Editor's Note: Breast cancer remains a major threat to women’s health, and early screening plays a crucial role in reducing both incidence and mortality. However, compared to developed countries in Europe and North America, China still faces numerous challenges in breast cancer screening. At the 2024 Chinese Congress of Holistic Integrative Oncology (CCHIO) during the Breast Oncology Integrative Rehabilitation session, Dr. Nanlin Li from Xijing Hospital of the Air Force Medical University delivered a report titled “Strategies and Gaps in Breast Cancer Screening for Chinese Women”, providing an in-depth analysis of the current state of breast cancer screening in China and the challenges faced. In an interview with Oncology Frontier, Professor Li highlighted that while progress has been made in recent years, obstacles such as the large population size, insufficient funding, a shortage of trained personnel, and low public awareness continue to limit the full implementation of screening efforts. He called on more women to recognize the importance of screening and encouraged collective efforts from governments and society to improve coverage and safeguard women's health.

1. Oncology Frontier: What are the major shortcomings in China’s breast cancer screening efforts? What specific strategies or recommendations do you propose to address these issues?

Dr. Nanlin Li: My report during the session, titled “Strategies and Gaps in Breast Cancer Screening for Chinese Women,” provided an overview of the current state of screening in China. Compared to developed countries, where early screening has led to nearly a 50% reduction in breast cancer mortality, China has not achieved such significant results, which points to considerable shortcomings in our screening efforts.

The primary challenges include four key factors. First, the size of China’s population poses a significant obstacle to universal screening. Second, funding for early screening remains inadequate. Third, there is a shortage of trained screening personnel. Fourth, many women of screening age do not place enough importance on breast cancer screening. Public attitudes often reflect a “wait-until-seriously-ill” mindset, with low health awareness compounded by insufficient health education and publicity efforts. These are significant barriers to advancing screening programs and aligning them with international standards.

In recent years, organizations such as the National Health Commission, the All-China Women’s Federation, and various health and cancer-related institutions have launched initiatives to address these issues, achieving some success. However, many women remain unscreened, particularly in underdeveloped regions. This disparity is evident when comparing major urban centers like Beijing, Shanghai, and Guangzhou, where screening and treatment outcomes are superior, to less developed western regions. The differences are primarily due to better screening implementation in developed areas.

Through Oncology Frontier, I want to make two appeals. First, I urge more women of screening age to recognize the importance of this issue and actively participate in national screening programs. Second, I call on governments at all levels and civil organizations to contribute their resources and efforts to ensure the successful implementation of these programs.

2. Oncology Frontier: What are the characteristics of an effective breast cancer screening strategy? How can screening programs be effectively promoted in rural or remote areas to improve coverage?

Dr. Nanlin Li: The challenges in China’s screening efforts are primarily due to its vast population and uneven regional development, with underdeveloped areas facing significant deficits in screening capacity. Additionally, our screening methods lag behind international standards. Globally, mammography is widely recognized as the gold standard for breast cancer screening due to its high accuracy. However, even many tertiary hospitals in China lack high-resolution mammography equipment, relying instead on ultrasound. Ultrasound examinations are highly subjective, with significant variability in results depending on the expertise and qualifications of the examiner, which directly affects the accuracy of reports.

To address these issues, several steps need to be taken. First, public health education campaigns must aim to change societal attitudes and raise awareness about the importance of early screening. Second, continuing education for medical professionals should be strengthened to train more qualified personnel for breast cancer screening. Third, resources, equipment, and technology should be directed toward underdeveloped areas. For example, some organizations have introduced mobile screening units equipped with mammography devices, bringing screening services directly to remote regions. While these measures cannot resolve all issues, they have proven effective in raising awareness among populations with limited access to healthcare.

These efforts are ongoing, but advancing cancer screening remains a long-term task.

3. Oncology Frontier: How should China’s breast cancer screening strategy evolve to better meet national needs and adapt to the current situation?

Dr. Nanlin Li: As societal development progresses and living standards improve, public awareness of health is gradually increasing. To build on this momentum, I believe that national measures must be implemented at a higher level, potentially through legislation. For instance, linking cancer screening programs to essential services could make screening mandatory. One example is rural cooperative medical insurance, which has achieved widespread adoption. If screening services were bundled with insurance programs, it could significantly boost participation in screening initiatives.

The integration of emerging technologies such as artificial intelligence (AI) and big data analytics can also help address existing challenges by improving the accuracy, efficiency, and accessibility of screening efforts. Collaboration across government agencies, healthcare institutions, and private organizations will be essential to pool resources and expertise.

With these measures in place, China can make meaningful progress in its screening efforts, identifying more breast cancer cases at an early stage and thereby reducing the burden of treatment and associated costs. While the challenges are significant, the potential benefits of enhanced screening programs cannot be overstated. I hope that more stakeholders will join the cause and contribute to this critical work.

Dr. Nanlin Li

• Associate Chief Physician, Associate Professor, and Doctoral Supervisor at the Thyroid, Breast, and Vascular Surgery Department, Xijing Hospital, Air Force Medical University
• Vice Chair, Breast Tumor Committee, Chinese Primary Health Care Foundation
• Standing Committee Member, Breast Cancer Specialty Committee, Chinese Anti-Cancer Association
• Member, Breast Cancer Expert Committee, Chinese Society of Clinical Oncology (CSCO)
• Standing Committee Member, CSCO Patient Education Expert Committee
• Standing Committee Member, Breast Cancer and Anticancer Drug Specialty Committees, Shaanxi Anti-Cancer Association
• Recognized as a Shaanxi Province Health Science Popularization Expert

Professor Li has dedicated his career to the diagnosis and treatment of breast and thyroid cancers. He has published over 30 SCI papers as the first or corresponding author, holds 13 national patents, and has authored or edited eight books. He has received numerous accolades, including a third-class personal merit award in 2014.