DOI QR코드

DOI QR Code

Socio-economic Factors Influencing Tumor Presentation and Treatment Options in Chinese Breast Cancer Patients

  • Wang, Ke (Department of Surgical Oncology, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University) ;
  • Li, Xiao (Department of Surgical Oncology, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University) ;
  • Zhou, Can (Department of Surgical Oncology, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University) ;
  • Ren, Yu (Department of Surgical Oncology, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University) ;
  • Wang, Xian-Bing (Department of Surgical Oncology, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University) ;
  • He, Jian-Jun (Department of Surgical Oncology, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University)
  • Published : 2013.01.31

Abstract

The impact of income and education level on the clinical and pathologic characteristics, implementation of clinical breast examination (CBE), and treatment patterns of a small population of Chinese female breast cancer patients was studeied in order to provide a theoretical basis and statistical reference for further nationwide research. We included 484 pathologically confirmed female primary breast cancer inpatients of the First Affiliated Hospital of Medical College of Xi'an Jiaotong University from February 2003 to January 2004. All cases were reviewed and relevant information was collected using a designed case report form (CRF). Chisquare tests, rank-sum tests, and Fisher's exact tests were used in the analysis. Our analysis showed that: (1) women in different occupation groups had significant differences in tumor size, pre-operative mammography, surgical options, post-operative estrogen receptor (ER), progestin receptor (PR) and human epidermal growth factor receptor 2 (Her2) status, and post-operative radiotherapy and chemotherapy (P < 0.05); and (2) women with different education levels had statistically significant differences in tumor size, post-operative ER, PR and Her2 status, and post-operative chemotherapy, radiotherapy, and endocrine therapy (P < 0.05). In Xi'an, China, women in low-income occupations or with low education levels are more likely to have advanced tumor stages at presentation, lower implementation rate of clinical breast examination, and less treatment.

Keywords

References

  1. Adibelli ZH, Oztekin O, Postaci H, Uslu A (2009). The Diagnostic Accuracy of Mammography and Ultrasound in the Evaluation of Male Breast Disease: A New Algorithm. Breast Care (Basel), 4, 255-9. https://doi.org/10.1159/000226284
  2. Andersen BL, Cacioppo JT (1995). Delay in seeking a cancer diagnosis: delay stages and psychophysiological comparison processes. Br J Soc Psychol, 34, 33-52. https://doi.org/10.1111/j.2044-8309.1995.tb01047.x
  3. Andersen RM, Yu HJ, Wyn R, et al (2002). Access to medical care for low-income persons: How do communities make a difference? Med Care Res Rev, 59, 384-411. https://doi.org/10.1177/107755802237808
  4. Andersen RS, Vedsted P, Olesen F, et al (2009). Patient delay in cancer studies: a discussion of methods and measures. BMC Health Serv Res, 9, 189. https://doi.org/10.1186/1472-6963-9-189
  5. Anderson BO, Jakesz R (2008). Breast cancer issues in developing countries: an overview of the Breast Health Global Initiative. World J Surg, 32, 2578-85. https://doi.org/10.1007/s00268-007-9454-z
  6. Arndt V, Sturmer T, Stegmaier C, et al (2002). Patient delay and stage of diagnosis among breast cancer patients in Germany - a population based study. Brit J Cancer, 86, 1034-40. https://doi.org/10.1038/sj.bjc.6600209
  7. Baade PD, Aitken JF, Ferguson M, et al (2010). Diagnostic and treatment pathways for men with prostate cancer in Queensland: investigating spatial and demographic inequalities. BMC Cancer, 10, 452. https://doi.org/10.1186/1471-2407-10-452
  8. Barry J, Breen N (2005). The importance of place of residence in predicting late-stage diagnosis of breast or cervical cancer. Health Place, 11, 15-29. https://doi.org/10.1016/j.healthplace.2003.12.002
  9. Bish A, Ramirez A, Burgess C, Hunter M (2005). Understanding why women delay in seeking help for breast cancer symptoms. J Psychosom Res, 58, 321-6. https://doi.org/10.1016/j.jpsychores.2004.10.007
  10. Burak WE, Jr., Agnese DM, Povoski SP (2004). Advances in the surgical management of early stage invasive breast cancer. Curr Probl Surg, 41, 882-935. https://doi.org/10.1067/j.cpsurg.2004.09.001
  11. Byers TE, Wolf HJ, Bauer KR, et al (2008). The impact of socioeconomic status on survival after cancer in the United States : findings from the National Program of Cancer Registries Patterns of Care Study. Cancer, 113, 582-91. https://doi.org/10.1002/cncr.23567
  12. Carey LA, Perou CM, Livasy CA, et al (2006). Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA, 295, 2492-502. https://doi.org/10.1001/jama.295.21.2492
  13. Carlsen K, Dalton SO, Diderichsen F, Johansen C (2008a). Risk for unemployment of cancer survivors: A Danish cohort study. Eur J Cancer, 44, 1866-74. https://doi.org/10.1016/j.ejca.2008.05.020
  14. Carlsen K, Oksbjerg Dalton S, Frederiksen K, et al (2008b). Cancer and the risk for taking early retirement pension: a Danish cohort study. Scand J Public Health, 36, 117-25. https://doi.org/10.1177/1403494807085192
  15. Chung HW, Noh SH, Lim JB (2010). Analysis of demographic characteristics in 3242 young age gastric cancer patients in Korea. World J Gastroenterol, 16, 256-63. https://doi.org/10.3748/wjg.v16.i2.256
  16. Cunningham PJ, O'Malley AS (2009). Do Reimbursement Delays Discourage Medicaid Participation By Physicians? Health Affair, 28, w17-28. https://doi.org/10.1377/hlthaff.28.1.w17
  17. Dalton SO, During M, Ross L, et al (2006). The relation between socioeconomic and demographic factors and tumour stage in women diagnosed with breast cancer in Denmark, 1983-1999. Brit J Cancer, 95, 653-9. https://doi.org/10.1038/sj.bjc.6603294
  18. Ferrante JM, Gonzalez EC, Pal N, Roetzheim RG (2000). Effects of physician supply on early detection of breast cancer. J Am Board Fam Pract, 13, 408-14. https://doi.org/10.3122/15572625-13-6-408
  19. Fleming ID (1997). American Joint Committee on Cancer: AJCC cancer staging manual. Lippincott-Raven Philadelphia, Philadelphia.
  20. Gilligan MA, Kneusel RT, Hoffmann RG, et al (2002). Persistent differences in sociodemographic determinants of breast conserving treatment despite overall increased adoption. Med Care, 40, 181-9. https://doi.org/10.1097/00005650-200203000-00002
  21. Greene FL (2002). American Joint Committee on Cancer: AJCC cancer staging manual. Springer Verlag, New York.
  22. Grunfeld EA, Hunter MS, Ramirez AJ, Richards MA (2003). Perceptions of breast cancer across the lifespan. J Psychosom Res, 54, 141-6. https://doi.org/10.1016/S0022-3999(02)00522-6
  23. Grunfeld EA, Ramirez AJ, Hunter MS, Richards MA (2002). Women's knowledge and beliefs regarding breast cancer. Brit J Cancer, 86, 1373-8. https://doi.org/10.1038/sj.bjc.6600260
  24. Goldsbury D, Harris MF, Pascoe S, et al (2012). Sociodemographic and other patient characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer: a retrospective cohort study. BMJ Open, 2, 1-13.
  25. Goyal A, Mansel RE (2008). Recent advances in sentinel lymph node biopsy for breast cancer. Curr Opin Oncol, 20, 621-6. https://doi.org/10.1097/CCO.0b013e32831369cb
  26. Green M, Raina V (2008). Epidemiology, screening and diagnosis of breast cancer in the Asia-Pacific region: Current perspectives and important considerations. Asian Pac J Clin Onco, 4, 5-13. https://doi.org/10.1111/j.1743-7563.2008.00191.x
  27. Hortobagyi GN, de la Garza Salazar J, Pritchard K, et al (2005). The global breast cancer burden: variations in epidemiology and survival. Clin Breast Cancer, 6, 391-401. https://doi.org/10.3816/CBC.2005.n.043
  28. Keating NL, Weeks JC, Borbas C, Guadagnoli E (2003). Treatment of early stage breast cancer: do surgeons and patients agree regarding whether treatment alternatives were discussed? Breast Cancer Res Tr, 79, 225-31. https://doi.org/10.1023/A:1023903701674
  29. Kent EE, Sender LS, Largent JA, Anton-Culver H (2009). Leukemia survival in children, adolescents, and young adults: influence of socioeconomic status and other demographic factors. Cancer Cause Control, 20, 1409-20. https://doi.org/10.1007/s10552-009-9367-2
  30. Lannin DR, Mathews HF, Mitchell J, et al (1998). Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA, 279, 1801-7. https://doi.org/10.1001/jama.279.22.1801
  31. Leong SPL, Shen ZZ, Liu TJ, et al (2010). Is Breast Cancer the Same Disease in Asian and Western Countries? World J Surg, 34, 2308-24. https://doi.org/10.1007/s00268-010-0683-1
  32. Li J, Zhang BN, Fan JH, et al (2011). A Nation-Wide multicenter 10-year (1999-2008) retrospective clinical epidemiological study of female breast cancer in china. BMC Cancer, 11, 364. https://doi.org/10.1186/1471-2407-11-364
  33. MacKinnon JA, Duncan RC, Huang YJ, et al (2007). Detecting an association between socioeconomic status and late stage breast cancer using spatial analysis and area-based measures. Cancer Epidem Biomar, 16, 756-62. https://doi.org/10.1158/1055-9965.EPI-06-0392
  34. Masi CM, Blackman DJ, Peek ME (2007). Interventions to enhance breast cancer screening, a diagnosis, and treatment among racial and ethnic minority women. Med Care Res Rev, 64, S195-42. https://doi.org/10.1177/1077558707305410
  35. Meechan G, Collins J, Petrie KJ (2003). The relationship of symptoms and psychological factors to delay in seeking medical care for breast symptoms. Prev Med, 36, 374-8. https://doi.org/10.1016/S0091-7435(02)00053-1
  36. Norsa'adah B, Rampal KG, Rahmah MA, et al (2011). Diagnosis delay of breast cancer and its associated factors in Malaysian women. BMC Cancer, 11, 141. https://doi.org/10.1186/1471-2407-11-141
  37. Pasick RJ, Burke NJ (2008). A critical review of theory in breast cancer screening promotion across cultures. Annu Rev Public Health, 29, 351-68. https://doi.org/10.1146/annurev.publhealth.29.020907.143420
  38. Porter P (2008). "Westernizing" women's risks? Breast cancer in lower-income countries. N Engl J Med, 358, 213-6. https://doi.org/10.1056/NEJMp0708307
  39. Povoski SP, Jimenez RE, Wang WP, Xu RX (2009). Standardized and reproducible methodology for the comprehensive and systematic assessment of surgical resection margins during breast-conserving surgery for invasive breast cancer. BMC Cancer, 9, 254. https://doi.org/10.1186/1471-2407-9-254
  40. Richardson JL, Langholz B, Bernstein L, et al (1992). Stage and delay in breast cancer diagnosis b1y race, socioeconomic status, age and year. Br J Cancer, 65, 922-6. https://doi.org/10.1038/bjc.1992.193
  41. Smith RA, Saslow D, Sawyer KA, et al (2003) American Cancer Society guidelines for breast cancer screening: update 2003. Ca-Cancer J Clin, 53, 141-69. https://doi.org/10.3322/canjclin.53.3.141
  42. Tavassoli FA, Devilee P (2003). Pathology and genetics of tumors of the breast and female genital organs. World Health Organization, Lyon.
  43. Thomson CS, Hole DJ, Twelves CJ, et al (2001). Prognostic factors in women with breast cancer: distribution by socioeconomic status and effect on differences in survival. J Epidemiol Commun H, 55, 308-15. https://doi.org/10.1136/jech.55.5.308
  44. Twelves CJ, Thomson CS, Gould A, Dewar JA (1998). Variation in the survival of women with breast cancer in Scotland. The Scottish Breast Cancer Focus Group and The Scottish Cancer Therapy Network. Br J Cancer, 78, 566-71. https://doi.org/10.1038/bjc.1998.541
  45. Ward E, Halpern M, Schrag N, et al (2008). Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin, 58, 9-31. https://doi.org/10.3322/CA.2007.0011
  46. WHO (1981). Histological typing of breast tumors. World Health Organization, Geneva.
  47. Wilf-Miron R, Peled R, Yaari E, et al (2011). The association between socio-demographic characteristics and adherence to breast and colorectal cancer screening: analysis of large sub populations. BMC Cancer, 11, 376. https://doi.org/10.1186/1471-2407-11-376
  48. Yang L, Parkin DM, Ferlay J, et al (2005). Estimates of cancer incidence in China for 2000 and projections for 2005. Cancer Epidem Biomar, 14, 243-50.
  49. Zhang BN (2002). Progress in surgical treatment of early stage breast cancer. J Practical Oncol, 17, 367-9.

Cited by

  1. Vascular Endothelial Growth Factor (VEGF) Gene Polymorphisms and Breast Cancer Risk in a Chinese Population vol.14, pp.4, 2013, https://doi.org/10.7314/APJCP.2013.14.4.2433
  2. Phase II Study on Breast Conservative Surgery Plus Chemo- and Radiotherapy in Treating Chinese Patients with Early Staged Breast Cancer vol.14, pp.6, 2013, https://doi.org/10.7314/APJCP.2013.14.6.3747