Liu Yang, Zhang Jian, Huang Rong, Feng Wei-Liang, Kong Ya-Nan, Xu Feng, Zhao Lin, Song Qing-Kun, Li Jing, Zhang Bao-Ning, Fan Jin-Hu, Qiao You-Lin, Xie Xiao-Ming, Zheng Shan, He Jian-Jun, Wang Ke
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.
Medicine (Baltimore). 2017 Apr;96(15):e6641. doi: 10.1097/MD.0000000000006641.
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.
本研究的目的是评估中国女性乳腺癌患者的职业和教育水平对其诊断时的癌症分期、临床和病理特征、治疗实施率及治疗选择的影响。回顾了来自中国各地7家乳腺癌中心的4211例1999年至2008年确诊的女性乳腺癌病例的病历。分析了包括患者社会人口学状况、临床和病理特征、临床检查实施情况及治疗方式等信息的数据。同时，通过TNM分期、临床和病理特征、临床检查实施情况及治疗模式，分析了不同职业和教育程度之间与肿瘤分期的关联。采用多因素logistic回归分析确定患者的职业和教育水平是否为诊断时TNM分期的独立因素。不同职业组和患者教育水平在病理特征和治疗选择方面存在显著差异。患者的职业和教育水平均为诊断时TNM分期的独立因素。对于低收入职业或低教育程度组的患者，肿瘤分期较晚，相关检查的实施率较低，放疗、化疗和内分泌治疗的实施率也较低。本研究表明，应制定更准确有效的乳腺癌预防和治疗策略，特别是针对低教育程度患者和特定职业群体。
