Journal of the National Cancer Institute Advance Access originally published online on September 23, 2008
JNCI Journal of the National Cancer Institute 2008 100(19):1352-1360; doi:10.1093/jnci/djn305
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© The Author 2008. Published by Oxford University Press.
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Effects of Reproductive and Demographic Changes on Breast Cancer Incidence in China: A Modeling Analysis
Affiliations of authors: Department of Epidemiology, Harvard School of Public Health, Boston, MA (EL, GAC); Division of Engineering and Applied Sciences, California Institute of Technology Pasadena, CA (DS); Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (BAR); Department of Government and Society of Fellows, Harvard University, Boston MA (KL); Institute of Child Health, University College London, London, UK (TH); Institute of Population Sciences, Zheijiang University, Hangzhou, People's Republic of China (JDQ); Department of Epidemiology, Shanghai Cancer Institute, Shanghai, People's Republic of China (YTG); Department of Medicine, Vanderbilt University, Nashville, TN (WZ); Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO (GAC)
Deceased
Correspondence to: Eleni Linos, MD, DrPH, Department of Dermatology, Stanford University School of Medicine, 900 Blake Wilbur Drive Stanford, CA 94305 (email: linos{at}stanford.edu).
Background: Breast cancer incidence is currently low in China. However, the distribution of reproductive and lifestyle risk factors for breast cancer among Chinese women is changing rapidly. We quantified the expected effect of changes in breast cancer risk factors on future rates of breast cancer in China.
Methods: We first validated and calibrated the Rosner–Colditz log-incidence breast cancer model in Chinese women who participated in the Shanghai Women's Health Study cohort (N = 74 942). We then applied the calibrated model to a representative sample of Chinese women who were aged 35–49 years in 2001 using data from the Chinese National Family Planning and Reproductive Health Survey (NFPRHS, N = 17 078) to predict the age-specific and cumulative breast cancer incidence among all Chinese women of this age group. We evaluated the relative impact of changes in modifiable risk factors, including alcohol intake, parity, postmenopausal hormone use, and adult weight gain, on cumulative incidence of breast cancer.
Results: Breast cancer incidence in China is expected to increase substantially from current rates, estimated at 10–60 cases per 100 000 women, to more than 100 new cases per 100 000 women aged 55–69 years by 2021. We predicted 2.5 million cases of breast cancer by 2021 among Chinese women who were 35–49 years old in 2001. Modest reductions in hormone and alcohol use, and weight maintenance could prevent 270 000 of these cases.
Conclusions: China is on the cusp of a breast cancer epidemic. Although some risk factors associated with economic development are largely unavoidable, the substantial predicted increase in new cases of breast cancer calls for urgent incorporation of this disease in future health care infrastructure planning.
| CONTEXT AND CAVEATS Prior knowledge Although the incidence of breast cancer is currently low in most of China compared with Western countries, it has increased dramatically over the last several decades in several cities in China and in other Asian populations, making breast cancer the most common cancer among women in these regions. Study design The Rosner–Colditz log-incidence breast cancer model was validated in Chinese women who participated in the Shanghai Women's Health Study and then applied to Chinese national survey data to predict future trends in the incidence of breast cancer in China associated with changes in demographic and reproductive factors. Contribution Breast cancer incidence in China is expected to increase substantially from the current estimated rate of 10–60 cases per 100 000 women to more than 100 cases per 100 000 women aged 55–69 years by 2021. Modeling predicts 2.5 million cases of breast cancer by 2021 among Chinese women who were 35–49 years old in 2001. Modest reductions in hormone and alcohol use, and weight maintenance are predicted to prevent approximately 10% of these cases. Implications The substantial predicted increase in breast cancer cases in China focuses attention on the adequacy of national infrastructure for breast cancer therapy, the possible benefits of population-based screening for breast cancer, and possible prevention strategies. Limitations Underreporting of the number of children a woman had given birth to in the national survey was possible. The limited availability of individual-level data for many of the demographic variables necessitated the use of various assumptions and imputations in the model, which may have resulted in uncertainty in some projected estimates. The model may slightly overestimate breast cancer incidence at older ages because it does not account for competing risks. From the Editors
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Manuscript received January 22, 2008; revised July 8, 2008; accepted July 30, 2008.
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J Natl Cancer Inst 2008 100: 1339-1341.
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  R. G. Ziegler, W. F. Anderson, and M. H. Gail Increasing Breast Cancer Incidence in China: The Numbers Add Up J Natl Cancer Inst, October 1, 2008; 100(19): 1339 - 1341. [Full Text] [PDF]
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