title: Influence of occupation and education level on breast cancer stage at diagnosis, and treatment options in China: A nationwide, multicenter 10-year epidemiological study.
abstract: The objective of this study was to evaluate the impact of occupation and education level of Chinese female breast cancer patients on their cancer staging at diagnosis, clinical and pathological features, rate of implementation, and selection of treatment.The medical charts of 4211 confirmed female breast cancer cases diagnosed between 1999 and 2008, from 7 breast cancer centers spread across the whole of China, were reviewed. Data including information on the patient's sociodemographic status, clinical and pathological characteristics, implementation of clinical examination and treatment modalities were analyzed. In parallel, the associations between different occupations and level of educational attainment were analyzed in relation to tumor stage through TNM staging, clinical and pathological characteristics, implementation of clinical examination, and treatment patterns. Multivariate logistic regression was used to identify whether the occupation and education level of patients are independent factors of TNM staging at diagnosis.There were significant differences among different occupation groups and the education level of patients in regards to pathological characteristics and treatment choice. Both the occupation and education level of patients were independent factors of TNM staging at diagnosis. For patients within the lower-income occupation or lower educational attainment group, the tumor stage was later, the rates of implementation of relevant investigations were lower, as were the rates of radiotherapy, chemotherapy, and endocrine therapy.This study suggests that strategies should work toward developing more accurate and effective breast cancer prevention and treatment strategies aimed specifically at patients with lower educational attainment levels and at specific occupation groups.
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou Department of Breast-thyroid Surgery, Xiangya Second Hospital, Central South University, Changsha Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang Center of Breast Disease, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.forename: Rong
authors.initials: R
authors.lastname: Huang
authors.forename: Wei-Liang
authors.initials: WL
authors.lastname: Feng
authors.forename: Ya-Nan
authors.initials: YN
authors.lastname: Kong
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.forename: Lin
authors.initials: L
authors.lastname: Zhao
authors.forename: Qing-Kun
authors.initials: QK
authors.lastname: Song
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Bao-Ning
authors.initials: BN
authors.lastname: Zhang
authors.forename: Jin-Hu
authors.initials: JH
authors.lastname: Fan
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
authors.forename: Xiao-Ming
authors.initials: XM
authors.lastname: Xie
authors.forename: Shan
authors.initials: S
authors.lastname: Zheng
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: He
authors.forename: Ke
authors.initials: K
authors.lastname: Wang
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology* / Q000523:psychology* / Q000628:therapy; D002681:China; D002755:Choice Behavior; D003657:Decision Making; D004522:Educational Status; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009790:Occupations