China is moving to promote a package of breast cancer prevention and treatment standards across the country, hoping to further prolong patients' survival time and narrow the diagnosis and treatment gap between urban and rural areas.

A series of guidelines covering breast cancer screening, early diagnosis and treatment and rational drug use to follow-up treatment and management of concomitant diseases were released Saturday at an ongoing cancer and health conference jointly held by the National Cancer Center (NCC), Cancer Foundation of China, Beijing Breast Disease Society and other related institutions.

Data released by the NCC in March 2018 showed that the mortality rate of breast cancer in China accounted for 16.5 percent of all cancers in females. As breast cancer continues to lay claim to top incidence rates both at home and abroad, its cure rate has been improving steadily in China, with the five-year survival rate reaching 83.2 percent between 2010 and 2014, up by 7.3 percent since 2000.

As survival time has been significantly prolonged, more patients have entered a chronic disease period, according to the guidelines for breast cancer follow-up and overall management of concomitant diseases, the first situation of its kind in China, by the NCC.

Common concomitant diseases of breast cancer include cardiovascular diseases, abnormal bone metabolism and depression. "Among elder patients, cardiovascular diseases have caused even more deaths than cancer itself," said Ma Fei, executive chairman of the conference and expert from the NCC.

Under the dual effects of ovarian dysfunction and drugs, postmenopausal patients suffer a distinct drop in estrogen levels, which often results in an abnormal lipid amount in the blood and increases the risk of cardiovascular diseases, Ma explained.

In addition, a large number of patients will continue to receive endocrine therapy for five to 10 years after cancer treatment, which is often accompanied by abnormal bone metabolism, osteoporosis and even fractures.

The guidelines clearly require doctors, through interdisciplinary collaborations, to take into consideration a patient's blood lipid level and bone density before giving endocrine therapy. It also suggests that doctors intervene to help patients quit smoking and drinking alcohol as well as avoid tumbles and serious body impacts according to the evaluation of their overall health conditions.

Xu Binghe, a professor at the NCC who has been focusing on breast cancer treatment for more than three decades, noted that the guidelines, by standardizing the follow-up visits and examinations, would bring the prevention of possible concomitant diseases earlier than before and extend health care to survivors over their entire lifetime.

"It will certainly assist the patients in returning to their family and society in a better state," Xu said.

Ma Fei regarded the guidelines as an important step to change the disease-centered diagnosis and treatment model into a patient-centered one. "The patients should not only live longer but also live well," he said.

China issued the blueprint for health care development "Healthy China 2030" in 2016, aiming to raise the whole five-year cancer survival rate by 15 percentage points by 2030.

As for breast cancer, the five-year survival rate varies a lot among different areas. The eastern coastal cities report a survival rate of 90 percent, roughly the same level as in developed Western countries, while the inland and rural area rates are lower at 70 to 80 percent.

Moreover, the incidence of breast cancer in China is still growing by 3 to 4 percent annually, which is higher than the global average.

"To further improve the cure rate of breast cancer in China, early diagnosis and treatment are very important. So far, no more than 20 percent of breast cancer cases are detected at an early stage, and less than 5 percent are found by screening," Ma said.

China has started to promote free breast cancer and cervical cancer screenings among rural women since 2009. But how to select among different screening techniques, especially when targeting different age groups, there are yet no unified standards. The lack of screening professionals has also resulted in high rates of false or missed diagnosis.

The NCC also released the guidelines for screening and early diagnosis and treatment at the conference, which defines the screening targets and methods as well as early diagnosis and treatment paths.

While European and American countries recommend mammography as the major screening method, these guidelines suggest the best option for Chinese patients is to combine mammography with ultrasound examination.

"We cannot just copy the international guidelines. For example, Western women usually have larger breasts with more fat, very suitable for mammography, but Chinese women often have smaller breasts with higher density, better for ultrasound equipment," Ma explained.

"Covering healthy people and paying particular attention to high-risk groups, the guidelines will help increase early detection of breast cancer," he said.

A consensus on the diagnosis and treatment of young patients who want to retain normal fertility was also issued during the conference.

According to Ma, the peak incidence age of breast cancer in China is 10 to 15 years earlier than that in western countries, with many patients younger than 35 years old. Most of these patients do not give birth yet and desire to have babies.

It is almost impossible for young patients to avoid chemotherapy, which usually contains cyclophosphamide (CTX) that is harmful to the reproductive system. The endocrine therapy is also likely to cause sterility due to its impact on the uterus and ovary, Ma said.

A research reveals that although more than half of the patients in China are worried about the procreation problem, very few ask to adjust their treatment plans.

The consensus suggests that young patients should all receive genetic counseling regardless of their family history and doctors think over the CTX adverse effects for young patients who desire pregnancy.

"The consensus fills in the gap in helping protect the reproductive health of cancer patients and provides practical operational instructions for medical institutions at all levels, marking a new step toward establishing an overall management system for breast cancer in China," Ma said.