Breast cancer Mammography (MAM) screening was proven to improve survival worldwide. However, younger patients with higher breast density made MAM less effective in China. It is necessary to establish Chinese-specific effective screening strategies. This study aims to explore the efficacy of artificial intelligence (AI)-assisted ultrasound breast cancer screening in China. Eligible participants were those aged 35–69 years and were attending the Chinese "Two Cancer (breast and cervical cancer) Screening" program. Two districts were selected as cluster to receive either AI-assisted ultrasound screening or routine ultrasound screening. We obtained data on cancer diagnosis through active follow-up and linkage with municipal cancer registry. The primary outcome was improved screening sensitivity enabling the detection of more true-positive cases. This study is registered at ClinicalTrials.gov under the number NCT06521788 (Initial Release Date: 07/22/2024). A total of 21,790 individuals in two districts were included in this study, with 8,736 participants in Hongkou district receiving AI-assisted ultrasound screening and 13,054 in Pudong district undergoing routine ultrasound screening. Of the 21,790 screened participants, 232 (10.7‰) tested positive, with AI detecting similar positivity rates compared to routine screening (12.2‰ vs. 9.6‰, P = 0.07). After one year of follow-up, 49 participants were diagnosed with breast cancer: 30 were screen-detected cancers, and 19 were interval cancers. The AI group demonstrated a significantly higher screening sensitivity (75

Background and purpose: Follow-up data of 6 737 patients undergoing surgery for gastric cancer were collected based on hospital registration, and the 1-, 3- and 5-years observed overall survival (OS) rates and disease-free survival (DFS) rates were analyzed to provide real-world research evidence for the prevention and control of gastric cancer and policy making in China. Methods: A total of 6 737 gastric cancer patients who underwent surgical treatment at Fudan University Shanghai Cancer center from 2015 to 2020 were included in this study. Clinical information and the follow-up endpoint data were collected through medical records review, telephone visits and death registry data linkage. The last follow-up date was November 30, 2023. Kaplan-Meier method was applied in evaluating the 1-, 3- and 5-year OS rate and DFS rate, and survival data were described by different subgroups including age group, gender, treatment period, tumor staging, and pathological characteristics. Results: With a median follow-up time of 50.99 months, the 5-year OS rate of surgically resected gastric cancer patients was 70.37%, and 5-year DFS rate in Ⅰ-Ⅲ stage cases was 69.46%. The 5-year OS rates of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 94.32%, 82.56%, 51.01% and 23.97%, respectively. The differences in survival among patients with different age, tumor location, gross classification, Borrmann classification and Lauren classification were significant. Conclusion: Staging is an important factor directly affecting the survival of gastric cancer patients. Screening and early diagnosis and treatment in large population, especially high-risk group, should be strengthened to further improve the patients’ survival.

Background and purpose: Effective treatment for cervical cancer patients is one of the global strategies to eliminate cervical cancer. By analyzing the metastasis characteristics and survival status of patients with distant metastasis of cervical cancer from a hospital-based cancer registry data, our study provided real-world evidence for better survival of cervical cancer and finally eliminating cervical cancer. Methods: A total of 572 cervical cancer patients who had metastasis cancer at the initial diagnosis or developed distant metastasis during follow-up in Fudan University Shanghai Cancer Center from 2008 to 2017 were included in this study. Medical records review, telephone visits and death registry data linkage were applied in collecting endpoint data. The first follow-up date was the diagnose date of metastasis, and the last follow-up date was November 1, 2020. Kaplan-Meier method was applied in evaluating the 1-, 3- and 5-year overall survival (OS) rates for overall and site-specific patients. Results: The median follow-up time was 38.93 months, and 348 cases died during the follow-up. 72.55% were single site metastasis, and 27.45% were multiple metastases. Among all metastatic sites, the proportion of lung metastasis was the highest, 41.26%, 15.21% to bone, and 11.54% to liver. After metastasis, the 1-year, 3-year and 5-year OS rates were 62.29% (95% CI: 62.25-62.33), 33.13% (95% CI: 33.08-33.18) and 23.42% (95% CI: 23.37-23.47), respectively. In single site metastasis, 1-year OS was the highest after metastasis to the lung (72.52%). Besides, there was no significant difference among different metastatic sites, both in 3-year and 5-year OS. Conclusion: The most frequent distant metastatic sites of cervical cancer are lung, bone and liver. The survival rate after metastasis is poor. Further research with systematic treatment strategy is required for better survival.

Background: Previous studies found that the long-term survival of male breast cancer patients differed from those of female patients, however, the conclusions were contradictory. We conducted the study to examine the sex disparity in breast cancer survival by carefully controlling demographic and clinical factors using data from the Shanghai Cancer Registry (SCR). Methods: Every male breast cancer patient was matched with four female patients by the diagnosis year, age, stage, and histology. We used Kaplan-Meier survival estimates to calculate the cumulative observed overall survival (OS) and cancer-specific survival (CSS) rates and log-rank tests to compare the survival rates by sex. We used Cox proportional-hazards regression models to assess the association between sex and risk of death. Results: A total of 50,958 patients with breast cancer (0.85% male) were registered in the SCR between 2002 and 2013. After matching, 434 male and 1,736 female patients were included in the study. With a median follow-up of 10 years, men with breast cancer showed worse OS (P<0.001) and CSS (P<0.001) than did women. The 5- and 10-year OS rates for male and female patients were 67.27% and 77.75%, and 45.95% and 62.60%, respectively; the 5- and 10-year CSS rates for male and female patients were 70.19% and 79.79%, and 50.57% and 67.20%, respectively. Compared with women, men had 65% increased risk of overall death [95% confidence interval (CI): 1.42-1.92] and 70% increased risk of cancer-specific death (95% CI: 1.44-2.00). Conclusions: This study found male patients with breast cancer had poorer long-term survival than women in China.

Background: Population-based penetrance studies of breast cancer gene 1/2 (BRCA1/2) pathogenic or likely pathogenic (P/LP) variants in the Eastern Chinese population are currently lacking; thus, we aimed to investigate the penetrance of breast cancer and other malignant tumors among BRCA1/2 P/LP variant carriers using a population-based breast cancer cohort from communities in Eastern China. Methods: Between July 2019 and March 2021, we tested 2216 breast cancer probands from Chinese communities for BRCA1/2 mutations and collected detailed information on the age, survival status, and malignancy history of first-degree relatives. The kin-cohort method was used to calculate the penetrance of breast cancer and other malignant tumors. Results: Of the 2216 breast cancer probands, 109 (4.90%) carried BRCA1/2 P/LP variants, 49 in the BRCA1 gene and 60 in the BRCA2 gene. The penetrance of female breast cancer by 85 years of age was 22.50% and 18.20% in BRCA1 and BRCA2 P/LP variant carriers, respectively. The penetrance of ovarian cancer by 85 years of age was 26.00% in BRCA1 P/LP variant carriers. The penetrance of other malignancies did not reach statistical significance owing to the small number of events. Conclusions: Our findings showed that breast cancer penetrance among BRCA1 and BRCA2 P/LP variant carriers was 22.50% and 18.20%, respectively, which suggests that prophylactic mastectomy may not be necessary for such Chinese individuals. Trial registration: ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT04265937.

Supplementary Table 1 from Genetic Variation in VEGF Family Genes and Breast Cancer Risk: A Report from the Shanghai Breast Cancer Genetics Study

1990年至2020年间,全球肺癌新发病例数不断增长,其间发病率保持稳定,但全球肺癌发病呈现性别、地区、年龄、组织学类型分布变化趋势.男、女发病率数据差异不断缩小,男性世界人口年龄标化发病率(世标发病率)下降12.5%,女性世标发病率上升22.3%.1998年至2012年,肺癌的发病具有明显的地区差异,欧洲、亚洲和北美洲的男性肺癌世标发病率均有下降趋势,平均年度变化百分比分别为-1.6%、-0.6%和-2.5%;而女性肺癌发病率,除了北美洲表现出下降趋势,其他地区则呈现出上升趋势.1998年至2012年,全球各地区的肺癌平均发病年龄均呈现逐年递增的趋势,亚洲男性的肺癌平均发病年龄增幅最大,从1998年的67.21岁增加到2012年的69.14岁.20世纪80年代初期开始,鳞状细胞癌占肺癌的构成比就呈现下降趋势,2004年起,腺癌已成为世界上最常见的肺癌组织学类型.2020年,我国是全球每年新发肺癌病例数最多的国家,达539181例.1989年至2008年,我国城乡肺癌发病率比由2.07降至1.14,城乡间的肺癌发病水平差异已明显缩小;我国经济欠发达地区,肺癌的发病率在上升,而一些肺癌高发地区则得到了控制.我国作为全球最大的烟草生产国和消费国,烟草的控制形势严峻,控制职业暴露也是我国预防肺癌发生的关键,环境污染造成肺癌的风险逐步走低,建立肺癌危险因素的监测网络是未来发展的方向.

PDF file - 99K, LocusZoom plots of the top two loci using stage 1 P values.

Disability weights are crucial for quantifying health loss associated with non-fatal outcomes and were not well assessed in different countries, especially for specific cancer. Therefore, this study aimed to identify disability weights with a focus on specific cancer in a large Chinese population. Two types of web surveys were conducted, and 254 health states, including 30 new states for specific cancer, were investigated using paired comparison methods. The years lived with disability (YLDs) of cancer were calculated as the sum of the prevalence of each sequela of cancer multiplied by its relative disability weight. In total, 44,069 participants were eligible for the disability weights study. The disability weights of 254 health states were estimated. Among those, the disability weights of 18 specific cancer types varied greatly at diagnosis and primary treatment stage, with the value ranging from 0.619 (95% uncertainty interval (UI) 0.606-0.632) for brain cancer to 0.167 (95% UI 0.158-0.176) for oropharyngeal cancer. The discrepancy in YLDs calculated by different disability weights was high, and the largest gap for all cancer combined was approximately 30.14%. When calculated using the cancer-specific disability weights, a total of 1,967,830 (95% UI 1,928,880-2,008,060) YLDs of cancer were recorded in China. The disability weights of cancer varied greatly among cancer types and populations, which had considerable influence on the estimation of the disease burden. Cancer-specific disability weights could provide a more accurate evaluation of the cancer burden.

Background and purpose: Artificial intelligence (AI) technology is increasingly being used in the medical field. This study aimed to assess the effectiveness of artificial intelligence ultrasound system for identifying breast lesions in Chinese women and its role in breast cancer early detection. Methods: A prospective study was conducted on healthy women aged 35-74 years who came to Fudan University Shanghai Cancer Center from August 2020 to December 2020 for breast ultrasonography. All the women were examined by AI-assisted ultrasound first, and then by conventional ultrasonography. We compared the differences between AI-assisted ultrasound and conventional ultrasonography in identifying breast lesions in Chinese women. One year later, we looked up the hospital medical history and Shanghai Cancer Registration Management System for the final diagnosis of breast cancer. Results: A total of 360 women were included in the study and received breast examinations using both AI-assisted ultrasound and conventional ultrasound. A total of 2 504 breast lesions were detected, of which, 2 217 were detected by AI-assisted ultrasound, with a lesion recognition rate of 88.5%. Conventional ultrasound identified 1 090 lesions, with a lesion recognition rate of 43.5%. Using conventional ultrasound as the standard, the sensitivity and specificity of AI-assisted ultrasound for Breast Imaging Reporting and Data System (BI-RADS) level 4 and above lesions were 93.3% (95% CI: 80.7-98.3) and 100.0% (95% CI: 99.5-100.0), respectively. During one-year follow-up, 10 patients were diagnosed with breast cancer, and 8 of whom were identified by both AI-assisted ultrasound and conventional B ultrasound. The sensitivity of AI-assisted ultrasound and conventional ultrasound for breast cancer was 80.0% (95% CI: 44.2-96.4), and the specificity was 88.6% (95% CI: 84.6-91.6). Conclusion: AI-assisted ultrasound has good identification ability for breast lesions in Chinese women. The recognition ability for high-risk breast lesions (BI-RADS 4A and above) and early breast cancer is equivalent to that of conventional ultrasound, which is suitable for breast cancer screening in large-scale community of women with general risk.

Background Early detection and prognosis prediction of colorectal cancer (CRC) can significantly reduce CRC-related mortality. Recently, circulating tumour DNA (ctDNA) methylation has shown good application foreground in the early detection and prognosis prediction of multiple tumours. Methods This multicentre cohort study evaluated ctDNA methylation haplotype patterns based on archived plasma samples (collected between 2010 and 2018) from 1138 individuals at two medical centres: Fudan University Shanghai Cancer Center (Shanghai, China) and Southern Medical University Nanfang Hospital (Guangzhou, Guangdong, China), including 366 healthy individuals, 182 patients with advanced adenoma (AA), and 590 patients with CRC. Samples were processed using the ColonES assay, a targeted bisulfite sequencing method that detects ctDNA methylation haplotype patterns in 191 genomic regions. Among these 1138 samples, 748 were used to develop a classification model, and 390 served as a blinded cohort for independent validation. The study is registered at https://register.clinicaltrials.gov with the unique identifier NCT03737591. Results The model obtained from unblinded samples discriminated patients with CRC or AA from normal controls with high accuracy. In the blinded validation set, the ColonES assay achieved sensitivity values of 79.0% (95% confidence interval (CI), 66%-88%) in AA patients and 86.6% (95% CI, 81%-91%) in CRC patients with a specificity of 88.1% (95% CI, 81%-93%) in healthy individuals. The model area under the curve (AUC) for the blinded validation set was 0.903 for AA samples and 0.937 for CRC samples. Additionally, the prognosis of patients with high preoperative ctDNA methylation levels was worse than that of patients with low ctDNA methylation levels (p = 0.001 for relapse-free survival and p = 0.004 for overall survival). Interpretation We successfully developed and validated an accurate, noninvasive detection method based on ctDNA methylation haplotype patterns that may enable early detection and prognosis prediction for CRC. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

BackgroundThe cancer screening rate in the working population is very low in China. Information-motivation-behavioral skills (IMB) model has been applied to elucidate screening behavior for various chronic diseases but has not been investigated in analyzing cancer screening behavior. This study aimed to examine factors influencing cancer screening behavior and their linkages based on the IMB model. MethodsA cross-sectional study was conducted in Shanghai, China from August to October 2021. Data were obtained through an anonymous questionnaire. Predictive relationships between variables in the IMB model and cancer screening behavior were evaluated. Structural equation modeling (SEM) was constructed to demonstrate the utility of the IMB model. ResultsAmong the 556 participants included in the analysis, 34.4% of participants had ever done a cancer screening. The construct validation analysis supported that the measure items included were acceptable. SEM found that knowledge of cancer warning signs and symptoms (& beta; = 0.563, p < 0.001) and cancer screening behavioral skills (& beta; = 0.264, p = 0.003) were related to participation in cancer screening, whereas cancer screening motivation was not directly influenced the participation in cancer screening (& beta; = - 0.075, p = 0.372). ConclusionThe cancer screening rate was found to be lower than expected in the working population. The IMB model could be used to make decisions in implementing behavioral interventions to participate in cancer screening among the Chinese working population. Enhancing the knowledge of cancer warning signs and symptoms and strengthening behavioral skills should be focused on to improve participation in cancer screening.

Thyroid cancer is the most common malignant tumor of the endocrine system. In the process of thyroid cancer diagnosis and treatment in China, there is a lack of systematic collection and collation of standardized clinical data, as well as a lack of high-level clinical studies related to diagnostic accuracy, treatment effectiveness and complication rate. Therefore, the establishment of a thyroid cancer specific disease database is a necessary way. The data structure, integrity, accuracy and timeliness of thyroid cancer single disease database should be guaranted. The construction of single-center thyroid cancer specific disease database is the foundation of multi-center database construction. Through the collaboration of multi-center clinical research based on blockchain technology alliance, the country′s first multi-center, integrated and standardized thyroid cancer characteristic disease database had been established. The difficulty of establishing multi-center thyroid cancer specific disease database mainly lies in the unification of data standards and data uploading format, which requires unified supervision, management organization and data sharing and cooperation mode.

PDF file - 70K, Candidate inflammation genes selected for stage 1 study, Annotation of potentially functional SNPs in linkage disequilibrium (r2 > 0.2) with rs352038 (CXCL3) or rs3918249 (MMP9)

Background and purpose: Currently, several studies have demonstrated that body mass index (BMI) is a prognostic factor in breast cancer. The study aimed to assess the association pattern of BMI with mortality risk among patients of different age groups. Methods: This retrospective cohort study included the clinical characteristics and survival status of 25 629 patients diagnosed with breast cancer and subsequently hospitalized in Fudan University Shanghai Cancer Center between January 1, 2008 and December 31, 2016. The association between BMI and prognosis of breast cancer patients in different age subgroups was analyzed using Cox proportional hazards regression model with restricted cubic splines adjusting the main prognostic factors. Results: BMI and age were both influencing factors of breast cancer prognosis, and there was a significant interaction (P = 0.011). The pattern of association between risk of death and BMI differed among different age groups. A "J-shaped" association between risk of death and BMI was observed in the patients younger than 35 years, with a BMI of 20.16 kg/m2 corresponding to the lowest risk of death. In the age group of 35-60 years, no significant change in the risk of death was observed in patients with BMI below 23 kg/m2, and the risk of death in patients with BMI above 23 kg/m2 increased with increasing BMI; A "U-shaped" association between risk of death and BMI was observed in the patients older than 60 years, with a BMI of 23.86 kg/m2 being the lowest. The risk of death was more sensitive to changes in BMI in patients aged less than 35 years than in those aged 35-60 years and those aged more than 60 years. Conclusion: BMI and age have a significant interaction in the prognosis of breast cancer when adjusted for potential confounding factors. The association pattern between the risk of death and BMI of patients in different age groups is different. For patients under 35 years old, the lowest risk of death corresponds to BMI at diagnosis of about 20 kg/m2, while for patients over 60 years old, the lowest risk of death corresponds to a BMI at diagnosis of about 24 kg/m2.

背景 与目的:目前已有研究表明体重指数(body mass index,BMI)是乳腺癌患者预后的影响因素.本研究旨在分析不同年龄段的乳腺癌患者的BMI与其死亡风险的关联.方法:回顾性收集2008年1月1日—2016年12月31日在复旦大学附属肿瘤医院住院治疗的25629例初诊乳腺癌患者的临床特征和生存状况,经调整主要预后影响因素,以限制性立方样条Cox比例风险回归模型分析在不同年龄亚组中BMI与乳腺癌患者预后的关联.结果:BMI与年龄均为乳腺癌预后的影响因素,且存在显著的交互作用.不同年龄组患者的死亡风险与BMI的关联模式有所不同.在年龄小于35岁组观察到死亡风险与BMI呈现"J"型的关联,BMI为20.16 kg/m2的患者死亡风险最低;在年龄35～60岁组观察到BMI在23 kg/m2以下的患者死亡风险随着BMI的增加没有明显变化,BMI在23 kg/m2以上的患者死亡风险随着BMI的增加而增加;而在年龄大于60岁组观察到死亡风险与BMI呈现"U"型的关联,BMI为23.86 kg/m2的女性死亡风险最低.年龄小于35岁组患者的死亡风险对BMI变化的敏感程度相较于年龄35～60岁组和大于60岁组更高.结论:在校正了相关预后因素后,BMI与年龄对乳腺癌患者预后的影响有显著的交互作用,不同年龄组患者的死亡风险与BMI的关联模式有所不同,对于年轻患者,死亡风险最低对应的诊断时BMI约为20 kg/m2,而对于60岁以上患者,死亡风险最低对应的诊断时BMI约为24 kg/m2.

Background: BRCA1 and BRCA2 genes have been proven to be genetic susceptibility genes for breast cancer. Their mutations are closely related to hereditary breast cancer, and can also increase the risk of other cancers. Several studies have been conducted to examine the distribution and prevalence of BRCA1 and BRCA2 mutations as well as the penetrance of breast cancer in BRCA1/2 mutation carriers among different populations. However, most studies conducted among Chinese were hospital-based research, whichmay not reflect the real epidemiology in the population. In order to fill the gaps in community research, this study aims to screen genetic susceptibility genes of breast cancer patients in the Chinese community and establish a cohort of genetic high-risk populations. Methods: This is a multisite, prospective, cohort study which has been ongoing in 3 provinces of eastern China since 2019. Up to 5,000 breast cancer survivors will conduct BRCA1, BRCA2, PTEN, CHEK2, and PALB2 genetic susceptibility genes testing, provide clinical and genetic information and family history. Participants were followed up based on the results. Discussion: This is the first study of breast cancer and other common malignancies penetrance and genetic susceptibility gene mutation carrying possibility which is based on community breast cancer data. It is superior to data from hospitals and high-risk clinics. The establishment of a mutation prediction model suitable for the Chinese population still has high socio-economic value. Trial Registration: This study is registered at ClinicalTrials.gov. (Registration number NCT04265937).