| ObjectiveTo investigate the prevalence, treatment pattern and prognosis condition of women with breast cancer in Wuhan, and to explore the impact of demographic characteristics, clinical characteristics, socio-economic status on breast cancer survival, in order to recommend effective strategy for preventing the incidence of breast cancer and improving the quality of life of patients who suffered from the cancer, so as to ultimately reduce the prevalence and mortality of breast cancer, and improve quality of life of women.MethodsPopulation-based, qualitative study combined with quantitative study method was adopted. The main qualitative study was literature review, mainly collecting data of women with breast cancer of different age groups at different regions from 2003 to 2008 in various large-scale surveys conducted in Wuhan and China; quantitative surveys used self-made questionnaire to carry out face-to-face interviews to patients with incipient breast cancer. All data were analyzed through statistical software SAS9.0 with descriptive analysis,χ2 test, nonparametric hypothesis testing, fitting univariate and multivariate COX proportional hazards regression models. Results1. Demographic characteristicsAmong the 204 women with breast cancer, the number of survival at the end of the study was 151, with a total survival rate as 74.02%; the number of death was 53, so the total mortality rate was 25.98%.Most of the women with breast cancer were diagnosed at age over 51 years old, the number of which was 132 (64.70%). The women who were diagnosed at age younger than 40 years old had the highest survival rate (88.89%). The mortality rates of various diagnosed age groups had statistically significant differences (χ2= 8.3270, P= 0.0039). The women with literacy of college or above had the highest survival rate (90.82%). Mortality rates of different literacy had statistically significant differences (χ2= 15.1842, P<.0001). Of the 204 women,141 (69.12%) were married, the survival rate of which was 90.78%. The mortality rates of different marital status groups had statistically significant differences (χ2= 66.6948, P<.0001).Most of the patients were engaged in intellectual work, the number of which was 105 (51.47%); followed by 99 (48.53%) who were engaged in physical labour. Patients engaged in intellectual work had the highest survival rate (80.95%). The mortality rates of different work attribute had statistically significant differences (χ2= 5.4076, P= 0.0200). There were 107 women who were menopausal (52.45%), the survival rate of which was 60.75%, lower than that of which who were not menopausal, the difference of which was statistically significant (χ2= 20.6119, P<.0001). Most of women had menopause at 46-50 age group, with number of 99 (48.53%); followed by the 41-45 age group as 58 (28.43%); The women who had menopause at 41-45 age group had the highest survival rate of 89.66%. Mortality rates of various menopause age groups was significantly different (x2= 21.3150,p<.0001).There were 27 (13.24%) women with a family history of breast cancer at first-degree relatives. The women who did not have family history of breast cancer had higher survival rate than that who had (χ2= 60.3245, P<.0001). A total of 170 (83.33%) women had a history of benign breast diseases. The women without history of benign breast diseases had higher survival rate (χ2= 0.9992, P= 0.3175).2. Clinical FeaturesThere are 14 ductal carcinoma in situ (6.86%) and 190 invasive breast cancer (93.14%) in this study. Patients with ductal carcinoma in situ were all survival, while the survival rate of invasive breast cancer patients was 72.11%; there was statistically significant difference for mortality rates of different breast cancer histological types (χ2=3.9251, P= 0.0476) as well as the mortality rates of breast cancer patients of different pathologic classification (x2 =15.9340,P<.0001). The highest breast cancer survival rate was early invasive ductal carcinoma (85.73%); the second was invasive ductal carcinoma (77.63%).There was statistically significant difference for mortality rates of different carcinoid tumor size (χ2=30.6770, P<.0001); patients with tumor diameter less than 2 cm had the highest survival rate (92.45%). The difference of mortality rates of different regional lymph node metastasis was statistically significant (χ2=35.6698, P<.0001); The survival rates of patients with subclavian (supraclavicular) lymph node metastasis or internal mammary lymph node metastases accompanying axillary node metastases were lowest (34.15%); the survival rates of patients with distant metastasis (20.63%) much lower than no distant metastasis (97.87%) (χ2=131.0939, P<.0001). The degree of tumor differentiation was lower, the mortality was higher, the difference was statistically significant (x2=5.9108, P=0.0150).There was statistically significant difference for mortality rates of different treatment methods (χ2=13.0673, P= 0.0003); In all treatment methods of breast cancer, the treatment combiming with a surgical operation, chemo-therapy and other treatments had the highest survival rate (88.00%). The survival rates of patients who responded well to treatment were much higher than those who were not with treatment, the difference was statistically significant (χ2=16.8585, P<.0001).3. Social factorsThe survival rates of patients with family and friends support (78.72%) were higher than no family and friends support (18.75%), the difference was statistically significant (χ2 =24.548, P<.0001). There was statistically significant difference for mortality rates of different methods of medical payment (χ2= 61.5931, P<.0001);The survival rates of patients with free medical care, social basic health insurance and business insurance were higher than those who has medical at their own expense. There was statistically significant difference for mortality rates of different hospital-level of postoperative chemotherapy (χ2 =15.584, P<.0001);The mortality rates from the lower to higher were ranked as follow: provincial/municipal hospital (three level of first-class hospital), Community Health Center (town or village hospital), provincial/municipal hospital (not three level of first-class hospital) and district hospital.4. Cox's model analysisThe result of univariate analysis of Cox showed that diagnosis age, regional lymph node metastasis, ER (+),PR (+),degree of tumor differentiation and tumor location all have an impact on breast cancer survival. Diagnosis age, regional lymph node metastasis and degree of tumor differentiation were incorporated into the model based on the multivariate Cox proportional hazards regression analysis; the diagnosis age of breast cancer had shown a protective effect; however, the regional lymph node metastasis and degree of tumor differentiation were risk factors; the results were statistically significant (P<0.05). ConclusionsBreast cancer survival is a common result of many factors. It depends not only on patients'physical, diagnosis age, education, job attributes and marital status also depends on the pathologic classification of cancer, treatment and social and psychological factors. Good physical function, strong immunity and tolerence to the drug therapy can resistance the development of breast cancer to prolong the survival time. Certain economic conditions are good patients could choose a better medical care hospital for treatment; even surgery can not be advanced breast cancer patients can also put chemo-therapy, Chinese medicine treatment and some biological therapies to extend survival of patients.Therefore, patients with breast cancer should establish confidence and clear of their disease to try hard to find the most appropriate treatment approach to improve the quality of life.
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