Breast cancer control in China: challenges and opportunities of the use of population-based routine data studies.

Abstract

Breast cancer is a major global public health problem, representing the first or second most common malignancy in the female population all over the world (1), accounting for about 1.4 million new cases annually (2). The worldwide trends are for an increase in breast cancer incidence and a decrease in mortality rates, although the latter is mostly seen only in the wealthier countries (3). Numerous efforts have been made to periodically assess cancer incidence and mortality rates for several cancers throughout the world, namely by the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) (4). Nevertheless, 5-year survival data of good quality with proper long-term follow-up are not widely available (4). One of the main reasons pertains to varying methods of estimating incidence and mortality across different countries, on one hand, and to shortcomings observed in national population-based cancer registries of some countries, on the other (4). Breast cancer 5-year survival rates vary geographically with lower rates noted in the most deprived areas, as shown in a worldwide population-based study using cancer registries’ data (5). Moreover, disparities in mortality and survival seen worldwide highlight not only the inequities in accessing healthcare but also the existent gap in developing countries between cancer burden and ability to put in place effective cancer control measures (6).China is the third largest country in the world, with an emerging economy (7). The reporting of breast cancer epidemiology in the Chinese female population is of utmost importance, since it relates to the highest number of new malignant cases per year in the female population (highest incidence) of the most populous country in the world (8). However, the exact incidence and mortality rates are unknown due to the inexistence or poor quality of cancer registries before 2002. Acknowledging this, the Chinese National Central Cancer Registry (NCCR) was established in 2002 and has published annual reports since 2008 (7). Zeng