Performance of breast cancer screening methods and modality among Chinese women: a report from a society-based breast screening program (SBSP) in Shanghai

Abstract

To evaluate the screening performance of individual and combined use of clinical breast examination, ultrasonography and mammography in Chinese women, we conducted a biennial breast cancer screening program among 14,464 women aged 35 to 74 years old who lived in Qibao County, Minhang district of Shanghai, China, between May 2008 and Sept 2012. All participants were submitted to clinical breast examination, and then women with positive results and all women at age of 45-69 years old were preformed breast ultrasonography and mammography. The examination results were compared against pathological findings as the gold standard of reference. A total of 66 women were diagnosed with breast cancer in the two rounds of the screening, yielding an incident rate of 194 per 100,000 person-years. The sensitivity of clinical breast examination, ultrasonography and mammography alone were 61.4%, 53.7% and 67.3%, respectively. While mammography performed better in elder age groups and hormone receptor positive disease groups, ultrasonography had a higher sensitivity in younger age group and did not differ in sensitivity by estrogen receptor or progesterone receptor status. Combined use of the two imaging examinations increased the sensitivity in almost all age groups, but had a higher sensitivity in hormone receptor positive cancers than in those negative. Our results suggest that the Qibao modality is an effective strategy for breast cancer screening among Chinese women, especially for early detection of elder and hormone receptor positive breast cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-2-276) contains supplementary material, which is available to authorized users.

Breast Cancer Challenges and Screening in China: Lessons From Current Registry Data and Population Screening Studies

“…Using these methods to screen 1.2 million women at 200 screening sites, the detection rate was 48.0/10 5 , and early-stage lesions were detected in 440 cases. A site variation was observed in the screening detection rate [37]. The general detection rate in these 35-to 59-year-old screened rural women was lower than the reported occurrence rate in the same general population of women.…”

“…US was more sensitive than mammography among Chinese women younger than 55 years [39]. Nevertheless, the age of women in the secondgeneration screening programs was extended to 64 years, and mammography might be a better screening tool for these older women [37]. It is necessary to create a practical guideline for screening site selection and to take actions to support the selected sites to conduct high-quality screening programs.…”

Quality assurance target for community-based breast cancer screening in China: a model simulation

“…It was identified, that to ensure a probability of 95% for cost effectiveness of the annual screening strategy at the 3 GDP level of WTP, the quality assurance target would need to be 50%. In another breast cancer screening program with a similar design in Qibao Shanghai, about 30% of participants who should have undergone imaging did not [ 33 ]. It is important to educate, train, and motivate referring clinicians in community health services of the importance of their role in enabling women to make informed decisions [ 34 , 35 ].…”

Mammography screening in less developed countries

“…Two-view film mammography with annual screening was used in a localized area in Shanghai. Sensitivity of MS was tested in different age group, 65.4 % in age 45–59 years and 66.8 % in age 60–69 years (Mo et al 2013 ). With adequate follow-up, long term outcome can be analyzed and CEA will be conducted in the near future.…”