Trends in Disparities and Transitions of Treatment in Patients With Early Breast Cancer in China and the US, 2011 to 2021

Author:

Li Jianbin12,Zhou Jifang3,Wang Haibo4,Liu Zhenzhen5,Fan Zhimin6,Liu Yinhua7,Geng Cuizhi8,Xiao Yue3,Jiang Zefei1,Liu Yunjiang9,Song Yuhua9,Yan Min9,Chen Qianjun9,Lin Ying9,Liu Qiang9,Jin Feng9,Teng Yuee9,Fu Peifen9,Zhang Jianguo9,Li Zhigao9,Chen Yiding9,Wang Kun9,Yin Yongmei9,Zha Xiaoming9,Zhang Haiqing9,

Affiliation:

1. Senior Department of Oncology, The Fifth Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China

2. Department of Medical Molecular Biology, Institute of Biotechnology, Academy of Military Medical Sciences, Beijing, China

3. Department of Public Administration, China Pharmaceutical University, Jiangning Campus, Nanjing, China

4. Breast Cancer Center, Affiliated Hospital of Qingdao University, Qingdao, China

5. Department of Breast Disease, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China

6. Department of Breast Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China

7. Department of Breast Surgery, Peking University First Hospital, Beijing, China

8. Breast Cancer Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China

9. for the Chinese Society of Clinical Oncology Breast Cancer Committee Database Collaborative Group

Abstract

ImportanceBreast cancer treatment has profoundly improved in China recently. However, trends in disparities and transitions of treatment in early-stage cancer between China and the US are not well known.ObjectiveTo identify changes for patients with early breast cancer by using large databases from China and the US.Design, Setting, and ParticipantsThis multicenter cross-sectional study used the Chinese Society of Clinical Oncology Breast Cancer (CSCO BC) database from hospitals in 13 provinces in China and the Flatiron Health (hereinafter referred to as Flatiron) database from more than 280 community oncology clinics in the US. Patients with stage I to III breast cancer diagnosed from January 1, 2011, to December 31, 2021, were included. Data were analyzed from June 10 to December 1, 2022.Main Outcomes and MeasuresThe distribution of age, clinical stage, and cancer subtypes at diagnosis were examined overall and by year. The mean annual percent change (MAPC) from 2011 to 2021 in systemic therapy and surgery was also analyzed.ResultsA total of 57 720 patients with early breast cancer were screened from the CSCO BC (n = 45 970) and Flatiron (n = 11 750) databases. The median age at diagnosis in China among the 41 449 patients included in the age analysis was 47 (IQR, 40-56) years; in the US, the median age was 64 (IQR, 54-73) years. Among patients with clinical stage data in the CSCO BC (n = 22 794) and Flatiron (n = 4413) databases, the proportion of stage I cancer was 7250 (31.8%) vs 2409 (54.6%); stage II cancer, 10 043 (44.1%) vs 1481 (33.6%); and stage III cancer, 5501 (24.1%) vs 523 (11.9%). The proportion of hormone receptor–positive cancer in China was 69.8%, lower than that in the US (87.5%). For patients with ERBB2 (formerly HER2 or HER2/neu)-positive cancer, the proportion in China (30.2%) was higher than that in the US (15.6%). For neoadjuvant therapy, the annual rate increased from 247 of 1553 (15.9%) to 200 of 790 (25.3%) in China, with an MAPC of −4.4% (95% CI, −50.6% to 85.0%; P = .89). For patients with ERBB2-positive cancer, the proportion treated with trastuzumab in early-stage cancer in China increased significantly, with an MAPC of 22.1% (95% CI, 17.4%-26.9%; P < .001), and overtook that in the Flatiron database since 2017 (1684 [68.5%] vs 550 [62.5%]; P < .001).Conclusions and RelevanceThe findings of this cross-sectional study suggest that disparities in treatment of early breast cancer narrowed between China and the US during the study period. The rapid growth of trastuzumab treatment in China was suggestive of differential access to targeted ERBB2 therapy.

Publisher

American Medical Association (AMA)

Subject

General Medicine

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