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Women's Feature Service

India - New Delhi

 

China - Breast Cancer: Higher Rates & Mortality, Younger Ages

 

By Wen Chihua\China Features

 

Sichuan (Women's Feature Service) - When the doctor advised her to get a mammogram done, Chen Ying's first reaction was one of despair. "The thought that my worst fear could come true sent chills down my spine," said Ying, 46, a manager at an aircraft factory in Chengdu, capital of the southwestern Sichuan province.

 

The mammogram revealed that Ying, the mother of an 18-year-old daughter, had a late stage ductal carcinoma in her left breast. "Remove the whole breast or die," said the oncologist.

 

Ying agreed to the mastectomy and chemotherapy in 2008, a year after she had first noticed the lump in her left breast. She had then ignored the lump thinking, "I'm a good person. Cancer would never find me. The lump will disappear by itself."

 

Unfortunately, the lump advanced quickly, with some fluid oozing out of her nipple in August. But Ying delayed seeing a doctor until November, when the oncologist delivered the verdict.

 

Ying's agony is avoidable but, unfortunately, it is also increasingly common among women in China. At a recent national conference on the early detection and treatment of cancer held in Chengdu, Deputy Director, Bureau of Disease Control, Kong Lingzhi said, "Because of changes in lifestyle and diet, breast cancer is advancing at a faster rate than in Western counties."

 

Lingzhi cited figures from the third National Survey on causes of death, which suggests that the mortality rate of breast cancer increased by 68.6 per cent between 2004-2005 from 1990-1992. In 2005, China had 142,732 new cases and, sadly, 40,134 women died. Across the country, breast cancer is at the eighth position on the list of causes of death brought about by malignant carcinomas.

 

Dr Qiao Youlin, an internationally acclaimed epidemiologist from the Cancer Institute of Chinese Academy of Medical Sciences, noted that breast cancer is the most common of malignant tumours in women in metropolitan cities, such as Shanghai and Beijing.

 

In Beijing, where the population stands at 10 million, nearly 50 out of every 100,000 women had breast cancer in 2004 - the highest rate in the country, and 10 per cent higher than that of 2000.

 

More alarmingly, the disease is afflicting younger and younger women. "In 2000-2001, the most vulnerable in the capital were those aged between 45-50 years -- this is five years younger than the most vulnerable between 1982-1983," informs Qiao. Oncologists says that even pre-menopausal women in their 30s, or early 40s are afflicted by the disease. In fact, Chinese film star Chen Xiaoxu was only 42 when she lost her battle against breast cancer, in 2007. "But, unfortunately, while breast cancer has been extensively studied in the West, experts have little idea as to the risk factors in China," reveals Dr Li Jiayuan from the West China School of Public Health at Sichuan University.

 

Jiayuan notices that the risk factors in the West are strongly associated with family history, obesity and reproduction and endocrine problems. These may apply in China as well. But she also likes to single out possible environmental factors and chemicals, such as dioxin.

 

She points at the unhealthy lifestyle of the younger women - such as the lack of regular exercise and a penchant for deep-fried chicken or hot dogs. "These Western foods are high-fat, high-protein and high-sugar. Chicken and beef are often full of hormones."

 

"Misinformation may also keep women from recognising or minimising their risk of breast care," warns Jiayuan. She also notes a couple of common myths: that stress and wearing wired bras causes cancer.

 

To catch the most vicious killer of women in China early and improve breast health, the Chinese medical community, recently, launched a retrospective review in an attempt to discover the clinical features and the epidemiological trend of breast cancer.

 

With financial aid of one million yuan from Pfizer, the multi-centre project is being carried out in seven major cities: Beijing, Shanghai, Chengdu, Xi'an, Guangzhou, Changsha and Shengyang where in one cancer hospital per city, researchers will study more than 3,500 breast cancer cases treated between 1999-2008. "The time span of the retrospective review touches upon the cases of the last 10 years. Data from patients will pretty much cover the whole country. This analysis will help us get a more complete picture of the disease's epidemiological and clinical features," says Qiao, the principal investigator of the project.

 

When the project finishes at the end of 2010, it should be possible to establish reliable grounds for action in standardised screening for breast cancer; find an effective screening model suitable for Chinese women; and curb the disease.

 

The current lack of a national cancer registration database means that Chinese oncologists do not completely understand the epidemic nature of the disease. Furthermore, with no clarity on the causes of breast cancer and with inspection facilities like a mammography available only in urban hospitals and are beyond the reach of the poor, primary prevention is difficult. Clearly, screening and proper treatment are crucial to bringing down the incidence and mortality rates.

 

Mammography, ultrasonography and clinical breast examination are three screening measures widely practised in the West, with the mammogram being the most effective method of early detection of breast cancer. A low-powered X-ray captures a picture of the internal structure of the breast, finding tumours and helping to tell the difference between a non-cancerous and cancerous one.

 

The World Health Organization (WHO) recommends that women aged between 40-69 years have regular clinical breast examination by well-trained medics. "Early detection and treatment can slash the cancer death rate by 30 per cent," elaborates Qiao.

 

As for Chen Ying, she now uses her avoidable ailment to make her daughter better aware of the killer disease. "Regular screening for the disease is a best safeguard, when a woman reaches a certain age," she reiterates. She has learnt this through a painful process of understanding.





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