about 4.1 million women in the United States have a history of breast cancer. About 4% suffer from metastatic disease, and more than half of them are initially diagnosed with early stage (stage I-III) cancer.
3 Current 5-year survival rate of breast cancer
The survival rates of breast cancer in different stages vary greatly when diagnosed. The 5-year relative survival rate for patients diagnosed with stage I between 2012 and 2018 was 99%, 93%, 75%, and 29% in stage IV.
U.S. 5-year breast cancer relative survival rate (%) listed by diagnosis stage and race/ethnicity from 2012 to 2018. Note: The survival period is based on how the high 5-year survival rate of patients diagnosed between 2012 and followed up to 2019 is created by the high 5-year survival rate of patients with diagnosis and follow-up from 2012 to 2018?
1 The "gradual distant" of morbidity and mortality
The incidence of breast cancer in the United States has been rising for most of the past 40 years: the increase in
in the 1980s and 1990s was mainly due to the increase in the detection rate of asymptomatic diseases during the rapid popularity of mammography screening. In women aged 50 and older, the incidence of DCIS increased by more than 10 times; the incidence of invasive breast cancer increased by 40%.
1975-2019 The incidence trend of ductal carcinoma in situ and invasive breast cancer in the United States by age
From 2001 to 2004, the incidence of invasive breast cancer decreased sharply, mainly due to the reduction in the use of estrogen-progesterone after After the publication of the research results on the risks of breast cancer related to breast cancer and heart disease .
Since 2004, the incidence of invasive breast cancer has slowly increased at a rate of 0.5% per year, and some studies attribute it to the increase in the body mass index and the continuous decline in fertility.
The increase in breast cancer incidence 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 localized disease increased by 0.9% per year, and the incidence of regional diseases decreased by 0.7% per year, which may reflect the early transition of breast cancer diagnosis.
2004-2019 Trend of breast cancer incidence in women by staging and race in the United States
In contrast, breast cancer mortality has steadily declined since its peak in 1989: From 1975 to 1989, the total breast cancer mortality rate increased at a rate of 0.4% per year, but has since fallen by 43% to 2020. Due to this decline, American women avoided 460,000 breast cancer deaths from 1989 to 2020. The decline in breast cancer mortality is attributed to better and more targeted treatments and early detection from mammogram screening.
However, the recent decline in mortality rate 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 stable mammogram screening rate.
Figure 9 Trends of mortality in female breast cancer in the United States by race/ethnicity from 1975 to 2020
1 Treatment threshold continues to move forward
2018, 63% of stage I or II patients underwent breast-conserving surgery with or without adjuvant radiotherapy, and 33% of patients underwent mastectomy. Although most patients receive chemotherapy after surgery, 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 non-radical radiotherapy and/or chemotherapy.
2018 breast cancer treatment model listed by stage and race (%)
has a gap from tertiary prevention . It depends on how Chinese breast cancer prevention and treatment is in line with "international"
. The overall US breast cancer patients are more than 90%, and the 5-year survival rate of stage I patients is close to 100%. The 5-year survival rate of Chinese breast cancer patients is 82.8%, which is still at the level of the United States in the last century [3,4]. It can be seen that my country has a long way to go in the road to prevent and control breast cancer.
For this annual report on breast cancer statistics, we might as well compare the current situation of breast cancer prevention and treatment in China and the United States from the third-level prevention and treatment step by step, and take a look at the successful experience of breast cancer prevention and treatment in the United States.
1 primary prevention
means etiology prevention. It is the most active and fundamental prevention method to prevent the occurrence of breast cancer by controlling etiology or risk factors. The risks associated with breast cancer can be classified into three categories: unchangeable (e.g. age), potentially alterable (e.g. estrogen exposure, fertility), and alterable (e.g. overweight, alcohol consumption).
Age is an unchangeable risk factor related to breast cancer. In the United States, the median age of breast cancer in women is 62 years old and is showing a continuous growth trend. The age trend of onset among Chinese women shows two major characteristics: the median onset age is 10-20 years ahead of schedule and is in a bimodal morphology [5].
Age trend of breast cancer in Chinese women
Among the potentially variable factors, the reduction in the use of hormone replacement therapy (HRT) in the United States has brought about a sharp decline in the incidence of breast cancer from 2001 to 2004; while the continued increase in infertility and late fertility rates may be related to the increase in the incidence of breast cancer since 2004. China's aging and fertility rate continue to decline will undoubtedly "help" the incidence of breast cancer to rise.
can change risk factors support the "half of the sky" of cancer [6]. 30% of breast cancer cases can be attributed to to mutable risk factors such as overweight, lack of exercise and alcohol consumption. This report directly points out that the slow increase in breast cancer in the United States has been a "overweight" "mark of military merit" since 2004. In my country, cancer deaths attributable to change risk factors account for more than 40%, and 23.2% of breast cancer, with obesity (16.4%) ranked first [7]. Seeing this, everyone, how about putting down the milk tea in your hand? (Dog head)
2 Secondary prevention
is what we most often emphasize "early detection, early diagnosis, and early treatment". Undoubtedly, the United States is at the forefront of the world in terms of early diagnosis and early screening of breast cancer. Since the 1980s, mammography for breast cancer has been widely popular in the United States. At present, European and American countries have increased the early detection rate to 80% by widely implementing standardized and standard breast cancer screening projects, of which more than 20% were found through screening [8].
In contrast, my country has only started large-scale breast cancer screening for women in rural and urban areas in 2008 and 2012, which is nearly 30 years later than in the United States. However, with the gradual deepening of Chinese women's perception of breast cancer and the further popularization of screening, early diagnosis and treatment are undoubtedly a major scoring point for the decline in breast cancer deaths in China.
3 Third-level prevention
is rehabilitation prevention, mainly providing various treatment methods for confirmed patients to improve survival and rehabilitation rates, including preventing tumor recurrence, 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 technology have largely replaced axillary lymph node dissection and become the basis for staging of breast cancer. Especially for women over 70 years of age who are ER-positive and HER2-negative small (T1) tumors, they are considered safe to avoid any axillary stage surgery.
21 gene recurrence score determination method Oncotype DX can be used to predict the efficacy of chemotherapy in patients with HR-positive/HER2-negative lymph node-negative breast cancer. Recently, TAILORx clinical trials also found that chemotherapy is only beneficial to women under 50 years old, and the "dechemotherapy" process is +1.
Although treatment progress in triple-negative breast cancer (TNBC) lags behind other subtypes, recent clinical trials have shown that some targeted and immunotherapeutic drugs have achieved inspiring results. For example, the combination of pembrolizumab in combination with standard chemotherapy can prolong progression-free survival and improve pathological complete remission in women with early TNBC. The blockbuster new drug targeted therapy DS-8201 has significantly improved the overall survival rate of patients with drug resistance, metastasis, HER2-positive and HER2-low-expressing breast cancer.
In my country, the concept of breast cancer has been deeply rooted in the hearts of the people. The pace of entry of new foreign drugs has accelerated. After domestic independent research and development is unwilling to be the case, the treatment end is progressing with each passing day, and the benefits of Chinese patients' survival have been continuously made.
But it is true, "the top treats before the disease is cured, the top treats the disease before the disease is cured, and the bottom treats the disease already." When it comes to preventing and treating breast cancer, the "best doctor" must be ourselves.
References:
[1]Xia, et al, 2022:profiles,trends, and determines.Chinese Medical Journal:March 5,2022-Volume 135-Issue 5-p 584-590
doi:10.1097/CM9.00000000000000002108
[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 survival 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,Zhen 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 survive 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 modified 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 for the development of Chinese female breast cancer screening guidelines for the Chinese female breast cancer screening guidelines (2022 edition)[J]. Chinese research hospital, 2022, 09(2):6-13.
This article is first published: Medicine World Tumor Channel
Author of this article: Lily
Review of this article: Xu Weiran
Editor: Sweet
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