Clinical–pathological characteristics and health care for Tibetan women with breast cancer: a cross-sectional survey

Abstract

BackgroundThe rural and urban integration health-care system is a new and improved health-care system in Tibet, China. The aim of this study was to investigate whether these improvements might alter the clinical–pathologic characteristics of Tibetan female with breast cancer in Tibet. MethodsThis was a single-centre cross-sectional study at Tibet Autonomous Region People's Hospital. We included Tibetan adult women who had been treated for breast cancer in this hospital between Jan 1, 1973, and Dec 31, 2015. The inclusion criteria were: (1) Tibetan adult woman living in Tibet; (2) histopathology or cytopathology, or both, confirming primary breast cancer; and (3) all the treatments were finished in this hospital. The Ethics Committee of TAR People's Hospital passed this project (ID Num: ME-TBHP-15-1). Patient consent was not required according to the routine. χ2 test and logistic regression were applied, using age group and census register as the two covariates. FindingsWe included 273 patients with breast cancer in the final analysis. 14 patients were in the free health-care system, 183 patients had medical insurance combined with a rural cooperative health-care system, and 76 were in a rural and urban integration health-care system. We found a decrease in tumour size (>2 cm vs 2cm; odds ratio 0·117; 95% CI 0·036–0·383) and a decrease in the proportion patients who had invasion (0·460; 0·265–0·797) among women in the rural and urban integration health–care system. The proportion of patients in early stage cancer (5·737; 1·117–29·468) and advanced stage cancer (3·917; 1·406–10·914) increased in the rural and urban integration health–care system. InterpretationThis was the first report about Tibetan women with breast cancer in Tibet. Except for advanced stage breast cancer, the clinical–pathological characteristics of Tibetan women with breast cancer improved during different health-care systems. The overall management in patients with breast cancer in advanced stage might be one of the emphases in the rural and urban integration health-care system. Information and selection bias might be the limitations of this study. FundingNatural Science Foundation of Tibet Autonomous Region (2015ZR-13-61).