title: [10-year changes and development of surgical treatment for breast cancer in China].
abstract: OBJECTIVE
  To investigate the changes and development of surgical treatment for breast cancer from 1999 to 2008 in China, and compare the differences between the surgical methods used in high-resource and low-resource areas.
  
  
  METHODS
  Clinicopathological data of surgical treatment for female primary breast cancer was collected via medical chart review at hospitals in seven geographic areas in China. Chi-square test and chisqure test for linear trends were used to analyze the changes and development of the surgical methods used for breast cancer in the 10 years.
  
  
  RESULTS
  A total of 4211 primary breast cancer patients were selected from the 10-year database, including 4078 women (97.5%) treated by surgical operation. Among 3271 women (80.21%) treated with modified radical mastectomy, the surgical rate was rising from 68.89% in 1999 to 80.17% in 2008, ascending by 11.28% (χ(2) = 31.143, P < 0.001). In high-resource areas, the surgical rate of modified radical mastectomy was rising from 45.64% in 1999 to 76.13% in 2008, ascending by 30.49% (χ(2) = 89.393, P < 0.001), while in low-resource areas it kept a steady rate at 80% in the ten years (χ(2) = 2.113,P = 0.146). Among 231 women (5.66%) treated with breast-conserving surgery, the surgical rate was rising from 1.29% in 1999 to 11.57% in 2008, ascending by 10.28% (χ(2) = 102.835, P < 0.001). In high-resource areas, the surgical rate of breast-conserving surgery was rising from 2.68% in 1999 to 16.87% in 2008, ascending by 14.19% (χ(2) = 69.544, P < 0.001), while in low-resource areas it was rising from 0.42% in 1999 to 6.22% in 2008, ascending by 5.80% (χ(2) = 30.003, P < 0.001). Among 469 women (11.50%) treated with Halsted radical mastectomy, the surgical rate was declining from 28.28% in 1999 to 4.96% in 2008, descending by 23.32% (χ(2) = 206.202, P < 0.001). In high-resource areas, the surgical rate of Halsted radical mastectomy was declining from 50.34% in 1999 to 3.29% in 2008, descending by 47.05% (χ(2) = 274.830, P < 0.001), while in low-resource areas it was declining from 14.58% in 1999 to 6.64% in 2008, descending by 7.94% (χ(2) = 8.166, P = 0.004). Among 3786 women treated with breast mastectomy (including modified radical mastectomy and Halsted radical mastectomy), the surgical rate was declining from 98.46% in 1999 to 86.36% in 2008, descending by 12.10% (χ(2) = 95.744, P < 0.001). In high-resource areas, the surgical rate of breast mastectomy was declining from 96.64% in 1999 to 80.66% in 2008, descending by 15.98% (χ(2) = 53.446, P < 0.001), while in low-resource areas it was declining from 99.58% in 1999 to 92.12% in 2008, descending by 7.46% (χ(2) = 36.758,P < 0.001).
  
  
  CONCLUSIONS
  The main primary surgical treatment for breast cancer is modified radical mastectomy during the period 1999 - 2008. Halsted radical mastectomy is gradually replaced by modified radical mastectomy and breast-conserving surgery. The rate of changes for breast-conserving surgery and mastectomy is higher in high-resource areas than that in low-resource areas. Breast-conserving surgery will become the main treatment for early-stage breast cancer.
authors.affiliation: Department of Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical Colledge, Beijing 100021, China.
authors.forename: Bao-ning
authors.initials: BN
authors.lastname: Zhang
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.forename: Zhong-hua
authors.initials: ZH
authors.lastname: Tang
authors.forename: Xiao-ming
authors.initials: XM
authors.lastname: Xie
authors.forename: Hong-jian
authors.initials: HJ
authors.lastname: Yang
authors.forename: Jian-jun
authors.initials: JJ
authors.lastname: He
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.forename: Jia-yuan
authors.initials: JY
authors.lastname: Li
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Jin-hu
authors.initials: JH
authors.lastname: Fan
authors.forename: Rong
authors.initials: R
authors.lastname: Huang
authors.forename: Qing-kun
authors.initials: QK
authors.lastname: Song
authors.forename: Hui-ming
authors.initials: HM
authors.lastname: Zhang
authors.forename: You-lin
authors.initials: YL
authors.lastname: Qiao
mesh_terms: D001943:Breast Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000191:economics / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D002681:China; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods* / Q000639:trends; D015411:Mastectomy, Modified Radical; D015409:Mastectomy, Radical; D015412:Mastectomy, Segmental; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012959:Socioeconomic Factors