Elsevier

The Breast

Volume 22, Issue 5, October 2013, Pages 676-681
The Breast

Original article
A 10-year (1999 ∼ 2008) retrospective multi-center study of breast cancer surgical management in various geographic areas of China

https://doi.org/10.1016/j.breast.2013.01.004Get rights and content

Abstract

Purpose

To study the change of surgical treatments for breast cancer in China over the recent 10 years and the relationship between such a changes and social economical development.

Methods

The data were extracted from the 10-year database of female primary breast cancer at 7 tertiary hospitals from various geographic areas in China. The Chi-square Cochran–Armitage trend test was used to measure the difference.

Results

Over the 10 year period, mastectomy showed a decline trend while breast conserving surgeries increased. The modified radical mastectomy was the primarily surgical treatment. Among various types of mastectomies, modified radical mastectomy was increasing while Halsted radical mastectomy had shown a decrease trend; no significant changes were observed for the simple mastectomy. Halsted radical mastectomy and breast conserving surgery were used in a higher proportion in high economic areas than low economic areas, while the modified radical mastectomy has been underused in hospitals from high economic areas.

Conclusions

Modified radical mastectomy was the overall most common choice of operation in China. Breast conserving surgery has been less popular but had been showing an increasing trend. Halsted radical mastectomy has still been in use but showing a decrease these years. Surgeries were not adherent to guidelines completely and needed further effective training.

Introduction

Breast cancer (BC) was the most prevalent female cancer with 1.40 million new cases occurring in 2008 worldwide and in China, 170 000 new cases amongst females in 2008, with the incidence of 21.6/105.1 From 1975 to 2004 the incidence of BC increased from 17.2/105 to 40.2/105 in Shanghai, with a 4.2% of annual percentage increase.2 Surgery was the major form of intervention for comprehensive treatment of BC and the impacts of various surgical methods were the hot topics in the studies. There were 4 common types of BC surgeries developed: Halsted radical mastectomy in the beginning of 19th century,3 Extended radical mastectomy in 1950s, Modified radical mastectomy in 1960s and the Breast conserving surgery (BCS) in 1980s. The choice of BCS has been increasing since 1990, when the National Institutes of Health Consensus Development Conference Statement was released advising breast conservation.4 Recently, BCS was the primary surgical treatment in United States and more than 60% of early stage (Stage 0 I and Ⅱ)BC patients received this treatment.5, 6 But one population-based study in Shanghai reported, the main surgical treatment was Modified radical mastectomy and few hospitals initiated the BCS2. This study aimed to describe the surgical treatments for female breast cancer under a multi-center design in China. It recruited the BC cases retrospectively in 10 years from 7 geographic regions and investigated the modalities and the development of BC surgical treatment in the 10-year period.

Section snippets

Patents and methods

This study was a hospital-based multicenter 10-year retrospective study and female BC patients were selected randomly from 7 tertiary hospitals of respectively geographic regions.7 Traditionally, China had 7 geographic regions - North east, North, Central, East, South, North west, South west; one tertiary hospital was selected from each region randomly. Since 1999, one month were selected randomly in the whole year in each hospital and then the patients in the selected month were included as

Results

A total of 4211 BC cases were recruited into the study, 4104 subjects received surgical treatments and 4016 patients received mastectomy and BCS. Among the mastectomy, the percentage of Halsted radical mastectomy, modified radical mastectomy and simple mastectomy were respectively 11.4%, 79.7% and 1.1%, respectively. Among the surgical treatments, the average percentage of BCS was 5.6% from 1999 to 2008. Table 1 presents the characteristics of the patients who received surgical treatments:

Discussion

This was the first multi-center hospital-based study investigating the characteristics of surgical treatment for BC and illustrated the trend over time. The data retrospectively covered a 10-year period on the alterations in BC treatment in hospitals. In China, from 1999 to 2008 the major surgical treatment for BC was modified radical mastectomy with the percentage of 79.7% averagely, similarly with the results in the population-based study in Shanghai.2 But the rate of modified radical

Conclusion

BCS was less used in China but could potentially increase in the future in both high and low economic areas. The proportion of mastectomy was higher in China but showed a decreasing trend. Currently in China, the primary surgical treatment for BC is still the modified radical mastectomy and the Halsted radical mastectomy, although still in use, is showing a decrease. At the hospitals from areas of high economic levels the proportions of Halsted radical mastectomy and BCS were higher, but lower

Role of the funding source

The sponsor had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Conflict of interest statement

The authors have no conflict of interests to declare.

Acknowledgments

This work was supported by Pfizer. We thank the Cancer Institute of the Chinese Academy of Medical Sciences (CICAMS) with providing their expertise in the development of this study. We also thank the local investigators from Beijing, Liaoning (Shenyang), Hunan (Changsha), Guangdong (Guangzhou), Zhejiang (Hangzhou), Shannxi (Xian), and Sichuan (Chengdu) for data collection and assisting us with completing this project successfully.

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    Baoning Zhang and Qingkun Song contributed equally.

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