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An exploration for quantification of overdiagnosis and its effect for breast cancer screening

Chinese Journal of Cancer Research 2020年第1期32卷 26-35页

作者： Lei Yang Shengfeng Wang Yubei Huang Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Beijing Office for Cancer Prevention and ControlPeking University Cancer Hospital&InstituteBeijing 100142China Department of Epidemiology&Biostatistics School of Public HealthPeking UniversityBeijing 100191China Department of Epidemiology and Biostatistics Key Laboratory of Cancer Prevention and TherapyTianjinKey Laboratory of Breast Cancer Prevention and TherapyMinistry of EducationNational Clinical Research Center for CancerTianjin Medical University Cancer Institute and HospitalTianjin 300060China

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<0.001). The 15-year survival rate of early-stage breast cancer patients increased from 51.1% to 61.5%(P<0.001), while the proportions of earlystage breast cancer patients with long-time survival to all breast cancer patients increased from 26.6%(52.1%×51.1%) to 44.7%(72.7%×61.5%). Assuming no improvements in cancer screening technology and treatment technology, 18.1%(44.7%-26.6%) of breast cancer patients were overdiagnosed associated with screening. The age-specific overdiagnosis rates were 18.9%, 24.7%, 24.5%, 20.5%, and 8.3% for breast cancer patients aged 40-49, 50-59, 60-69, 70-74, and ≥75 years old, respectively.Conclusions: Overdiagnosis caused by mammographic screening is probably overestimated in current screening practices. Further trials with more sophisticated designs and analyses are needed to validate our findings in the future.

关键词： Breast cancer screening overdiagnosis

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Development and evaluation of the screening performance of a low-cost high-risk screening strategy for breast cancer

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Cancer Biology & Medicine 2022年第9期19卷 1375-1384页

作者： Yubei Huang Huan Wang Zhangyan Lyu Hongji Dai Peifang Liu Ying Zhu Fengju Song Kexin Chen Department of Cancer Epidemiology and Biostatistics 2Department of Breast ImagingTianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and Therapy of TianjinTianjin’s Clinical Research Center for CancerKey Laboratory of Cancer Molecular Epidemiology of TianjinKey Laboratory of Breast Cancer Prevention and TherapyMinistry of EducationTianjin 300060China

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.

关键词： Cancer screening breast cancer high risk mammography ultrasonography

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Comparison of outcomes between immediate implantbased and autologous reconstruction: 15-year, single-center experience in a propensity score-matched Chinese cohort

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Cancer Biology & Medicine 2022年第9期19卷 1410-1421页

作者： Shanshan He Bowen Ding Gang Li Yubei Huang Chunyong Han Jingyan Sun Qingfeng huang Jing Liu Zhuming Yin Shu Wang Jian Yin Department of Breast Reconstruction Key Laboratory of Breast Cancer Prevention and TherapyTianjin Medical UniversityMinistry of EducationSino‐Russian Joint Research Center for Oncoplastic Breast SurgeryTianjin Medical University Cancer Institute&HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinTianjin’s Clinical Research Center for CancerTianjin 300060China School of Pharmacy University College LondonLondon WC1N 1AXUK Department of Cancer Epidemiology and Biostatistics Tianjin Medical University Cancer Institute&HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinTianjin’s Clinical Research Center for CancerTianjin 300060China

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 implantbased 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(implantbased,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.

关键词： Oncological safety immediate breast reconstruction implant-based autologous Chinese propensity-score matched

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Efficient decomposition of sulfamethoxazole in a novel neutral Fered-Fenton like/oxalate system based on effective heterogeneous-homogeneous iron cycle

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Chinese Chemical Letters 2019年第12期30卷 2231-2235页

作者： Chen Wang yubei Liu Tao Zhou Mingjie huang Juan Mao Xiaohui Wu School of Environmental Science and Engineering Huazhong University of Science and TechnologyWuhan 430074China Key Laboratory of Water and Wastewater Treatment(HUST) MOHURDWuhan 430074China

In this study,efficient sulfamethoxazole(SMX) degradation was demonstrated in a novel neutral FeredFenton like/oxalate(electro-Fe^2+/PDS/Ox,Fered-FL/Ox) system adopting pre-anodized Ti@Ti02 cathode.Optimization of operational parameters was conducted and the whole reaction mechanism based on the critical solid-liquid interfacial reactions was explored.An efficient neutral heterogeneous-homogenous iron cyclewould exist in the Fered-FL/Ox system,depending on the formation of specific C-O-Ti bonds through the inner sphere surface complex(ISSC) of Fe(C2 O4)3^3-.It would induce ultrafast electron transfer from the cathode to the FeⅢ core,effectively accelerating the neutral Fenton-like reactions and complete mineralization of SMX with relative low dosage of ferrous catalyst and applied voltage.The result of this study is expected to supply a good alternative in treating complex neutral industrial wastewaters.

关键词： Fered-fenton like Heterogeneous iron cycle Iron-oxalate complexes Surface electron transfer Persulfate

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Interpretation of breast cancer screening guideline for Chinese women

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Cancer Biology & Medicine 2019年第4期16卷 825-835页

作者： Yubei Huang Zhongsheng Tong Kexin Chen Ying Wang Peifang Liu Lin Gu Juntian Liu Jinpu Yu Fengju Song Wenhua Zhao Yehui Shi Hui Li Huaiyuan Xiao Xishan Hao Department of Epidemiology and Statistics Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin 300060China Medicine Department of Breast Oncology Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin 300060China China Anti-Cancer Association Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin 300060China Department of Breast Imaging Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin 300060China The 2nd Surgery Department of Breast Oncology Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin 300060China Cancer Prevention Center Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin 300060China Cancer Molecular Diagnostics Core Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin 300060China Department of Gastrointestinal Cancer Biology Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin 300060China Department of Research and Education Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin 300060China

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.

关键词： Breast cancer screening ultrasound mammography guideline

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弥补行为和自我惩罚对内疚感的降低作用

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心理研究 2021年第3期14卷 216-226页

作者：黄煜蓓刘海燕海南师范大学心理学院海口571158

本研究采用情境性问卷,通过三个实验探讨弥补行为和自我惩罚对内疚感的降低作用,结果发现:(1)选择弥补行为的被试明显多于选择自我惩罚和同时采取两种行为的被试;(2)弥补行为和自我惩罚对内疚感均有降低作用,且弥补行为对内疚感的降低... 详细信息

本研究采用情境性问卷,通过三个实验探讨弥补行为和自我惩罚对内疚感的降低作用,结果发现:(1)选择弥补行为的被试明显多于选择自我惩罚和同时采取两种行为的被试;(2)弥补行为和自我惩罚对内疚感均有降低作用,且弥补行为对内疚感的降低作用更高;(3)冒犯者与被冒犯者的社会距离越近,冒犯者内疚感越强,但社会距离对冒犯者采取弥补行为或自我惩罚后的内疚感无影响,且对内疚感降低程度也无影响。因此,弥补行为对内疚感的降低作用高于自我惩罚。

关键词：弥补行为自我惩罚内疚感社会距离

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营改增对工程总承包企业的影响及应对策略

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化工与医药工程 2016年第4期37卷 61-64页

作者：黄昱蓓中石化上海工程有限公司上海200120

全面实施营改增,是深化财税体制改革、推进经济结构调整和产业转型的重头戏,是对工程公司发生重大影响的创新改革。说明了营改增的发展及意义、纳税模式变化,分析了营改增后的工程项目中的税负变化以及产生的一些影响,阐述了对EPC企业... 详细信息

全面实施营改增,是深化财税体制改革、推进经济结构调整和产业转型的重头戏,是对工程公司发生重大影响的创新改革。说明了营改增的发展及意义、纳税模式变化,分析了营改增后的工程项目中的税负变化以及产生的一些影响,阐述了对EPC企业影响和应对策略。

关键词： EPC工程总承包营改增降低税负规避风险

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全基因组关联研究在乳腺癌筛查中的应用价值初探

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中华流行病学杂志 2019年第6期40卷 713-718页

作者：黄育北宋丰举陈可欣天津医科大学肿瘤医院流行病与生物统计室国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室 300060

目的探索全基因组关联研究(GWAS)发现的单核苷酸多态性位点(SNP)在乳腺癌筛查中的潜在应用价值。方法基于我国女性2013年的年龄构成、年龄别的乳腺癌发病率,以及明确的乳腺癌传统危险因素分布情况,对中国200万35~69岁女性人群进行模拟... 详细信息

目的探索全基因组关联研究(GWAS)发现的单核苷酸多态性位点(SNP)在乳腺癌筛查中的潜在应用价值。方法基于我国女性2013年的年龄构成、年龄别的乳腺癌发病率,以及明确的乳腺癌传统危险因素分布情况,对中国200万35~69岁女性人群进行模拟。进一步模拟GWAS发现的23个与我国女性乳腺癌风险相关的SNP位点的分布情况。依据SNP的遗传风险解释程度及风险再分类准确性的改善程度,初筛出可用于预测乳腺癌高危人群的目标SNP,并进一步探索目标SNP对乳腺癌检出率、乳腺癌风险预测曲线下面积(AUC)、高危人群中乳腺癌发病风险的影响。结果共发现12个SNP可用于预测乳腺癌高危人群。如果将预测风险位于P95及更高风险的人群定义为高危人群,并在此类人群中进行筛查,采用目标SNP预测的高危人群中的乳腺癌检出率(146.99/10万)明显低于采用传统危险因素预测的高危人群中的乳腺癌检出率(177.46/10万)(P<0.001)。在传统危险因素基础上,加上目标SNP进行高危人群预测,高危人群中乳腺癌检出率(229.00/10万)提高29.0%(P<0.001)。同时乳腺癌风险预测的AUC从64.4%上升至67.8%(P<0.001),高危人群中乳腺癌发病风险OR值从3.32上升至4.33。结论GWAS筛选出的目标SNP可提高乳腺癌检出率、乳腺癌总体风险预测准确性,并有助于在乳腺癌筛查前发现潜在的乳腺癌高危人群。

关键词：乳腺肿瘤全基因组关联研究单核苷酸多态性

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Methods of computed tomography screening and management of lung cancer in Tianjin: design of a population-based cohort study

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Cancer Biology & Medicine 2019年第1期16卷 181-188页

作者： Yihui Du Yingru Zhao Grigory Sidorenkov Geertruida H.de Bock Xiaonan Cui Yubei Huang Monique D.Dorrius Mieneke Rook Harry J.M.Groen Marjolein A.Heuvelmans Rozemarijn Vliegenthart Kexin Chen Xueqian Xie Shiyuan Liu Matthijs Oudkerk Zhaoxiang Ye Department of Epidemiology University of Groningen University Medical Center Groningen Center for Medical Imaging-North East Netherlands University of Groningen University Medical Center Groningen Department of Radiology Tianjin Medical University Cancer Institute and Hospital National Clinical Research Center for Cancer Key Laboratory of Cancer Prevention and Therapy Tianjin Tianjin’s Clinical Research Center for Cancer Department of Epidemiology and Biostatistics Tianjin Medical University Cancer Institute and Hospital National Clinical Research Center for Cancer Key Laboratory of Cancer Prevention and Therapy Tianjin Tianjin’s Clinical Research Center for Cancer Department of Radiology University of Groningen University Medical Center Groningen Department of Radiology Martini Hospital Department of Pulmonary Diseases University of Groningen University Medical Centre Groningen Medisch Spectrum Twente Department of Pulmonology Department of Radiology Shanghai General HospitalShanghai Jiao Tong University School of Medicine Department of Radiology Shanghai Changzheng Hospital The Second Military Medical University Shanghai

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.

关键词： Lung cancer lung nodules screening computed tomography China

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中国乳腺癌筛查模式探讨

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中华流行病学杂志 2016年第7期37卷 1039-1043页

作者：李卫芹李蓉刘佩芳黄育北天津市妇女儿童保健中心项目办公室 300070 天津市妇女儿童功能检查科 300070 天津医科大学肿瘤医院乳腺影像科 300060 天津医科大学肿瘤医院肿瘤研究所流行病与卫生统 300060

乳腺X线（钼靶）筛查乳腺癌虽然在西方国家取得病死率逐年下降的实效，但是目前不断有证据质疑乳腺癌筛查的综合收益，包括钼靶检查造成的放射线损害和重复钼靶检查以及活检等造成的过度诊断问题。此外，筛查模式的不同（包括不同的筛... 详细信息

乳腺X线（钼靶）筛查乳腺癌虽然在西方国家取得病死率逐年下降的实效，但是目前不断有证据质疑乳腺癌筛查的综合收益，包括钼靶检查造成的放射线损害和重复钼靶检查以及活检等造成的过度诊断问题。此外，筛查模式的不同（包括不同的筛查人群、不同的筛查方法，以及不同的筛查间隔）所造成的筛查综合收益评价的差异，同样也是引起乳腺癌筛查争议的重要原因之一。为此本文阐述导致上述争议的主要原因，同时在合理评定筛查综合收益的基础上，进一步提出改善乳腺癌筛查综合收益的可能途径。为了探寻适合中国国情的乳腺癌筛查模式，决策者应综合考虑优化筛查人群、完善筛查技术、体现知情同意及探索个体化筛查模式4个方面问题。

关键词：乳腺癌筛查风险预测

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