Yuan Huang

Sichuan University, Chengdu, Sichuan Sheng, China

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Publications (10)11.71 Total impact

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    ABSTRACT: To evaluate the accuracy and direct medical cost of different screening modalities of physical examination (PE), mammography (MAM), and high-frequency ultrasonography (US) for breast cancer among Chinese women. This study was designed as a blindly carried outcom parative parallel screening trial for breast cancer among Chinese women aged 35 years or older. Physical examination was conducted with the subjects in the first round of breast cancer screening. The negative cases were followed up approximately 1 year later and moved into the second round of screening. Using the results of biopsies and 1-year follow-up as the gold standards, the accuracy and cost indexes of different screening modalities were calculated. Data were analyzed by McNemar test. A total of 2 471 eligible women were included in this trial, and 14 breast cancers were identified among them. Mammography enabled to detect 11 cancers, high-frequency ultrasonography detected 9 cancers and physical examination detected 8 cancers. Considering the three modalities separately, MAM identified the fewest suspicious cases (52 cases) and detected the most cancers (11 cases). Using US alone at the first stage, followed by MAM when indicated, offered the highest specificity (99.7%)and correct positive predictive value (11.4%), meanwhile the sensitivity was 78.6%, and the mean costs of the screening modality in urban and rural areas were 291, 210 yuan and 886,050 yuan per cancer case detected. The strategy of screening with US alone at the first stage, followed by MAM when indicated, may be the most suitable modality of breast cancer detection in most regions of China, but the cost is still too high to develop the breast cancer screening in some low incidence regions with limited health resources.
    Zhonghua zhong liu za zhi [Chinese journal of oncology] 03/2014; 36(3):236-239.
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    ABSTRACT: Few studies have investigated the association between body mass index (BMI) and breast cancer with consideration to estrogen/progesterone/human epidermal growth factor type 2 receptor status (ER/PR/HER2) in the breast tissue among Chinese pre- and post-menopausal women. Four thousand two hundred and eleven breast cancer patients were selected randomly from seven geographic regions of China from 1999 to 2008. Demographic data, risk factors, pathologic features, and biological receptor status of cases were collected from the medical charts. Chi-square test, fisher exact test, rank-correlation analysis, and multivariate logistic regression model were adopted to explore whether BMI differed according to biological receptor status in pre- and post-menopausal women. Three thousand two hundred and eighty one eligible cases with BMI data were included. No statistically significant differences in demographic characteristics were found between the cases with BMI data and those without. In the rank-correlation analysis, the rates of PR+ and HER2+ were positively correlated with increasing BMI among post-menopausal women (rs BMI, PR+ = 0.867, P = 0.001; rs BMI, HER2+ = 0.636, P = 0.048), but the ER+ rates did not vary by increasing BMI. Controlling for confounding factors, multivariate logistic regression models with BMI<24 kg/m(2) as the reference group were performed and found that BMI≥24 kg/m(2) was only positively correlated with PR+ status among post-menopausal breast cancer cases (adjusted OR = 1.420, 95% CI: 1.116-1.808, Wald = 8.116, P = 0.004). Post-menopausal women with high BMI (≥24 kg/m(2)) have a higher proportion of PR+ breast cancer. In addition to effects mediated via the estrogen metabolism pathway, high BMI might increase the risk of breast cancer by other routes, which should be examined further in future etiological mechanism studies.
    PLoS ONE 01/2014; 9(1):e87224. · 3.53 Impact Factor
  • Hui Li, Yuan Huang, Rong Huang, Jia-Yuan Li
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    ABSTRACT: To evaluate the standard treatment cost of female breast cancer at different tumor node metastasis (TNM) stages. Extracting previous data, calculating by clinical pathway, face-to-face interviewing, and telephone interviewing were adopted to estimate the treatment cost of female breast cancer. The cost was consisted of direct medical expenditure, direct non-medical expenditure, and indirect expenditure. The direct medical expenditure was extracted from medical record and expense statement of 316 breast cancer cases in Sichuan Cancer Hospital. The direct non-medical expenditure was investigated from 211 patients and their relatives. The indirect expenditure was surveyed from 181 cases who received surgery more than one year ago. The average treatment cost of female breast cancer was ¥160 457 ($23 702), which was adjusted by the proportions of ER, PR, and menses status, and the willingness of patients. The treatment cost (including the outpatient cost for 5 years after surgery, radiotherapy, and chemotherapy) of TNM 0 stage, TNM I stage, TNM II stage, TNM III stage, and TNM IV stage were ¥37 941, ¥122 622, ¥159 594, ¥215 014, and ¥214 229, respectively. The patients with early stage breast cancer payed considerably lower treatment cost than those at advanced stage. Early detection and treatment of breast cancer may have a real economic significance for reducing the burden of disease.
    Zhonghua zhong liu za zhi [Chinese journal of oncology] 12/2013; 35(12):946-50.
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    ABSTRACT: Background: The characteristics of established risk factors for breast cancer may vary among countries. A better understanding of local characteristics of risk factors may help in devising effective prevention strategies for breast cancer.Methods: Information on exposures to risk factors was collected from the medical charts of 4211 women with breast cancer diagnosed during 1999-2008. The distributions of these exposures among regions, and by menopausal status and birth period, were compared with the χ(2) test. Crude associations between the selected factors and breast cancer were estimated using the cases in the present study and a representative control population, which was selected from qualified published studies.Results: As compared with cases from less developed regions, those from more developed regions were significantly more likely to be nulliparous, had fewer childbirths (P < 0.05), and were less likely to have breastfed (P = 0.08). As compared with premenopausal cases, postmenopausal cases were more likely to be overweight and to have breastfed and had more childbirths (P < 0.05). The number of live births and rate of breastfeeding decreased in relation to birth period (P for trends <0.001). Overweight, late menopause, and family history of breast cancer were significantly associated with breast cancer among Chinese women.Conclusions: Breast cancer incidence was associated with nulliparity and history of breastfeeding. Population attributable risks should be assessed, especially for more developed areas and young women. The effects of body mass index, age at menopause, and family history of breast cancer should be given priority during assessment of breast cancer risk among Chinese women.
    Journal of Epidemiology 11/2013; · 2.11 Impact Factor
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    ABSTRACT: To evaluate the quality of life (QOL) in patients with breast cancer at different TNM stages and to estimate the value of EuroQol Five Dimension Indicator (EQ-5D) in measuring QOL among Chinese breast cancer patients. A survey with Quality of Life Instruments for Cancer Patients-Breast Cancer (QLICP-BR) and EQ-5D was undertaken in breast cancer patients who had completed their standardized treatment (except for the endocrine treatment) six months ago. Chi-square test, one-way ANOVA, and covariance analysis were used to evaluate the possible factors influencing the QOL of breast cancer patients. Simultaneously, with the results of Quality of Life Instruments for Cancer Patients-General Module (QLICP-GM, which is included in QLICP-BR.) and the total scores of QLICP-BR as standard, we conducted Pearson correlation analysis to evaluate the value of EQ-5D. A total of 178 female breast cancer survivors were collected from March 2010 to September 2010. There were 47 cases (26.4%) at stage 0 and I, 81 cases (45.5%) at stage II, and 50 cases (28.1%) at stage III and IV. The total standardized score of QLICP-BR was 72.55 ± 3.10 in patients at stage 0 and I, 64.09 ± 2.69 in patients at stage II and 58.21 ± 3.00 in patients at stage III and IV. The total standardized score of QLICP-BR and social domain of patients at stage 0 and I were higher than patients at stage II (all P < 0.05). The total standardized score of QLICP-BR, specific domain of breast cancer, psychological, social and physical domains of patients at stage 0 and I were higher than patients at stage III and IV (all P < 0.05). Covariance analysis showed that QOL standardized scores were significantly different across TNM stages when age, degree of education, birth place (metropolis or rural), occupation, domestic income, and medical insurance were controlled (P = 0.002). Correlation analysis indicated that EQ-5D has a positive correlation with QLICP-GM and QLICP-BR (all P < 0.05). QOL of patients with early stage breast cancer is better than those at late stage. Early diagnosis and treatment can improve QOL of breast cancer patients. Chinese version of EQ-5D can well detect the differences of QOL among patients with different TNM stages, which can be used for evaluating QOL in Chinese female breast cancer patients.
    Zhonghua zhong liu za zhi [Chinese journal of oncology] 01/2013; 35(1):71-7.
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    ABSTRACT: SULT1A1 is involved in both detoxification of estrogens and bioactivation of carcinogens in smoked meat. SULT1A1 Arg213His polymorphism's effect on breast cancer risk is still unclear. We recruited 400 case-control pairs to investigate the association between SULT1A1 genotypes and breast cancer risk, and the combined effect of SULT1A1 polymorphism and daily intake of smoked meat. Participants were questioned about their dietary habits and other risk factors, and their SULT1A1 genotypes were determined. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated by multivariable unconditional logistic regression. We also performed a meta-analysis of relevant published studies to test these associations. In the case-control study, no significant associations were observed between SULT1A1 polymorphism and breast cancer risk. In the meta-analysis, SULT1A1 His/His genotype slightly increased risk among both overall and postmenopausal women (OR(pooled-overall)=1.12, 95% CI: 1.02-1.24; OR(pooled-post)=1.17, 95% CI: 1.03-1.32). A larger positive association was observed in Asian populations (OR(pooled-Asian)=2.01, 95% CI: 1.24-3.26). In our case-control study, high energy-adjusted daily intake of smoked meat was significantly associated with breast cancer risk in overall, pre- and postmenopausal women (aORs: 2.31-3.13, OR 95% CIs exclude 1). High smoked meat intake interacted positively with the His variant allele (all γ>1). These results correlated with those of the meta-analysis (γ(pooled-overall)=1.27). The SULT1A1 His/His genotype may increase the risk of breast cancer among Asian women, and dietary exposure to heterocyclic amines and polycyclic aromatic hydrocarbons, along with the SULT1A1 His/His variant genotype, may synergistically increase the risk of breast cancer.
    DNA and cell biology 10/2011; 31(5):688-99. · 2.28 Impact Factor
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    ABSTRACT: CYP1A1, CYP1B1, and COMT are key enzymes involved in estrogen metabolism. Soy isoflavones, phytoestrogens found in soy foods, may modify the activity of these enzymes. A case-control study was conducted to assess the associations between soy isoflavone intake and the CYP1A1 Ile462Val, CYP1B1 Val432Leu, and COMT Val158Met polymorphisms and breast cancer, as well as their combined effects on breast cancer. A total of 400 newly diagnosed breast cancer cases and 400 healthy controls were recruited. Participants' daily intake of soy isoflavones (DISI [mg/day]) was calculated and transformed to energy-adjusted DISI by the residual method. Gene sequencing was used to analyze CYP1A1, CYP1B1, and COMT polymorphisms. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were estimated by conditional logistic regression. A strong protective dose-dependent effect of energy-adjusted DISI on breast cancer was found in both pre- and postmenopausal women (P(trend) < 0.05). Among all women and in the postmenopausal subgroup, COMT Met/Met and CYP1B1 Leu/Leu susceptible genotype carriers had higher risk of breast cancer (aORs > 1, OR 95% CIs exclude 1). In premenopausal women, only carrying CYP1B1 Leu/Leu was associated with breast cancer risk (aOR = 2.05, 95% CI: 1.11-3.79). Carrying CYP1A1 Val/Val was related to breast cancer risk only among all women. A stratified analysis was performed at two levels of energy-adjusted DISI, with wildtype homozygous genotypes and low energy-adjusted DISI as the reference. In the high energy-adjusted DISI subgroup, carrying the CYP1B1 Leu/Leu genotype did not affect breast cancer risk in either all women or in the menopausal subgroups, compared with the reference. Overall, in Han Chinese women, carrying CYP1A1 Val/Val and COMT Met/Met appears to be associated with breast cancer risk, especially in postmenopausal women. CYP1B1 susceptible genotypes (Val/Leu or Leu/Leu) also contribute to increased breast cancer risk, regardless of menopausal status, but high soy isoflavone intake may reduce this risk.
    DNA and cell biology 03/2011; 30(8):585-95. · 2.28 Impact Factor
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    ABSTRACT: To evaluate the risk factors of breast cancer in Asian women and to provide evidences for establishing a risk assessment model. Published studies concerning risk factors of breast cancer in Asian women were searched systemically and assessed by NOS (Newcastle-Ottawa Scale) items between 1995 and 2010. RevMan 4.2 software was used for data analysis and for calculating OR and its 95%CI on every risk factor. 27 studies including 403 170 women were selected for Meta-analysis. According to NOS items, 20 studies were classified as A degree and 7 studies were evaluated as B degree. The risk factors of breast cancer and its pooled odds ratio values with statistical significance were as follows: 3.00 (95%CI: 1.68 - 5.36) when number of abortions ≥ 3; 2.39 (95%CI: 1.78 - 3.21) when with family history of breast cancer; 1.54 (95%CI: 1.30 - 1.82) when age at first live birth ≥ 30 (year); smoking was 1.50 (95%CI: 1.03 - 2.20); 1.48 (95%CI: 1.20 - 1.83) with no live births; 1.29 (95%CI: 1.12 - 1.47) with no breast feeding; 1.26 (1.07 - 1.49) with age at menarche ≤ 12 (year) and 1.16 (95%CI: 1.01 - 1.32) with alcohol drinking. Number of abortions ≥ 3, family history of breast cancer, age at first live birth ≥ 30 (year), smoking, no live births, no breast feeding, age at menarche ≤ 12 (year), and alcohol drinking were among the priorities in the establishment of breast cancer risk assessment model for Asian women.
    Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 02/2011; 32(2):164-9.
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    ABSTRACT: In most developed countries, breast cancer screening (BCS) is a well-established practice which is widely accepted by women. In contrast, national BCS projects in China were only launched in the last two years, so little is known about their public response. We surveyed 1,162 Chinese women from different socio-economic regions in Sichuan Province to assess participants' knowledge, attitudes, and behaviour regarding BCS. ANOVA/t-test, Chi-square test, SNK test, and covariance analyses were used to compare subgroups and a multinomial logistic regression model was adopted to examine factors associated with BCS attendance. Statistically significant differences in scores of BCS knowledge were seen across regions. Most women from all four regions were interested in knowing the risk factors for (1,053, 90.6%) and means of prevention (912, 78.5%) of breast cancer. Eight hundred thirty-seven (72.0%) women expressed willingness to pay extra insurance fees when young in exchange for reimbursement for cancer screening when they reached the age at which screening is recommended. Approval of primary medical institutions was generally low. Regional socio-economic level, work status, and education were strong predictors of BCS attendance. To eliminate geographic disparities and raise the participation rate of BCS, future health education should be adjusted to local conditions and strengthened for women in under-developed regions. Incorporating BCS into a regular program of community-based prevention of chronic non-communicable diseases, and increasing medical insurance funds to cover BCS, especially in rural areas, may be effective means to increase BCS attendance.
    Asian Pacific journal of cancer prevention: APJCP 01/2011; 12(1):203-9. · 1.50 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate the accuracy and value of high-frequency ultrasound for breast cancer screening in Asian women. METHODS: Published studies on high-frequency ultrasound for screening breast cancer in Asian women were systemically searched and assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Meta-DiSc 1.4 software was used for extracting data, calculating the summary sensitivity and specificity, and drawing the Summary Receiver Operating Characteristic (SROC) curve. Furthermore, the proportion of screening of diagnosis on early breast cancer (TNM stage 0, I and II) by high-frequency ultrasound was calculated. RESULTS: Seven screening studies including 22 244 women were selected for Meta-analysis. According to the QUADAS items, 5 studies were classified as A degree and 2 studies were evaluated as B degree. For study in the heterogeneous of these 7 studies (Q = 38.97, P < 0.0001), Random Effects Model (REM) was selected. The combined sensitivity (95%CI) and specificity (95%CI) were 0.785 (0.726 - 0.837) and 0.975 (0.973 - 0.977) respectively. The Area Under the Curve (AUC) of SROC was 0.9800. Among the follow-up studies of following period over one year, 96.9% of the diagnosed patients with breast cancer were at clinical stage II or prior to it. CONCLUSION: Because of its high accuracy, high-frequency ultrasound could be recommended for screening breast cancer in Asian women.
    Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 11/2010; 31(11):1296-1299.