title: Breast Cancer Disparities: A Multicenter Comparison of Tumor Diagnosis, Characteristics, and Surgical Treatment in China and the U.S.
abstract: OBJECTIVE
  Incidence of and mortality rates for breast cancer continue to rise in the People's Republic of China. The purpose of this study was to analyze differences in characteristics of breast malignancies between China and the U.S.
  
  
  METHODS
  Data from 384,262 breast cancer patients registered in the U.S. Surveillance, Epidemiology, and End Results (SEER) program from 2000 to 2010 were compared with 4,211 Chinese breast cancer patients registered in a Chinese database from 1999 to 2008. Outcomes included age, race, histology, tumor and node staging, laterality, surgical treatment method, and reconstruction. The Pearson chi-square and Fisher's exact tests were used to compare rates.
  
  
  RESULTS
  Infiltrating ductal carcinoma was the most common type of malignancy in the U.S. and China. The mean number of positive lymph nodes was higher in China (2.59 vs. 1.31, p < .001). Stage at diagnosis was higher in China (stage IIA vs. I, p < .001). Mean size of tumor at diagnosis was higher in China (32.63 vs. 21.57 mm). Mean age at diagnosis was lower in China (48.28 vs. 61.29 years, p < .001). Moreover, 2.0% of U.S. women underwent radical mastectomy compared with 12.5% in China, and 0.02% in China underwent reconstructive surgery.
  
  
  CONCLUSIONS
  Chinese women were diagnosed at younger ages with higher stage and larger tumors and underwent more aggressive surgical treatment. Prospective trials should be conducted to address screening, surgical, and tumor discrepancies between China and the U.S.
  
  
  CONCLUSIONS
  Breast cancer patients in China are diagnosed at later stages than those in America, which might contribute to different clinical management and lower 5-year survival rate. This phenomenon suggests that an earlier detection and treatment program should be widely implemented in China. By comparing the characteristics of Chinese and Chinese-American patients, we found significant differences in tumor size, lymph nodes metastasis, and age at diagnosis. These consequences indicated that patients with similar genetic backgrounds may have different prognoses due to the influence of environment and social economic determinates.
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Priya G
authors.initials: PG
authors.lastname: Sivasubramaniam
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Bai-Lin
authors.initials: BL
authors.lastname: Zhang
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Zhong-Hua
authors.initials: ZH
authors.lastname: Tang
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Guo-Ji
authors.initials: GJ
authors.lastname: Chen
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Xiao-Ming
authors.initials: XM
authors.lastname: Xie
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Xiao-Zhou
authors.initials: XZ
authors.lastname: Xu
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Hong-Jian
authors.initials: HJ
authors.lastname: Yang
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: He
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Jia-Yuan
authors.initials: JY
authors.lastname: Li
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Jin-Hu
authors.initials: JH
authors.lastname: Fan
authors.affiliation: Fogarty Global Health Fellowship Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Departments of Epidemiology and Breast Cancer, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Beijing, People's Republic of China; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA; Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, People's Republic of China; Department of Breast-Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China; Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Gungzhou, People's Republic of China; Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Oncosurgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China; Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu, People's Republic of China; Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China qiaoy@cicams.ac.cn.
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D002681:China / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States / Q000453:epidemiology
keywords: Breast cancer; China; Disparities