Lili Xiong, Zhiyu Liu, Yinglan Wu, Aihua Wang, Hongyun Li, Ting Liang, Yingxia Wang, Guanghui Yang, Xianghua Chen, Junqun Fang, Donghua Xie, Fanjuan Kong
Department of Information Management.
Department of Maternal Healthcare.
Medicine (Baltimore). 2020 Apr;99(17):e19954. doi: 10.1097/MD.0000000000019954.
The Hunan provincial government has implemented a free breast cancer screening program for rural women aged 35 to 64 years from 2016, under a 2015 policy aimed at of poverty eradication and improving women's health in China. However, there has been no population study of the breast cancer screening program in China to date, especially considering exploring differences related to the area's poverty status. We explored differences in risk factors, clinical examination results, and clinicopathological features among breast cancer patients in poor compared with non-poor counties in rural areas of Hunan province from 2016 to 2018 using χ and Fisher's exact test, and multivariate logistic regression analysis. A total of 3,151,679 women from rural areas participated in the screening program, and the breast cancer prevalence was 37.09/10. Breast cancer prevalence was lower in poor (29.68/10) than in non-poor counties (43.13/10). There were differences between breast cancers in poor and non-poor counties in terms of cysts, margins, internal echo, blood flow in solid masses in the right breast on ultrasound examination, lump structure in mammograms, and clinicopathological staging and grading in pathological examinations. Breast cancer in poor counties was more likely to be diagnosed at later stages as determined by ultrasound, mammography, and pathological examinations. Furthermore, indexes of the breast screening program including early detection, prevalence, pathological examination, and mammography examination were lower in poor compared with non-poor counties. Multivariate logistic regression analysis showed that education, ethnicity, reproductive history and the year 2017 were associated with an increased risk of breast cancer in poor counties (odds ratio >1, P < .05). In conclusion, women in poor areas were more likely to be diagnosed with breast cancer at a later stage compared with women in non-poor areas. Women in poor areas of Hunan province should therefore have better access to diagnostic and clinical services to help rectify this situation.
湖南省政府自2016年起针对35至64岁农村女性实施了免费乳腺癌筛查项目，该项目依据2015年一项旨在消除贫困和改善中国女性健康状况的政策开展。然而，迄今为止中国尚未有关于乳腺癌筛查项目的人群研究，尤其缺乏对与地区贫困状况相关差异的探索。我们利用χ检验和Fisher精确检验以及多因素逻辑回归分析，探究了2016年至2018年湖南省农村贫困县与非贫困县乳腺癌患者在危险因素、临床检查结果及临床病理特征方面的差异。共有3151679名农村女性参与了筛查项目，乳腺癌患病率为37.09/10万。贫困县的乳腺癌患病率（29.68/10万）低于非贫困县（43.13/10万）。贫困县与非贫困县的乳腺癌在超声检查右乳实性肿块的囊肿、边界、内部回声、血流情况、乳房X线照片中的肿块结构以及病理检查中的临床病理分期和分级方面存在差异。根据超声、乳房X线照片及病理检查确定，贫困县的乳腺癌更有可能在晚期被诊断出来。此外，贫困县在乳腺癌筛查项目的早期发现、患病率、病理检查及乳房X线照片检查等指标方面低于非贫困县。多因素逻辑回归分析显示，教育程度、民族、生育史以及2017年与贫困县乳腺癌风险增加相关（比值比>1，P<0.05）。总之，与非贫困地区女性相比，贫困地区女性更有可能在晚期被诊断出患有乳腺癌。因此，湖南省贫困地区的女性应能更好地获得诊断和临床服务，以改善这种状况。
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