Three out of four Chinese women have never had a mammogram

by Michael Woodhead
Breast cancer incidence has increased dramatically among Chinese women in the past 20 years most have never had a mammogram and have little interest in undergoing screening, a new study has found.
A survey conducted in 400 women in Wuhan flu d that 75% of the women never had a mammogram. Most women felt that there was little need to have breast cancer screening, especially if they were healthy, and many showed a lack of awareness and knowledge of breast cancer screening.
The study researchers said that the changes in breast cancer incidence and distribution of breast cancer patterns in Chinese women present opportunities for developing and implementing effective public health programs to promote breast cancer screening for women in China.
"It is essential that public health campaigns focus on the importance of early detection and prevention that target both general public and health care professionals working directly with their clients," they say.
They note that the concept of screening while asymptomatic is lacking among Chinese women and a low priority toward breast cancer screening was observed in the study.
"As a result, this study highlights a critical need among general public, health professionals, and the health care system to work collaboratively toward narrowing the gap in breast cancer screening and to improve the quality of breast cancer care in this population.
Source: International Journal of Breast Cancer

Cervical cancer more common in China than previously thought

New review shows high rates of high risk HPV infection and pre-cancerous CIN lesions in Chinese women

by Michael Woodhead
New findings show a high prevalence of high risk-HPV infection and precancerous lesions (CIN2+ ) in Chinese women, suggesting that the cervical cancer burden in China is much greater than previously thought, and that comprehensive screening and HPV immunisation efforts are warranted.
Researchers from the Cancer Institute/Hospital at the Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, say that estimates of cervical cancer rates in China have been based on a small and potentially unrepresentative pool of women in relatively affluent and developed urban areas such as Beijing.
Therefore they reviewed HPV and CIN rates in studies involving 30,207 women throughout China who had HPV testing and liquid-based cytology.
They found that the overall high-risk HPV prevalence was 17.7%. The study also showed high prevalence of every grade of CIN among Chinese women. Nearly 2% of women in the study harbored CIN3+, "an elevated prevalence that is most probably explained by the inadequacy of past and current cervical cancer screening practices in China, particularly among rural women," the researchers say.
Rates of high-risk HPV prevalence were similar in rural and urban areas but showed declines in women aged 25–29  in rural areas and at age 35–39  in urban women. These transient declines may be because the period of childbearing in China and elsewhere tends be accompanied by stronger family ties and fewer extramarital sexual affairs. The earlier dip in high-risk HPV prevalence in rural women may  be explained by the fact that age at first intercourse and first birth were 3 and 4 years earlier, respectively, for rural women compared to urban women. Furthermore, more rural women reported having two or more lifetime sexual partners (22%) than urban women (16%).
In rural and urban women, the CIN2 prevalence was 1.5% and 0.7% respectively and CIN3+ prevalence was 1.2%  and 0.6%, respectively. The prevalence of CIN3+ steadily increased with age, peaking in 45- to 49-year-old women. The steady rise of CIN3+ up to the age group of 45–49 is attributable to lack of lesion removal through screening.
The combined prevalence of CIN2 and CIN3+ in Chinese women (∼3%) was higher than the corresponding prevalence in other Asian countries, where it ranged between 0.5% in Thailand and 1.6% in Mongolia. In addition, the maximal prevalence of combined CIN2 and CIN3+ was observed in Chinese women older than 40–44 years, which was later than the maximal prevalence of CIN2+ in a recent meta-analysis of Asian women.
"Our findings document the inadequacy of current cervical cancer screening in China while indirectly raising the possibility that the cervical cancer burden in China is under-reported," they conclude.
"The high prevalence of CIN2+ in middle-age Chinese women should inform cervical cancer screening policies in China and other low- and intermediate-resource countries. Current cervical cancer screening recommendations are that women between the ages of 35 and 40 years be screened at least once  ... however, our findings show that Chinese women aged 40 years or older should also be screened as they harbour a substantial proportion of precancerous cervical lesions that accumulated over time and may still be the target of life-saving treatments," they suggest.
Read more: International Journal of Cancer

Breast cancer more aggressive and has earlier onset in Chinese women

Breast cancers have a younger age of diagnosis in China

 by Michael Woodhead
Screening for breast cancer in China may need to start earlier because breast tumours are more aggressive and strike earlier than in western countries, Beijing clinicians say.
Researchers from the Department of Pathology at the Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College analysed the pathologic character of female breast cancers treated in seven tertiary hospitals in China between 1999–2008.
They found that on the whole breast cancers in Chinese women were similar in character to those seen in other Asian countries. However, breast cancers in Chinese women showed a younger age at diagnosis, larger tumor size, later tumor stage, than those typically seen in western countries, the researchers found.
They say the  lack of breast cancer screening in China might explain some of the difference as this would reduce the chance of early diagnosis.
Apart from  environmental and social economic factors, the differences of pathological features and biological markers between the Western and Chinese population may also reflect the magnitude of background breast cancer risk and differences in genetic background such as oestrogen receptor alpha gene polymorphisms.
"Our results suggest that Chinese women need breast cancer screening at an earlier age and that Chinese invasive breast cancer may be more aggressive than in western counterparts and need more specific therapeutic models," they conclude.
"Our study provides new findings showing that breast cancer can vary between different ethnic populations due to the magnitude of background breast cancer risk, genetic and/or environment discrepancies. We also [show] the urgent need to employ race-specific breast cancer screening, diagnosis methods and therapeutic models in China."
Source: International Journal of Cancer

Major Chinese path lab provider sees profits drop

Path lab company plans for expansion into rural Chinese hospitals

A leading provider of medical diagnostics and food safety testing in China, China Health Labs & Diagnostics has seen profits fall by 15% in the last nine months.
However, China Health says it has made progress in installing its 'total lab solutions' and delivering its proprietary products to new provinces and regions in China and expects steady growth in the near future.
Gross margins increased by 32% to $5.630 million and by 22% to $13.962 million for the three and nine months ended September 30, 2012, respectively, compared to the same period last year. Profit increased by 48% to $2.357 million and revenue decreased by 11% to $9.623 million for the three months ended September 30, 2012 compared to the same period last year.
Profit decreased by 15% to $3.837 million and revenue increased by 1% to $25.867 million for the nine months ended September 30, 2012 compared to the same period last year.
"The Company continued to show strong financial results and growth of its total lab solutions business into new provinces and regions in China. Since the beginning of 2012, the Company has installed or contracted its BK Clinlabs in six new provinces and regions, which shows significant progress of our marketing team as we were only in four provinces prior to 2012," said Wilson Yao, CEO of China Health.
For the nine months ended September 30, 2012, the decrease in revenue for the point of care testing (POCT) products was offset by an increase in revenue of 25% for the large urban hospital and labs sector. Revenue from POCT solutions and products is generally from large sales orders that are not placed evenly throughout the year.  The Company expects revenue from POCT solutions and products to increase in fiscal 2012, compared to 2011.  In fiscal 2011, revenue from large urban hospitals decreased by 6%, compared to the overall growth in revenue of 35% in fiscal 2011.  In fiscal 2012, the Company expects the large urban sector to grow due to expected increased sales in recurring revenue of reagents and consumables.
Research and development ("R&D") expenditure for the three and nine months ended September 30, 2012 increased by 427% to $0.585 million and by 160% to $1.174 million, respectively, compared to the same periods last year.  In March 2012, the Company launched four new products: Type C POCT Diagnostic Field Lab, Rural Emergency Rescue Medical Total Solution, BK Early Diagnosis System for Cardio-Cerebral Vascular Disease and BK Food Safety Rapid Test System.  These new products were developed to meet specific medical diagnostic and food testing needs of customers and based on the Company's knowledge of Chinese government policy and budget priorities. The margins on new products launched are generally higher than the existing products.
China Health says it is well positioned to expand its business for rural total lab solutions, POCT lab solutions and food safety lab solutions.  However, the Company may need to access additional debt or equity funding if it seeks to accelerate its growth, if it enters into an agreement for a large number of total lab solutions or if it pursues suitable acquisition opportunities. The Company believes that for the fiscal year 2012 it can continue its strong growth in revenue and profits and build on the leading position it has established in China in providing total lab solutions for rural hospitals and clinics, POCT solutions for military and emergency services, and food safety lab solutions, based on the size and growth of the Chinese market for medical diagnostics and food safety, the government support for the market and the Company's proprietary products and services and customer relationships.
In 2012, China Health intends to expand its business by focusing its efforts on expanding its sales network to additional Chinese provinces and cities in the areas where it has proprietary products and limited competition. Going forward, China Health expects revenue growth from its total lab solutions business lines to continue to be stronger than growth from its traditional business with large urban hospitals, and to comprise a higher percentage of revenue.
Read more: Equities

Flawed PSA screening means Chinese men have unnecessary surgery

Many Chinese men have unnecessary prostate biopsies because the PSA screening test cutoff of 4ng/ml is too low

by Michael Woodhead
The first major study to evaluate PSA screening for prostate cancer in a China has found that  the currently-used PSA screening test cutoffs are far too low and will lead to overdiagnosis and over treatment.
Doctors at the Department of Urology of Huashan Hospital, Fudan University in Shanghai, reviewed data from 1,650 men who underwent prostate biopsy for prostate cancer at the hospital from 2003–2011
They found that the overall rate of positive biopsy (47%) was much higher than that seen in western countries (less than 35%), but the positive biopsy rate had fallen gradually over the last ten years.
"This may be due to the fact that PSA testing was not popular in China in earlier years and patients were more likely to be biopsied because they were experiencing other symptoms (e.g. hematuria, dysuria). Therefore, they observed higher detection rates of prostate cancer and dropped thereafter due to widespread use of PSA test," the researchers say.
However, their study also showed that the current benchmark PSA level of 4ng/ml for suspicion of prostate cancer - as used in western countries, was inappropriate for the Chinese population.
Only 5% of men with a total PSA level of 4 ng/mL were diagnosed with prostate cancer, much lower than rates in western countries. Even men with a PSA level of 10 ng/mL had lower risk (15%) than men studied in western studies. The tPSA levels at diagnosis for Chinese men were much higher than levels for men in western countries. The tPSA level at diagnosis fluctuated from 28.6 ng/mL to 50.9 ng/mL (median), while in western trials the median ranged from 11.8 ng/mL to 6.3 ng/L.
"Using a cutoff value of 4 ng/mL for prostate biopsy will cause a large number of men to undergo unnecessary prostate biopsies. Thus, we believe that using a cutoff value of total PSA of greater than 4 ng/mL for prostate biopsy in China is not appropriate," they conclude
"We suggest that when using a PSA of over 4 ng/mL as cutoff value for prostate biopsy, fPSA/tPSA, PSAD or other clinical information should be comprehensively considered before a new cutoff value is set up based on further prospective and larger population studies," they add.
Read more: PLOS One