Breast cancer screening guideline for Chinese women

The incidence of breast cancer is increasing year-by-year and is the most common malignant tumor in Chinese women. During the past half century, numerous studies in various countries around the world have confirmed that breast cancer screening is the most effective way of improving the rate of early diagnosis, survival rate, and the quality of life of breast cancer patients. Developed countries such as European countries, the United States, and Japan have developed and implemented guidelines for population-based breast cancer screening since the end of the last century. The 5-year survival rate of breast cancer has been increased to 89%. The World Health Organization has stated that early breast cancer is a curable disease, and early diagnosis/treatment is the best way to improve the survival rate of breast cancer. With the development of China's social economy and the comprehensive construction of a well-off society, raising the level of prevention and control of breast cancer is an important task for the Chinese government. Chinese women generally have smaller and denser breasts than Western women. The peak onset age for breast cancer in Chinese women is between 40 and 50 years, which is younger than that in Western countries by 5 to 10 years. Therefore, the development of a population-based breast cancer screening guideline suitable for Chinese women is imperative. In cooperation with the National Clinical Research Center for Cancer (Tianjin Medical University Cancer Institute and Hospital), the China Anti-Cancer Association organized an interdisciplinary expert group consisting of clinicians, epidemiologists, biostatisticians, and public-health administrators to design and implement three large-scale breast cancer screening projects, including the Chinese National Breast Cancer Screening Program (CNBCSP) which targets urban women (CNBCSP-Urban), the CNBCSP-Rural project which targets rural women, and the Chinese Breast Cancer Multi-modality Independent Screening Trial (MIST). These three programs have obtained basic data on population-based breast cancer screening in China, particularly the MIST program. In MIST, all participants received clinical breast examination (CBE), breast ultrasonography (BUS), and mammography (MAM) separately and concurrently. Pathological examination is recommended for any positive or suspicious CBE, BUS, or MAM findings. By summarizing the current evidence on breast cancer screening in Chinese women, referring to the latest breast cancer screening guidelines of Western and East Asian countries, and considering the present social and economic conditions in China, the guideline development group (GDG) formulated the population-based breast cancer screening guideline for women at average-risk and those at h igh-r i sk , r e spec t ive ly . The gu ide l ine prov ides recommendations for breast cancer screening according to the following three aspects: age of screening, screening methods, and screening interval.