I will introduce our recent questionnaire survey about 110 hospitals in mainland China focussing on the breast cancer surgical options. I will review the data according to our survey.
What did you find?
In 2017 in those 110 hospitals in mainland China almost all these hospitals have more than 200 cases in that year so totally we had around 85,000 cases in this survey. We found that in those hospitals the early stage breast cancer, stage 1 is around 30%, stage 2 is around 43% and we still see more than 20% for stage 3 diseases; the DCIS patients is around 15%. So in those patients the breast cancer patients who are receiving conservative surgery is around 22% which is relatively lower than reported in Western countries.
The breast cancer breast conservative surgery, the rate is related to the economic levels. We surveyed the per capita GDP level in 2016; we found that with higher GDP levels in these areas the breast conservative surgery rate is relatively higher. We also investigated the sentinel biopsy in those hospitals. We found that for clinically node negative patients almost all these hospitals will apply sentinel biopsy to evaluate the axilla region status. Also we want to know the breast reconstruction rate for those patients receiving mastectomy in so many patients. We found that the percentage of post-mastectomy breast reconstruction rate is around 10.6% in all series and around 75% of those reconstructions were immediate reconstruction and most of them were implant based breast reconstruction. The autologous flap reconstruction rate is relatively lower and the technique of autologous flap is mainly latissimus dorsi flap. So this is our finding in our series.
What are the main differences between what you find in China and what you see in Western countries?
The breast screening programme needs to be progressed in the future because we do see some locally advanced breast cancer patients and our stage 1/stage 2 disease is relatively lower than in Western countries. Another thing is that our breast surgery speciality training needs to be improved in the future because most of my colleagues who are specialised in breast cancer surgery are from general surgery and they need to be trained in the future to do good clinical practice focussing on breast conservative surgery, especially with oncoplastic conservative surgery and breast reconstruction. We need to push forward some collaboration with plastic surgeons in mainland China.
Did you find differences in China between areas with contrasting economy?
Absolutely because what we investigated this time are all the tier 3 hospitals because these are the top hospitals all over China, almost cover all the provinces in China. But, as you know, China is so big from east to west, the economy level, the teaching level, the medical teaching level is also different dramatically. So we do find some difference between the different areas in the management for breast cancer patients, especially focussing on the options for breast surgeries.
