CRISIS IS OPPORTUNITY:The State of Breast Cancer Care in China

 

Shanghai China

 Crisis is Opportunity

I had the great fortune to be asked to write the introduction for my dear friend Susan Apollon’s new book An Inside Job: Healing Wisdom for your Cancer Journey. I was able to read this amazing manuscript on my recent flight to Shanghai China. She talks in the book about the irony that in the Chinese characters for “Crisis” and “Opportunity” share a symbol. I have always believe that through adversity we have the opportunity to grow spiritually and apparently the Chinese are in agreement.

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Four hours after take off from Newark, NJ the wheels of United Airlines Flight 86 touched down at Pudong International Airport Shanghai China. I left the USA on a Wednesday at eleven AM and touched down in China 14 hours later Thursday at 2:30 PM. Fast way to lose a day. I awoke half way through the flight and checked our flight path to find that we were over the northern most regions of Russia and the temperature outside was -90 degrees Fahrenheit. By the time I opened my IPad to snap a pic the temperature increased by a whole degree. We flew over the Arctic Circle who knew?

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The 13th Chinese Breast Cancer Conference and The 9th Shanghai International Breast Cancer Symposium took place over a three-day period. There were in excess of two thousand breast cancer physicians in attendance. I was honored and humbled to be one of several invited speakers from around the world. I was quite surprised to find that minimally invasive biopsies for diagnosis and treatment of breast disease were not the standard of care in China. It has been over 6 years that I have given a lecture specifically on the benefits of vacuum assisted biopsy to diagnose breast cancer.

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If your eyes are really good you can read my name on the main event roster!

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I was one of a handful of speakers from the “West” our names are obvious

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2000 Chinese Breast Cancer Physicians in Shanghai China

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I met my interpreter the evening before my talk, as she would have to know what I was going to say to simultaneously translate during the conference. On my last trip to Beijing China in May, I lectured on the technique of nipple sparing mastectomies. I would speak and then wait for the translation live that was done by a Chinese surgeon. That method required me to speak slowly in complete sentences and not use any slang!

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My lecture for this conference was on minimally invasive vacuum assisted biopsy to diagnose breast cancer. This is a technique that has been the standard of care in the USA for the last 10-15 years.

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The incidence of breast cancer is on the rise globally particularly in recently industrialized nations. China has one of the fastest growing breast cancer rates. The western diet and “western ways” are thought to be the major part of the problem. Chinese women are also delaying child baring, have higher incidence of abortions as there is a limit to the number of children that they can have and the out of control pollution are all felt to play their part. That being said, women are still taken to the operating room to make the diagnosis of breast cancer for the most part. With the numbers of breast cancers on the rise, the shift to minimally invasive biopsies seems imminent.

The dynamics of the conference itself was interesting in comparison with conferences in the USA. The room was jam-packed with attentive eager to learn physicians waiting to ingest the latest information and cutting edge treatments from around the world. I think that I was the only blonde at the entire conference so I stuck out like a sore thumb.

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The meeting ran from 8 AM to 12 noon breaking only briefly for lunch and resumed at 1 PM and ended at 6 PM. The audience was glued to their seats not wanting to miss a morsel of information being shared from around the world. I have to admit that the lectures given in Chinese, i.e. the majority of them were difficult to comprehend, but I was amazed at the amount of information I could surmise from the slides alone with the disease free survival curves and overall survival curves being the easy ones to understand.

Dr. Robert Carlson, the head of the NCCN, National Comprehensive Cancer Network, spoke about the recent changes in the guidelines in the hour before my lecture. His content was a great transition into minimally invasive biopsies for cancer diagnosis as it is one of the quality standards in the USA for attaining accreditation from the NAPBC (National Accreditation Program for Breast Centers). It was during his lecture that I realized that they were doing real-time interpretation. Suddenly my lecture seemed short, as I had planned the half hour to include the translation time. Fear not, as I can always elaborate on any topic and I would also have time for questions.

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I remembered to speak slowly and in simple sentences so that my Chinese surgical oncology fellow, my interpreter, could easily translate in real time. That means that she has to listen, interpret and as she is speaking listen for the next thought process, clearly she drew the short straw getting this gig. (We traveled to Russia a few years ago and our tour guides were two neurosurgery fellows. My husband, Joe, joked with them, “ So who did you bump off that you are stuck being our tour guides!” They didn’t understand his humor and as it turns out, being the tour guide to the visiting surgeon from the USA was an honor for them!)

The lecture went well from my perspective and there were several excellent questions so I know that al least three people understood what I was trying to get across to the conference. Performing minimally invasive biopsies, with ultrasound, stereotactic or MRI guidance, is the standard of care in the USA and allows us to obtain a diagnosis and construct a treatment plan with out patients. We use vacuum assisted biopsies (www.mammotome.com ) to accomplish accurate minimally invasive diagnosis so that we can create a care plan to treat our patient’s cancers.

I am hopeful that my lecture will open the door for positive change in a country that is facing a breast cancer “crisis” as the average of a woman obtaining a diagnosis of breast cancer in China is 10 years younger than in the USA. China does not have wide spread screening to date and that is another opportunity for early detection.

There was a time in the not too distant past that being a woman in Asia conferred a benefit as they had a low incidence of breast cancer. There are several theories as to why the shift in incidence and why the lower age at diagnosis. The Western influence has had its blessings and curses. (I would like to think that my trip and educational opportunity is a blessing and not a curse)

In a 2001 lecture from The University of Pittsburgh

Jesse Huang, MD, MHPE, MPH, MBA黄建始

Professor of Epidemiology

Assistant President
Chinese Academy of Medical Sciences

Peking Union Medical College Medical Center of Qing Hua University

Presented an overview of proposed causes of this shift.

Breast Cancer in China

  • Breast Cancer in China is increasing rapidly
  • This increase resulted mainly from metropolitan female at reproductive age
  • Highest risk age group at 40-49, which is earlier than that in developed countries (50-79 yrs)
  • Highest risk (40-49) age group’s characteristics:
  • High educational level
  • Engaging in scientific research
  • Depression
  • High BMI
  • High protein intake
  • Disharmonious marital life/divorce
  • Induced abortion
  • Late age at first pregnancy
  • Oral contraceptive use
  • Lack of lactation
  • Benign breast disease
  • Family history of BC
  • Late menopause
  • Passive smoking

Many of these factors are modifiable and should be a lesson to the entire world. Since China jumped so rapidly in breast cancer incidence and lifestyle and gestational history are huge factors, we should take notice and begin to truly embrace lifestyle modification around the world before breast cancer becomes an epidemic.

Traveling to China this year has been amazing!

The culture of Asia, the hospitality of the people, the history a nation and breathtaking sites were worth every second of travel.  Being able to potentially influence breast care in China is PRICELESS! 

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FOcal Point of the Shanghai Evening Skyline

The TV Tower

The Breast Cancer Crisis is our Opportunity to change the factors in our lives and the lives of young women around the world that are modifiable.

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  • Regular exercise is essential to maintain our breast health and overall health (3-5 hours per week)
  • Nutrition is key and we are what we eat ( viverhealth.com)
  • Maintain a healthy BMI ~25 (lean muscle mass matters)
  • Young women should limit alcohol before their first pregnancy
  • Alcohol in moderation after childbearing
  • Do not delay childbearing
  • Breast feed
  • Meditation and stress reduction
  • Obtain adequate sleep

Be aware of your personal and family risk factors.

Traveling to China this year has been amazing

But when it comes to HealthCare

THERE IS NO PLACE LIKE HOME!

God Bless Americagiphy