Socioeconomic Disparity in Breast Cancer Detection in Hong Kong – A High Income City: Retrospective Epidemiological Study Using the Breast Cancer Registry

<div><p>Background</p><p>It is not known whether socioeconomic disparities affect the detection of breast cancer in Asian countries where the incidence of breast cancer is a rising trend. In this study, we explore the socioeconomic profiles of women and the stage of the disease at the time of diagnosis in breast cancer patients aged 40 or over in Hong Kong.</p><p>Method</p><p>During the period 2008 to 2011, 5393 breast cancer patients registered with the Hong Kong Breast Cancer Registry. Participants and their clinicians were asked to complete standardised questionnaires including patient socio-demographics, health history and risk factors, the course of the disease, post-treatment physical discomfort and psychosocial impact, follow-up recurrence and survival status.</p><p>Results</p><p>Monthly household incomes, educational levels and the practice of regular screening are independently associated with the stage of the disease at diagnosis. Higher socioeconomic status and a higher educational level were associated with an earlier stage of the disease at the time of diagnosis. Yearly clinical examinations, ultrasound and mammographic screening every 2 to 3 years were significantly associated with the earlier detection of breast cancer.</p><p>Conclusion</p><p>There were socioeconomic disparities among Hong Kong women who were found to have breast cancer. Population-based screening policies, including raising awareness among women at risk, should be implemented.</p></div

Association of the practice of ultrasound with detection of cancer at early stage.

<p>Result of logistic regression with age, education level and monthly household income adjusted (N = 1624).</p><p>*significant association as <i>p</i><0.05.</p><p>Association of the practice of ultrasound with detection of cancer at early stage.</p

Association of the screening practices (clinical examination and mammogram) with detection of cancer at an early stage.

<p>Result of logistic regression with age, education level and monthly household income adjusted (N = 1699).</p>∧<p>Marginally significant as <i>0.05;*significant association as <i>p</i><0.05.</i></p><p><i>Association of the screening practices (clinical examination and mammogram) with detection of cancer at an early stage.</i></p

Percentage of early stage cancer detection by practice of screening.

<p>Percentage of early stage cancer detection by practice of screening.</p

Association of education level with detection of cancer at early stage.

<p>Result of logistic regression with age group and residential district adjusted (N = 2781).</p><p>*significant association as <i>p</i><0.05.</p><p>Association of education level with detection of cancer at early stage.</p

Association of monthly household income with detection of cancer at early stage.

<p>Result of logistic regression (N = 1799).</p><p>*significant association as <i>p</i><0.05.</p><p>Association of monthly household income with detection of cancer at early stage.</p

Association of the practice of mammogram with detection of cancer at an early stage.

<p>Result of logistic regression with age, education level and monthly household income adjusted (N = 1721).</p><p>*significant association as <i>p</i><0.05.</p><p>Association of the practice of mammogram with detection of cancer at an early stage.</p

Association of the screening practices (clinical examination and ultrasound) with detection of cancer at early stage.

<p>Result of logistic regression with age, educational level and monthly household income adjusted (N = 1609).</p><p>*significant association as <i>p</i><0.05.</p><p>Association of the screening practices (clinical examination and ultrasound) with detection of cancer at early stage.</p

Association of the practice of clinical examination with detection of cancer at an early stage.

<p>Result of logistic regression with age, education level and monthly household income adjusted (N = 1723).</p><p>*significant association as <i>p</i><0.05.</p><p>Association of the practice of clinical examination with detection of cancer at an early stage.</p

Multivalent <i>N</i>‑Acetylgalactosamine-Conjugated siRNA Localizes in Hepatocytes and Elicits Robust RNAi-Mediated Gene Silencing

Conjugation of small interfering RNA (siRNA) to an asialoglycoprotein receptor ligand derived from <i>N</i>-acetylgalactosamine (GalNAc) facilitates targeted delivery of the siRNA to hepatocytes <i>in vitro</i> and <i>in vivo</i>. The ligands derived from GalNAc are compatible with solid-phase oligonucleotide synthesis and deprotection conditions, with synthesis yields comparable to those of standard oligonucleotides. Subcutaneous (SC) administration of siRNA–GalNAc conjugates resulted in robust RNAi-mediated gene silencing in liver. Refinement of the siRNA chemistry achieved a 5-fold improvement in efficacy over the parent design <i>in vivo</i> with a median effective dose (ED₅₀) of 1 mg/kg following a single dose. This enabled the SC administration of siRNA–GalNAc conjugates at therapeutically relevant doses and, importantly, at dose volumes of ≤1 mL. Chronic weekly dosing resulted in sustained dose-dependent gene silencing for over 9 months with no adverse effects in rodents. The optimally chemically modified siRNA–GalNAc conjugates are hepatotropic and long-acting and have the potential to treat a wide range of diseases involving liver-expressed genes