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Objective: To develop and evaluate the screening performance of a low-cost high-risk screening strategy for breast cancer in low resource areas. Methods: Based on the Multi-modality Independent Screening Trial, 6 questionnaire-based risk factors of breast cancer (age at menarche, age at menopause, age at first live birth, oral contraceptive, obesity, family history of breast cancer) were used to determine the women with high risk of breast cancer. The screening performance of clinical breast examination (CBE), breast ultrasonography (BUS), and mammography (MAM) were calculated and compared to determine the optimal screening method for these high risk women. Results: A total of 94 breast cancers were detected among 31,720 asymptomatic Chinese women aged 45–65 years. Due to significantly higher detection rates (DRs) and suitable coverage of the population, high risk women were defined as those with any of 6 risk factors. Among high risk women, the DR for BUS [3.09/1,000 (33/10,694)] was similar to that for MAM [3.18/1,000 (34/10,696)], while it was significantly higher than that for the CBE [1.73/1,000 (19/10,959), P = 0.002]. Compared with MAM, BUS showed significantly higher specificity [98.64% (10,501/10,646) vs. 98.06% (10,443/10,650), P = 0.001], but no significant differences in sensitivity [68.75% (33/48) vs. 73.91% (34/46)], positive prediction values [18.54% (33/178) vs. 14.11% (34/241)], and negative prediction values [99.86% (10,501/10,516) vs. 99.89% (10,443/10,455)]. Further analyses showed no significant difference in the percentages of early stage breast cancer [53.57% (15/28) vs. 50.00% (15/30)], lymph node involvement [22.73% (5/22) vs. 28.00% (7/25)], and tumor size ≥ 2 cm [37.04% (10/27) vs. 29.03% (9/31)] between BUS and MAM. Subgroup analyses stratified by breast densities or age at enrollment showed similar results. Conclusions: The low-cost high-risk screening strategy based on 6 questionnaire-based risk factors was an easy-to-use method to identify women with high risk of breast cancer. Moreover, BUS and MAM had comparable screening performances among high risk women.

Single nucleotide polymorphisms (SNPs) within microRNA binding sites can affect the binding of microRNA to mRNA and regulate gene expression, thereby contributing to cancer prognosis. Here we performed a two-stage study of 2647 breast cancer patients to explore the association between SNPs within microRNA binding sites and breast cancer prognosis. In stage I, we genotyped 192 SNPs within microRNA binding sites using the Illumina Goldengate platform. In stage II, we validated SNPs associated with breast cancer prognosis in another dataset using the TaqMan platform. We identified 8 SNPs significantly associated with breast cancer prognosis in stage I (P

The burden of breast cancer has grown rapidly in China during recent decades. However, the association between tumor markers (CA15-3, CA125, and CEA) and breast cancer survival among certain molecular subtypes is unclear; we described this association in a large, population-based study. We conducted a cohort study including 10,836 women according to the Tianjin Breast Cancer Cases Cohort. Demographic and epidemiologic data were collected by a structured face-to-face questionnaire. Clinico-pathological parameters were abstracted from medical records, and follow-up information was obtained once a year by telephone. The primary endpoints were breast cancer-specific survival (BCSS) and disease-free survival (DFS). We utilized the Cox proportional hazard model to calculate hazard ratios (HRs) and 95% confidence intervals (CI). Among all patients, elevated CA15-3 and CEA exhibited consistently and statistically significant reduced BCSS compared with normal ones (CA15-3: HR 1.54, 95% CI 1.01–2.34; CEA: HR 2.45, 95% CI 1.40–4.30). Similar patterns of association were observed for DFS (CA15-3: HR 2.09, 95% CI 1.44–3.02; CEA: HR 2.71, 95% CI 1.71–4.27). Moreover, in luminal A subtype, high CA15-3 and CEA levels were associated with decreased BCSS (CA15-3: HR 4.47, 95% CI 2.04–9.81; CEA: HR 3.79, 95% CI 1.68–8.55) and DFS (CA15-3: HR 4.06, 95% CI 2.29–7.18, CEA: HR 3.41, 95% CI 1.75–6.64). In basal-like subtype, elevated CEA conferred reduction for BCSS (HR 5.13, 95% CI 1.65–15.9). However, no association was observed between CA125 and breast cancer outcome. Preoperative CA15-3 and CEA levels differ in breast cancer molecular subtypes and yield strong prognostic information in Chinese women with breast cancer. Measuring CA15-3 and CEA levels before surgery may have the potential in predicting breast cancer survival and offering patients’ personalized treatment strategy among luminal A and basal-like subtypes.

Objective To redefine overdiagnosis and reestimate the proportion of overdiagnosis of breast cancer caused by screening based on the Surveillance, Epidemiology, and End Results (SEER, 1973−2015) Program data. Methods The breast cancer diagnosed before 1977 was defined as the no-screening cohort since America had initiated breast cancer screening from 1977. The breast cancer diagnosed in 1999 was defined as the screening cohort due to no increases in both the proportion of early-stage breast cancer until 1999 and the overall survival of early-stage breast cancer diagnosed over the three years since 1999. The magnitude of overdiagnosis was calculated as the difference in the proportions of early-stage breast cancer patients with long-time (15-year) survival to all breast cancer patients between two cohorts. Results Over 23 years before and after widespread screening in America, the proportion of early-stage breast cancer patients increased from 52.1% (16,891/32,443) to 72.7% (16,021/22,025) (P

Breast cancer is the most common malignant tumor in Chinese women. Early screening is the best way to improve the rates of early diagnosis and survival of breast cancer patients. The peak onset age for breast cancer in Chinese women is considerably younger than those in European and American women. It is imperative to develop breast cancer screening guideline that is suitable for Chinese women. By summarizing the current evidence on breast cancer screening in Chinese women, and referring to the latest guidelines and consensus on breast cancer screening in Europe, the United States, and East Asia, the China Anti-Cancer Association and National Clinical Research Center for Cancer (Tianjin Medical University Cancer Institute and Hospital) have formulated population-based guideline for breast cancer screening in Chinese women. The guideline provides recommendations on breast cancer screening for Chinese women at average or high risk of breast cancer according to the following three aspects: age of screening, screening methods, and screening interval. This article provides more detailed information to support the recommendations in this guideline and to provide more direction for current breast cancer screening practices in China.

Purpose We aim to construct a nomogram to predict breast cancer survival and guide postoperative adjuvant chemotherapy in China. Patients and methods A total of 5,504 breast cancer patients from the Tianjin Breast Cancer Cases Cohort were included. Multivariable Cox regression was used to investigate the factors associated with overall survival (OS) and a nomogram was constructed based on these prognostic factors. The nomogram was internal and external validated and the performance was evaluated by area under the curve (AUC) and calibration curve. The partial score was also constructed and stratified them into low, moderate and high-risk subgroups for death according to the tripartite grouping method. Multivariate Cox regression analysis and the propensity score matching method were respectively used to test the association between adjuvant chemotherapy and OS in different risk subgroups. Results Age, diameter, histological differentiation, lymph node metastasis, estrogen, and progesterone receptor were incorporated into the nomogram and validation results showed this nomogram was well-calibrated to predict the 3-year [AUC =74.1%; 95% confidence interval (CI): 70.1-78.0%] and 5-year overall survival [AUC =72.3%; 95% CI: 69.6-75.1%]. Adjuvant chemotherapy was negatively associated with death in high risk subgroup [Hazard Ratio (HR) = 0.54; 95% CI: 0.37-0.77; P

Objective: The number of immediate breast reconstruction (IBR) procedures has been increasing in China. This study aimed to investigate the oncological safety of IBR, and to compare the survival and surgical outcomes between implant-based and autologous reconstruction. Methods: Data from patients diagnosed with invasive breast cancer who underwent immediate total breast reconstruction between 2001 and 2016 were retrospectively reviewed. Long-term breast cancer-specific survival (BCSS), disease-free survival (DFS), and locoregional recurrence-free survival (LRFS) were evaluated. Patient satisfaction with the breast was compared between the implant-based and autologous groups. BCSS, DFS, and LRFS were compared between groups after propensity score matching (PSM). Results: A total of 784 IBR procedures were identified, of which 584 were performed on patients with invasive breast cancer (implant-based, n = 288; autologous, n = 296). With a median follow-up of 71.3 months, the 10-year estimates of BCSS, DFS, and LRFS were 88.9% [95% confidence interval (CI) (85.1%–93.0%)], 79.6% [95% CI (74.7%–84.8%)], and 94.0% [95% CI (90.3%–97.8%)], respectively. A total of 124 patients completed the Breast-Q questionnaire, and no statistically significant differences were noted between groups (P = 0.823). After PSM with 27 variables, no statistically significant differences in BCSS, DFS, and LRFS were found between the implant-based (n = 177) and autologous (n = 177) groups. Further stratification according to staging, histological grade, lymph node status, and lymph-venous invasion status revealed no significant survival differences between groups. Conclusions: Both immediate implant-based and autologous reconstruction were reasonable choices with similar long-term oncological outcomes and patient-reported satisfaction among patients with invasive breast cancer in China.

OBJECTIVE: To evaluate the efficiency of low-dose computed tomography (LDCT) screening for lung cancer in China by analyzing the baseline results of a community-based screening study accompanied with a meta-analysis.METHODS: A first round of community-based lung cancer screening with LDCT was conducted in Tianjin, China, and a systematic literature search was performed to identify LDCT screening and registry-based clinical studies for lung cancer in China. Baseline results in the community-based screening study were described by participant risk level and the lung cancer detection rate was compared with the pooled rate among the screening studies. The percentage of patients per stage was compared between the community-based study and screening and clinical studies.RESULTS: In the community-based study, 5523 participants (43.6% men) underwent LDCT. The lung cancer detection rate was 0.5% (high-risk, 1.2%; low-risk, 0.4%), with stage I disease present in 70.0% (high-risk, 50.0%; low-risk, 83.3%), and the adenocarcinoma present in 84.4% (high-risk, 61.5%; low-risk, 100%). Among all screen-detected lung cancer, women accounted for 8.3% and 66.7% in the high- and low-risk group, respectively. In the screening studies from mainland China, the lung cancer detection rate 0.6% (95 %CI: 0.3%-0.9%) for high-risk populations. The proportions with carcinoma in situ and stage I disease in the screening and clinical studies were 76.4% (95 %CI: 66.3%-85.3%) and 15.2% (95 %CI: 11.8%-18.9%), respectively.CONCLUSIONS: The stage shift of lung cancer due to screening suggests a potential effectiveness of LDCT screening in China. Nearly 70% of screen-detected lung cancers in low-risk populations are identified in women.

The aims of the present study were to clarify the prognostic value of peripheral blood variables in patients with pancreatic ductal adenocarcinoma (PDAC), including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR), and to determine the association between these variables and S100 calcium-binding protein A4 (S100A4) expression in tumor tissue, which is another prognostic factor for PDAC. Patients with PDAC were recruited at the Tianjin Medical University Cancer Institute and Hospital (Tianjin, China) between December 2008 and December 2014. A retrospective analysis was performed based on the recorded pre-treatment hematological parameters and clinical data. The prognostic value of NLR, PLR and LMR was examined. The association between these variables and S100A4 tissue expression was analyzed. Descriptive statistics and χ2 analyses were used in the present study. The median overall survival (OS) time of patients with PDAC was 9 months (range, 1-32 months). Univariate analysis revealed that NLR, LMR, carbohydrate antigen 19-9, surgery, chemotherapy, stage at diagnosis, tumor grade and age significantly affected OS. Although PLR exhibited no significant effects on OS, NLR and LMR were independent prognostic factors according to the multivariate analysis. Unpaired Student's t-test revealed differences between S100A4 expression and NLR, PLR and LMR. The results of the present study indicated that low NLR and high LMR were associated with a favorable prognosis in patients with PDAC. As a simply obtained and widely available index at diagnosis, NLR and LMR may become a novel predictive and classifying marker for PDAC in the clinical setting.

Objective: European lung cancer screening studies using computed tomography (CT) have shown that a management protocol based on measuring lung nodule volume and volume doubling time (VDT) is more specific for early lung cancer detection than a diameter-based protocol. However, whether this also applies to a Chinese population is unclear. The aim of this study is to compare the diagnostic performance of a volume-based protocol with a diameter-based protocol for lung cancer detection and optimize the nodule management criteria for a Chinese population.Methods: This study has a population-based, prospective cohort design and includes 4000 participants from the Hexi district of Tianjin, China. Participants will undergo low-dose chest CT at baseline and after 1 year. Initially, detected lung nodules will be evaluated for diameter and managed according to a routine diameter-based protocol (Clinical Practice Guideline in Oncology for Lung Cancer Screening, Version 2.2018). Subsequently, lung nodules will be evaluated for volume and management will be simulated according to a volume-based protocol and VDT (a European lung nodule management protocol). Participants will be followed up for 4 years to evaluate lung cancer incidence and mortality. The primary outcome is the diagnostic performance of the European volume-based protocol compared to diameter-based management regarding lung nodules detected using low-dose CT.Results: The diagnostic performance of volume- and diameter-based management for lung nodules in a Chinese population will be estimated and compared.Conclusions: Through the study, we expect to improve the management of lung nodules and early detection of lung cancer in Chinese populations.

Background To investigate the performance of primary ultrasound (P-US) screening for breast cancer, and that of supplemental ultrasound (S-US) screening for breast cancer after negative mammography (MAM). Methods Electronic databases (PubMed, Scopus, Web of Science, and Embase) were systematically searched to identify relevant studies published between January 2003 and May 2018. Only high-quality or fair-quality studies reporting any of the following performance values for P-US or S-US screening were included: sensitivity, specificity, cancer detected rate (CDR), recall rate (RR), biopsy rate (BR), proportion of invasive cancers among screening-detected cancers (ProIC), and proportion of node-negative cancers among screening-detected invasive cancers (ProNNIC). Results Twenty-three studies were included, including 12 studies in which S-US screening was used after negative MAM and 11 joint screening studies in which both primary MAM (P-MAM) and P-US were used. Meta-analyses revealed that S-US screening could detect 96% [95% confidential intervals (CIs): 82 to 99%] of occult breast cancers missed by MAM and identify 93% (95% CIs: 89 to 96%) of healthy women, with a CDR of 3.0/1000 (95% CIs: 1.8/1000 to 4.6/1000), RR of 8.8% (95% CIs: 5.0 to 13.4%), BR of 3.9% (95% CIs: 2.7 to 5.4%), ProIC of 73.9% (95% CIs: 49.0 to 93.7%), and ProNNIC of 70.9% (95% CIs: 46.0 to 91.6%). Compared with P-MAM screening, P-US screening led to the recall of significantly more women with positive screening results [1.5% (95% CIs:0.6 to 2.3%), P = 0.001] and detected significantly more invasive cancers [16.3% (95% CIs: 10.6 to 22.1%), P Conclusions Current evidence suggests that S-US screening could detect occult breast cancers missed by MAM. P-US screening has shown to be comparable to P-MAM screening in women with dense breasts in terms of sensitivity, specificity, cancer detection rate, and biopsy rate, but with higher recall rates and higher detection rates for invasive cancers.

Background: Single nucleotide polymorphisms (SNPs) within microRNA binding sites can affect the binding of microRNA to mRNA and regulate gene expression, thereby contributing to the prognosis of cancer. We performed this study to explore the association between SNPs within microRNA binding sites and the prognosis of breast cancer.Methods: We carried out a two-stage study including 2647 breast cancer patients. In stage I, we genotyped 192 SNPs within microRNA binding sites using the Illumina Goldengate platform. In stage II, we validated SNPs significantly associated with breast cancer prognosis in another dataset using the TaqMan platform. Survival times was calculated, and Kaplan-Meier curves and Cox regression model were used to analyze survival of breast cancer patients with different genotypes.Results: We identified 8 SNPs significantly associated with breast cancer prognosis in stage I (PConclusions: The LRKK2 rs10878441 CC genotype is associated with poor prognosis of breast cancer in a Chinese population, and it could be used as a potential prognostic biomarker for breast cancer. Further studies are warranted.

Until now, no studies have investigated whether women other than those with dense breasts are suitable for adjunctive ultrasonography after negative mammography, and investigated whether all women with negative mammography are suitable for adjunctive ultrasonography.Based on the Multi-modality Independent Screening Trial in China, a total of 31,918 women aged 45 to 65 years underwent both ultrasonography and mammography. Physicians performed ultrasonography and mammography separately and were blinded to each other's findings until their interpretations had been recorded. For both ultrasonography and mammography, suspicious results and those highly suggestive of a malignancy were confirmed by pathologic examination, whereas other results were confirmed by 1-year follow-up after initial screening.Based on Breast Imaging Reporting and Data System (BIRADS) assessments, 84 (84.8%) of 99 cancers were identified on mammography (detection rate, 2.6/1000), and 61 (61.6%) of 99 cancers were identified on ultrasonography (detection rate, 1.9/1000). Integrated mammography with ultrasonography identified 94 (95.0%) of 99 cancers, with an increment of 11.9% in cancer detection rate (from 2.6/1000 to 2.9/1000) (P .05). Moreover, among women with BIRADS 3, adjunctive ultrasonography detected no cancers. All 10 additional cancers detected by adjunctive ultrasonography were from women with BIRADS 0 to 2, at a cost of 207 women with false positives. Additionally, dense breasts and benign breast disease were significantly associated with positive ultrasonography after BIRADS 0 to 2 (all P values .05).After negative mammography, adjunctive ultrasonography should only be recommended for BIRADS 0 to 2 but not BIRADS 3, especially for women with dense breasts or benign breast disease.

Aim Childhood obesity is a major public problem worldwide, and sleep duration may be associated with childhood obesity. We conducted a systematic review and meta-analysis of prospective cohort studies to estimate the associations between sleep duration and obesity/body mass index (BMI) in children. Methods PubMed, Embase and the Cochrane Library were searched. For the meta-analysis, the pooled relative risk (RR) and 95% confidence intervals (CI) were estimated to reveal the association between short sleep duration and obesity. For the review, the outcomes focused on BMI change or subsequent BMI status. Results A total of 12 studies (15 populations) met the criteria for inclusion in the meta-analysis. Short sleep duration was significantly associated with obesity (RR: 1.45; 95% CI: 1.14–1.85). After excluding two cohorts that substantially affected the heterogeneity, the pooled results remained significant (RR: 1.30; 95% CI: 1.20–1.42), and the association was not substantially altered in the subgroup analysis. In addition, we summarised 24 studies that met the criteria for our review of the relationship between sleeping and BMI. Conclusion The present meta-analysis indicated that short sleep duration increased the risk of childhood obesity. Public health efforts that encourage children to have sufficient sleep time may be important in combating obesity.

Background To investigate whether women with benign breast disease (BBD) history have higher breast cancer detection rate in screening. Methods We reviewed data for 33 001 female participants in Multi-modality Independent Screening Trial (MIST). Corresponding data for 6823 breast cancer patients were retrieved from the Tianjin Breast Cancer Cases Cohort (TBCCC) and analyzed for comparison. Results The breast cancer detection rate was 2.83‰ among women with BBD history and 3.28‰ in women without. Moreover, the proportion of carcinoma in situ (CIS) was also lower in women with BBD history than women without (7.69 versus 20.31%). In contrast, analysis of TBCCC data revealed a higher proportion of CIS in patients with BBD history (5.05%) than patients without (3.26%). Our data showed that a larger proportion of women with BBD history had undergone previous breast examinations. Additionally, among participants diagnosed with both breast cancer and BBD in MIST, we found a lower proportion of CIS in women with BBD history (11.76%) compared to women without (32.14%). Conclusions Women with BBD history were not found to have higher detection rate in breast cancer screening. Women with BBD history were more likely to be proactive in seeking breast examinations and to have breast cancer be diagnosed in clinic.

// Ying Gao 1, 2, * , Qiliang Cai 3, * , Yubei Huang 2, * , Shu Li 1 , Hongxi Yang 1 , Li Sun 1 , Kexin Chen 2 , Yaogang Wang 1 1 Department of Health Service Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China 2 Department of Cancer Epidemiology and Biostatistics, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China 3 Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China * Co-first authors, these authors contributed equally to this work Correspondence to: Yaogang Wang, email: wangyg@tmu.edu.cn Keywords: microRNA-21, breast cancer, diagnostic, biomarker, meta-analysis Received: January 17, 2016 Accepted: April 16, 2016 Published: May 02, 2016 ABSTRACT MicroRNA-21 (miR-21) has been reported as the potential novel diagnostic biomarker for breast cancer in several studies, but their results were inconsistent. Therefore, we conducted a systematic analysis to evaluate the diagnostic value of miR-21 in detecting breast cancer. A comprehensive electronic and manual search was conducted for relevant literatures through several databases up to November 9, 2015. QUADAS-2 was used to assess the quality of the studies included in the study. All statistical analyses were performed using Meta-Disc 1.4 and Stata 12.0. Eleven studies with a total of 918 breast cancer patients and 613 controls were included. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) with their 95% confidence intervals (CIs) were 0.72 (95% CI: 0.69–0.75), 0.80 (95% CI: 0.77–0.83), 3.37 (95% CI: 2.24–5.07), 0.30 (95% CI: 0.19–0.50), and 11.79 (95% CI: 5.23–26.57), respectively. The area under the curve of SROC was 0.8517. In conclusion, our analyses suggested that miR-21 is a promising biomarker in diagnosing breast cancer. For clinical purpose, further large-scale studies are warranted to validate its clinical application.

To investigate the association between overall life satisfaction and healthy lifestyle, knowledge of breast cancer, physical examination, and detection rate of breast cancer and benign breast disease in Chinese women. In a multicentered breast disease screening program in China, we enrolled 33,057 women aged 45–65 years without prior diagnosis of breast cancer. After completing an epidemiological questionnaire, all participants were examined by clinical breast examination, breast ultrasound, and mammography independently. All breast cancer cases and a selected sample of benign breast diseases were confirmed pathologically. Univariate and multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate the association between life satisfaction and lifestyle, knowledge of breast cancer, physical examination, and detection rate of breast diseases. Overall life satisfaction was positively associated with women's healthy lifestyle. Compared with less satisfied women, satisfied women were less likely to be smokers (OR = 0.54; 95% CI: 0.47–0.62), have more exercise (OR = 1.49; 95% CI: 1.26–1.75), eat less fried (OR = 0.60; 95% CI: 0.50–0.71), smoked (OR = 0.54, 95% CI: 0.47–0.63), pickled (OR = 0.66, 95% CI: 0.55–0.79), and grilled (OR = 0.63, 95% CI: 0.54–0.74) foods. Satisfied women were more likely to have knowledge of breast cancer (OR = 1.48, 95% CI: 1.29–1.70), and have regular physical examinations (OR = 1.11, 95% CI: 1.01–1.12). Compared to less satisfied women, we found significantly lower detection rate of benign breast diseases (OR = 0.90, 95% CI: 0.82–0.99), and lower but nonsignificant detection rate of breast cancer (OR = 0.66, 95% CI: 0.35–1.25) in satisfied women. Women with a higher overall life satisfaction are more likely to have healthy lifestyle, knowledge of breast cancer, and regular physical examination, thus resulting in a lower detection rate of breast diseases in screening.

Background The Gail model has been widely used and validated with conflicting results. The current study aims to evaluate the performance of different versions of the Gail model by means of systematic review and meta-analysis with trial sequential analysis (TSA). Methods Three systematic review and meta-analyses were conducted. Pooled expected-to-observed (E/O) ratio and pooled area under the curve (AUC) were calculated using the DerSimonian and Laird random-effects model. Pooled sensitivity, specificity and diagnostic odds ratio were evaluated by bivariate mixed-effects model. TSA was also conducted to determine whether the evidence was sufficient and conclusive. Results Gail model 1 accurately predicted breast cancer risk in American women (pooled E/O = 1.03; 95% CI 0.76–1.40). The pooled E/O ratios of Caucasian-American Gail model 2 in American, European and Asian women were 0.98 (95% CI 0.91–1.06), 1.07 (95% CI 0.66–1.74) and 2.29 (95% CI 1.95–2.68), respectively. Additionally, Asian-American Gail model 2 overestimated the risk for Asian women about two times (pooled E/O = 1.82; 95% CI 1.31–2.51). TSA showed that evidence in Asian women was sufficient; nonetheless, the results in American and European women need further verification. The pooled AUCs for Gail model 1 in American and European women and Asian females were 0.55 (95% CI 0.53–0.56) and 0.75 (95% CI 0.63–0.88), respectively, and the pooled AUCs of Caucasian-American Gail model 2 for American, Asian and European females were 0.61 (95% CI 0.59–0.63), 0.55 (95% CI 0.52–0.58) and 0.58 (95% CI 0.55–0.62), respectively. The pooled sensitivity, specificity and diagnostic odds ratio of Gail model 1 were 0.63 (95% CI 0.27–0.89), 0.91 (95% CI 0.87–0.94) and 17.38 (95% CI 2.66–113.70), respectively, and the corresponding indexes of Gail model 2 were 0.35 (95% CI 0.17–0.59), 0.86 (95% CI 0.76–0.92) and 3.38 (95% CI 1.40–8.17), respectively. Conclusions The Gail model was more accurate in predicting the incidence of breast cancer in American and European females, while far less useful for individual-level risk prediction. Moreover, the Gail model may overestimate the risk in Asian women and the results were further validated by TSA, which is an addition to the three previous systematic review and meta-analyses. Trial registration PROSPERO CRD42016047215. Electronic supplementary material The online version of this article (10.1186/s13058-018-0947-5) contains supplementary material, which is available to authorized users.

Association between fruit intake and risk of type 2 diabetes is inconsistent. In this study, we performed a meta-analysis of all prospective cohort studies to clarify the association between fruit intake and risk of type 2 diabetes. Relevant studies were identified by searches of the PubMed and Embase databases up to November 2013. The summary relative risks of association were obtained using a fixed- or random-effects model. A total of nine prospective studies (403,259 participants, including 27,940 with incident type 2 diabetes) from seven publications were included in the meta-analysis of fruit intake and risk of type 2 diabetes. We found that individuals in the highest category of fruit intake had a reduced risk of type 2 dia- betes (relative risk 0.92, 95 % confidence interval 0.86-0.97, p = 0.003) compared to those in the lowest category, with moderate evidence of between-study heter- ogeneity (I 2 = 37.6 %, p = 0.12). There was an evident non-linear association of fruit intake with type 2 diabetes (P for nonlinearity \0.001). A non-linear threshold of 200 g/day of fruit intake was identified and the risk of type 2 diabetes reduced by about 13 % at this cut-off. Our findings are consistent with diet recommendations to con- sume about 200 g/day of fruits to prevent type 2 diabetes.

To determine the preliminary effectiveness of breast cancer screening among Chinese females, 1226714 women aged 35–69 years first received clinical breast examinations. Urban women with suspected cancer received mammography followed by breast ultrasound (BUS), while rural suspected women underwent BUS followed by mammography. After one-year follow-up, 223 and 431 breast cancers were detected among urban and rural women (respectively), with overall detection rates of 0.56/1000 and 0.52/1000. Higher detection rates were significantly associated with older age at screening for both urban and rural women; additionally, urban women were at significantly higher risk if they had no job, no insurance, or were obese; additional risk factors specific to rural women included Han nationality, higher income, being unmarried, and having a family history of cancer (all P values in situ. All abovementioned cancer characteristics were significantly better than clinic-detected cancers (all P values

© 2016 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background It is widely reported that long-Term use of four preventive medications (antiplatelet agents, angiotensin converting enzyme inhibitor / angiotensin receptor blocker, statin and betablockers) reduce the risk of subsequent acute coronary syndromes (ACS). It is unclear whether these four medications benefit patients who develop ACS despite its use. Methods and Results Logistic regression and propensity-score was applied among 14790 ACS patients to assess the association between prior use of four preventive medications and in-hospital outcomes including severity of disease at presentation (type of ACS, systolic blood pressure = 100 beats/min), complicating arrhythmia and major adverse cardiovascular events (MACEs, including all deaths, non-fatal myocardial infarction or reinfarction, and non-fatal stroke). Prior use of each of the four medications was significantly associated with less severity of disease (ORs ranged from 0.40 to 0.82, all P

A number of prospective cohort studies have investigated the associations between consumption of sugar-sweetened beverages (SSB) and the risk of hypertension, CHD and stroke, but revealed mixed results. In the present study, we aimed to perform a dose–response meta-analysis of these prospective studies to clarify these associations. A systematic literature search was conducted using the PubMed and Embase databases up to 5 May 2014. Random- or fixed-effects models were used to calculate the pooled relative risks (RR) with 95 % CI for the highest compared with the lowest category of SSB consumption, and to conduct a dose–response analysis. A total of six prospective studies (240 726 participants and 80 411 incident cases of hypertension) from four publications on hypertension were identified. A total of four prospective studies (194 664 participants and 7396 incident cases of CHD) from four publications on CHD were identified. A total of four prospective studies (259 176 participants and 10 011 incident cases of stroke) from four publications on stroke were identified. The summary RR for incident hypertension was 1·08 (95 % CI 1·04, 1·12) for every additional one serving/d increase in SSB consumption. The summary RR for incident CHD was 1·17 (95 % CI 1·10, 1·24) for every serving/d increase in SSB consumption. There was no significant association between SSB consumption and total stroke (summary RR 1·06, 95 % CI 0·97, 1·15) for every serving/d increase in SSB consumption. The present meta-analysis suggested that a higher consumption of SSB was associated with a higher risk of hypertension and CHD, but not with a higher risk of stroke.

In order to easily identify high-risk population of breast cancer and to determine the optimal screening modality among Chinese high-risk women, a total of 33234 asymptomatic Chinese women aged 45-65 years underwent breast ultrasound (BUS) and mammography (MAM) screening concurrently. Physicians performed these screening modalities separately and blindly. The number of risk factors of breast cancer, rather than complex risk prediction models, was used to identify potential high-risk women. Initially, a total of 13 factors (age at menarche, menopausal status, age at menopause, number of live birth, age at first pregnancy, breast feeding, duration of breast feeding, abortion, oral contraceptive, hormone replacement therapy, obesity, history of benign breast disease, and family history of breast cancer) were selected. After excluding correlated factors, factors with risk frequency ≥ 20% and factors with missing values ≥ 5%, 6 factors (age at menarche, age at menopause, age at first pregnancy, oral contraceptive, obesity, family history of breast cancer) were selected as risk-evaluating factors. High-risk women was defined as those with ≥ 1 of the abovementioned 6 factors. According to this strategy, the detection rate among high-risk women (4.34/1000) was significantly higher than their counterpart (2.23/1000, p=0.001), and the percent of high-risk women accounted for 34.9% of the whole population. . Among high-risk women, the cancer detection rate on MAM (3.2/1000) was non-significantly different from that on BUS (3.1/1000; p=0.663). Comparisons on screening accuracy showed no significant difference on sensitivities (73.9% vs. 68.8%, p=0.663), positive prediction values (14.1% vs. 18.5%, p=0.221), and negative prediction values (99.9% vs. 99.9%, p=0.574) between MAM and BUS, but significant higher specificity for BUS (98.6%) than MAM (98.0%, p=0.001). Comparisons on cancer characteristics showed no significant difference on breast carcinoma in situ (22.6% vs. 17.2%, p=0.605), lymph-node involvement (24.1% vs. 20.0%, p=0.715), and tumor size ≥ 2 cm (25.0% vs. 35.5%, p=0.350) between MAM-detected cancers and BUS-detected cancers. Subgroup analyses stratified by breast densities (four groups: 0~ 75%) or age at enrolment (four groups: ≤49, 50-54, 55-59, ≥60 years) also showed no significant difference on sensitivities between MAM and BUS across subgroups. In conclusion, high-risk screening strategy based on the number of exposure to risk factors is an easy-to-use method to identify potential high-risk women of breast cancer, and the performance of BUS is very similar to that of MAM among high-risk women. Citation Format: Yubei Huang, Fengju Song, Kexin Chen. Screening performance of ultrasonography and mammography among Chinese women at high-risk of developing breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5295. doi:10.1158/1538-7445.AM2017-5295

Background: Chronic exposure to ambient particulate matter (PM) has been suggested to be associated with an increased risk of lung cancer, but the results were inconsistent. We performed a systematic review and meta-analysis of prospective studies to assess the association between exposure to PM and the incidence and mortality of lung cancer in adults. Methods: We searched PUBMED and EMBASE databases for prospective cohort studies that evaluated the association between PM2.5 (diameter < 2.5 μm), PM10 (diameter < 10 μm) and lung cancer incidence and mortality. Relative risks (RRs) and 95% confidence interval (CI) were calculated using fixed-effect or random-effects models when appropriate. Results: We initially identified 1987 citations, and 19 prospective cohort studies were finally included in our meta-analysis. The pooled adjusted RRs for lung cancer mortality were 1.09 (95% CI: 1.06–1.11; I2 = 18.3%, P = 0.26) for 10 µg/m3 increase in the concentration of PM2.5 (12 studies), and 1.05 (95% CI: 1.03–1.07; I2 = 41.9%, P = 0.11) for 10 µg/m3 increase in the concentration of PM10 (seven studies). The increased risk of lung cancer mortality associated with PM2.5 and PM10 was consistent across most subgroups. PM10 (three studies) and PM2.5 (two studies) were not found to be significantly associated with lung cancer incidence. Conclusions: Ambient PM2.5 and PM10 pollutions are prospectively associated with a significantly increased risk of lung cancer mortality. More studies addressing the association between PM and lung cancer incidence are required.

Although positive association between abortion and breast cancer was frequently reported from case–control studies, results from prospective studies were still unclear. This study aimed to evaluate this association based on prospective studies. PubMed, ISI Web of Knowledge and Embase were systematically searched for prospective studies on the association between abortion and breast cancer up to April 2014, supplemented by manual searches on the references. Two reviewers independently conducted the literature search, study selection, data extraction, and quality assessment of included studies. Random effects models were used to estimate the combined relative risks (RRs) and corresponding 95 % confidence intervals (95 % CIs). Fifteen prospective studies [14 focused on induced abortion (IA), and 12 focused on spontaneous abortion (SA)] were included in the final analysis. The combined RRs (95 % CIs) of breast cancer risk were 1.00 (0.94–1.05) [1.00 (0.92–1.08) for cumulative-incidence data and 1.00 (0.94–1.05) for incidence-rate data] for IA, and 1.02 (0.95–1.09) [1.06 (0.96–1.16) for cumulative-incidence data and 1.01 (0.92–1.09) for incidence-rate data] for SA, respectively. Non-significant associations of breast cancer with IA and SA were also found among nulliparous women, women with abortion before or after the first full-term pregnancy, women with one or ≥2 abortions, and women with first abortion after 30 years old. The current prospective evidences are not sufficient to support the positive association between abortion (including IA and SA) and breast cancer risk.

To evaluate the association between induced abortion (IA) and breast cancer risk among Chinese females. We searched three English databases (PubMed, ScienceDirect, and Wiley) and three Chinese databases (CNKI, WanFang, and VIP) for studies up to December 2012, supplemented by manual searches. Two reviewers independently conducted the literature searching, study selection, and data extraction and quality assessment of included studies. Random effects models were used to estimate the summary odds ratios (ORs) and the 95 % confidence intervals (CIs). A total of 36 articles (two cohort studies and 34 case–control studies) covering 14 provinces in China were included in this review. Compared to people without any history of IA, an increased risk of breast cancer was observed among females who had at least one IA (OR = 1.44, 95 % CI 1.29–1.59, I 2 = 82.6 %, p

Background: With an increasing number of single nucleotide polymorphisms (SNPs) being identified from genome-wide association studies (GWAS), it's important to examine whether these SNPs have values in public health. And it's also unclear how to select the targeted SNPs valuable for population-based screening from numerous GWAS-identified SNPs. Methods: Based on the fraction of the genetic risk explained by a SNP, the area under the receiver operating characteristic curve (AUC), integrated discrimination improvement, and net reclassification improvement were used to select targeted SNPs and to evaluate the values of genetic risk score (GRS) with targeted SNPs on risk prediction, risk reclassification, and effects of population-based screening among 2 million simulated Chinese women aged 35-69 years. Results: A total of 11 targeted SNPs from 23 GWAS-identified SNPs would be valuable for population-based screening of breast cancer among Chinese women. After incorporating GRS with targeted SNPs into traditional risk predication based on established risk factors (ERF) of breast cancer, the AUC significantly improved from 65.5% to 67.5% (P Conclusion: GRS based on targeted GWAS-identified SNPs could significantly improve the risk prediction, risk reclassification, and the effects of population-based screening. Further real-world studies are needed to validate this method and these results. Citation Format: Yubei Huang, Fengju Song, Kexin Chen. Values of single nucleotide polymorphisms identified from genome-wide association studies on risk prediction, risk reclassification, and population-based screening of breast-cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3932.

Background: Disparity of overweight/obesity distribution had been investigated in developed countries, but rarely been investigated in developing countries, especially for China with rapid socio-economic development in the past decades. Methods: A total of 1 210 762 participants were recruited from the Chinese National Breast Cancer Screening Program. Overweight and obesity were defined as body mass index (BMI) ranged 24.0-27.9 kg/m2 and BMI ≥ 28.0kg/m2, respectively. Results: The prevalence of overweight/obesity for Chinese rural women (35.2%, 29.2% for overweight and 6.0% for obesity) was significantly higher than that for Chinese urban women (33.4%, 27.7% for overweight and 5.7% for obesity) (P Conclusions: There was an obvious urban-rural disparity of overweight/obesity distribution among Chinese females, which could also lead to an obvious disparity of breast cancer distribution. Citation Format: Ying Gao, Yubei Huang, Hongji Dai, Peishan Wang, Haixin Li, Fengju Song, Hong Zheng, Henglei Dong, Jiali Han, Yaogang Wang, Kexin Chen. Urban-rural disparity of overweight/obesity distribution and its potential association with breast cancer among Chinese females. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4045.

TO THE EDITOR: We read with great interest the article by Liu et al. titled “MetaAnalysis Added Power to Identify Variants in FTO Associated With Type 2 Diabetes (T2D) and Obesity in the Asian Population” (1) on the associations of FTO variants (rs9939609 and rs8050136) with obesity and T2D in a Chinese population and the meta-analysis of these associations in Asian populations. The study showed significant association of FTO variants with obesity and T2D in their independent study and in their meta-analysis. This is a very important investigation because there were conflicting results with regard to these associations in Asian populations. We would like to draw attention to three aspects of the article.