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. 2023 May;12(9):10865-10876.
doi: 10.1002/cam4.5792. Epub 2023 Mar 23.

Disparities in stage at diagnosis among breast cancer molecular subtypes in China

Hongmei Zeng  1 , Siqi Wu  2 , Fei Ma  1 , John S Ji  3 , Lingeng Lu  4 , Xianhui Ran  1 , Jin Shi  2 , Daojuan Li  2 , Lan An  1 , Rongshou Zheng  1 , Siwei Zhang  1 , Wanqing Chen  1 , Wenqiang Wei  1 , Yutong He  2 , Jie He  1
Affiliations

Disparities in stage at diagnosis among breast cancer molecular subtypes in China

Hongmei Zeng et al. Cancer Med. 2023 May.

Abstract

Background: Disease stage at diagnosis and molecular subtypes are the main determinants of breast cancer treatment strategies and prognosis. We aimed at examining the disparities and factors associated with the stage at diagnosis among the molecular subtypes in breast cancer patients in China.

Methods: We identified patients with first primary breast cancer diagnosed between January 1, 2016, and December 31, 2017, from 23 hospitals in 12 provinces in China. We analyzed the proportion of non-early-stage (stages II-IV) breast cancer cases based on the family history of breast cancer, body mass index (BMI), insurance status, and molecular subtypes. Multivariable analyses were used to estimate the factors associated with non-early-stage diagnosis among the molecular subtypes. We further compared these estimates with that in the United States using the Surveillance, Epidemiology, and End Results database.

Results: A total of 9398 Chinese were identified with first primary invasive breast cancer. Of the 8767 patients with known stages, the human epidermal growth factor receptor 2 (HER2)-enriched subtype had the highest proportion of stages II-IV (76.6%) patients, followed by triple-negative breast cancer (73.2%), luminal B (69.9%), and luminal A (62.3%). The percentage of non-early-stage patients was higher in women with overweight or obesity than in those with a body mass index (BMI) <25 kg/m2 (adjusted odds ratio [OR] 1.3, 95% confidence interval (CI) 1.1-1.4). Patients with a family history of breast cancer had a higher likelihood of early-stage (adjusted OR 0.7, 0.5-0.8) breast cancer. Patients with rural insurance had a substantially higher risk of non-early-stage disease than those with urban insurance (adjusted OR 1.8, 1.4-2.2). Regarding the subtype, being overweight/obese only increased the risk of non-early-stage in luminal A breast cancer. Compared with the United States, China had a higher proportion of non-early-stage breast cancer for all subtypes, with the largest gap in luminal A (adjusted OR 2.2, 95% CI 2.0-2.4).

Conclusion: The wide disparities in stage at breast cancer diagnosis imply that China urgently needs to improve early breast cancer diagnosis and health equity.

Keywords: China; United States; breast cancer; molecular subtype; stage at diagnosis; surveillance.

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Conflict of interest statement

The authors declared no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study sample in China.
FIGURE 2
FIGURE 2
Stage distribution of breast cancer molecular subtypes by family history of breast cancer, body mass index(BMI), and medical insurance type. (A) By family history of breast cancer. (B) By BMI. (C) By medical insurance type.
FIGURE 3
FIGURE 3
Stage distribution for breast cancer and by molecular subtype in China and in the United States. (A) Stage distribution for all patients. (B) Stage distribution for all patients excluded with unknown stage at diagnosis.
See this image and copyright information in PMC

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