Don't ignore that lump

By Wen Chihua (China features)
Updated: 2009-10-21 11:58

When the doctor advised her to get a mammogram done, Chen Ying's first reaction was one of despair. "The thought that my worst fears could come true sent a chill down my spine," recalls Chen, a manager of an aircraft factory in Chengdu, capital of Sichuan province.

The mammogram revealed the 46-year-old mother of an 18-year-old girl had late stage cancer in her left breast. The oncologist was clear: Remove the breast or face death.

Chen agreed to the mastectomy and chemotherapy in 2008.

Many events have been launched nationwide to prevent the spread of breast cancer, such as this yoga class in Haikou, Hainan province, which helps local women improve breast health. Peng Tong

She first noticed the lump in her left breast in the spring of 2007 but had ignored it. "I thought, I live a healthy lifestyle and am a good person. Cancer would never find me; the lump would disappear by itself," recalls Chen.

Instead, the lump began to grow - and did so rapidly. In August last year, Chen noted some fluid oozing out of her nipple. But she put off seeing a doctor until November. And when she did, the diagnosis was breast cancer.

Chen's agony was avoidable, but, unfortunately, is becoming increasingly common in the country.

At a recent national conference on the early detection and treatment of cancer held in Chengdu, Kong Lingzhi, deputy director of the disease prevention and control bureau of the Health Ministry said that "owing to changes in lifestyle and diet, breast cancer is spreading more rapidly in China than in Western countries".

She cited figures from the third national survey on causes of death, which suggest that the mortality rate of breast cancer increased 68.6 percent between 2004 and 2005, compared with 1990 to 1992.

Nationally, breast cancer ranks eighth among deaths caused by malignant tumors.

Qiao Youlin, an internationally acclaimed epidemiologist from the Cancer Institute of the Chinese Academy of Medical Sciences, says that breast cancer is the most common malignant tumor afflicting women in cities such as Shanghai and Beijing.

In Beijing alone, where the population stands at 10 million, nearly 50 out of every 100,000 women were diagnosed with breast cancer in 2004, the highest rate in the country and 10 percent higher than in 2000.

More alarmingly, the disease is afflicting younger and younger women. "In 2000 to 2001, the most vulnerable group in the capital was the 45 to 50 age group. "That is five years younger than the most vulnerable group between 1982 and 1983," says Qiao.

One celebrity victim was Chinese movie star Chen Xiaoxu who was only 42 when she lost her battle against breast cancer in 2007.

No one knows why. While breast cancer has been extensively studied in the West, experts have little idea about the risk factors in China, says Dr Li Jiayuan from the West China School of Public Health at Sichuan University.

Li has noticed that the risk factors in the West are strongly associated with family history, being overweight, and reproduction and endocrine problems. They may apply in China as well. But she also believes environmental factors and chemicals play a role here.

She points at the unhealthy lifestyle of younger women - a lack of regular exercise and a penchant for deep-fried chicken or hot dogs. "These fast foods are high in fat, protein and sugar. Chicken and beef are often full of hormones."

Misinformation may also keep women from recognizing or minimizing their risk of breast cancer," warns Li. She notes a couple of common falsehoods - that stress and wearing wired-bras can cause the disease.

Unfortunately, a large number of Chinese women remain ignorant or oblivious to the mounting danger.

To catch the No 1 killer of Chinese women early, and to improve their breast health, the Chinese medical community launched a review last month, in an attempt to discover the clinical features and epidemiological trend of breast cancer.

With financial aid of 1 million yuan ($146,000) from Pfizer, the multi-center project is being carried out in seven major cities - Beijing, Shanghai, Chengdu, Xi'an, Guangzhou, Changsha and Shenyang.

In seven cancer hospitals in these cities, researchers will collect the records of more than 3,500 breast cancer cases treated between 1999 and 2008, and analyze them.

"The review covers cases diagnosed in the past 10 years. The data will pretty much cover the whole country and their analysis will help us get a more complete picture of the disease's epidemiological and clinical features," says Qiao, principal investigator of the project.

Hopefully, when the project is completed at the end of next year, "we can establish reliable grounds for action in standardized screening for breast cancer, find an effective screening model suitable for Chinese women and curb the disease".

The lack of a national cancer registration database means that Chinese oncologists do not completely understand the epidemic nature of the disease. "The data we have now are mostly based on spot checks in a few places in Beijing and Shanghai, which only scratches the surface of the problem," says Qiao.

Since the causes of breast cancer are not yet clear, primary prevention is difficult. Therefore, screening and proper treatment are crucial to bringing down the incidence and mortality rates, according to Qiao.

Dismayingly, "because China has no population-based screening program for breast cancer, the majority of patients are in the advanced stages", says Qiao. He is urging the government to invest more resources in effective screening.

In most areas of Sichuan, the screening has a long way to go. "Experienced doctors and indispensable tools, such as mammography, are only available in big urban hospitals," says Li.

Furthermore, she says, in a recent survey of about 2,000 rural women aged 35 to 69 in the city of Mianyang, none of them ever had mammograms or screening for early breast cancer. Another community-based research of 323 women in Chengdu and Mianyang indicates that only 22.9 percent said they had heard about mammography.

There are three screening methods widely practiced in the West - mammography, ultrasonography and clinical breast examination.

The mammogram is, by far, the most effective method of identifying breast cancer early. It is a low-powered X-ray that captures a picture of the internal structure of the breast, finds tumors, and helps distinguish between non-cancerous and cancerous ones, says Qiao.

Most breast cancer cases are detected by mammography. There is ample evidence from a variety of well-conducted RCTs (randomized controlled trials) that annual or biennial mammography is effective in reducing breast cancer mortality in women between 50 and 69, he says.

One problem is that the cost of about 200 yuan every 1 or 2 years is expensive for women from low-income families.

The World Health Organization recommends that women aged 40 to 69 have regular clinical breast examinations by well-trained medics. "This method is economical, practical, and basic for women without any symptoms.

"Early detection and treatment can slash the cancer death rate by 30 percent," says Qiao.

As for Chen Ying, she is making her "daughter aware of the rising killer. Regular screening for the disease is the best safeguard, when a woman reaches a certain age."