A network data-based survey and analysis of attention towards breast reconstruction after breast cancer surgery in Chinese and American populations

Songxue Guo,Xueqing Hu,Zheren Shao,Hui Wang,Quan Fang,Nan Li

Department of Plastic Surgery,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,Zhejiang,China

Keywords:Breast cancer Breast reconstruction China United States Network searching

ABSTRACT Background: Breast reconstruction is an effective technique to rebuild the appearance of the breasts in patients after mastectomy and improves the prognosis.The current study aimed to compare and analyze willingness for breast reconstruction after breast cancer between populations in China and the United States,from the perspective of social concern,using big data analysis.We also aimed to explore factors affecting surgical selection and to identify methods that can improve social cognition and acceptance of breast reconstruction.Methods: Using Baidu and Google,two representative Internet search engines in China and the United States as research tools,and using big data search volume as the benchmark,we compared and analyzed breast reconstruction willingness and attention characteristics between Chinese and American people,based on search heat,geographical distribution,age and sex,keyword distribution,ethnic group,and social development degree.Results:In both the long-term and short-term,Chinese people paid more attention towards searching about breast cancer,but less attention to breast reconstruction after breast cancer surgery.However,in both the short-term and long-term,people from the United States paid more attention towards breast cancer and breast reconstruction with the help of the Internet,showing a synchronous change relationship.There was a large regional difference in the search volume for breast cancer among the Chinese population,while no significant regional differences were noted in the search volume for breast cancer in the United States.However,a large regional difference was observed in the search volume for breast reconstruction between the two countries;people in the coastal and economically developed areas paid more attention to it.Most people who paid attention to breast reconstruction in China were women aged 20-39 years,while the attention among men was low.Search keywords were also limited to breast cancer-related information.However,between Asians and European Americans,Americans paid more attention to breast cancer and were affected by regional development,religious beliefs,and health facilities.Conclusion: Attention towards breast reconstruction after breast cancer was lower in the Chinese population than in the American population,and this difference was closely related to the level of regional development.There is insufficient information on breast reconstruction after breast cancer in recent Internet media.In addition to strengthening communication in clinics,media education is important to improve the cognitive level and social awareness of patients and their families,which is conducive to breast reconstruction.

1.Introduction

Breast cancer contributes to a severe health risk in women,worldwide,and has garnered significant attention from the society.Modified radical mastectomy is the main surgical approach to treat breast cancer.However,secondary absence of breast due to unilateral breast cancer may impact the psychological and physical health of patients.Breast reconstruction is an effective option to rebuild the appearance of the breasts of patients after mastectomy,which also helps to improve the prognosis and boost their confidence.In our previous multicenter study,we observed a cognitive deficiency in Chinese patients after radical mastectomy on breast reconstruction and limited education from clinics,all of which will be potentially improved.1In Western countries,especially the United States,the proportion of patients undergoing radical mastectomy is higher than 50%.2However,current data are mainly based on the investigation of clinical patients rather than a social population.Furthermore,there are no systematic surveys from a social perspective on the cognitive level and factors affecting cognition of breast reconstruction after radical mastectomy.Therefore,in this study,we compared and analyzed willingness for breast reconstruction after breast cancer between the Chinese and American populations from the perspective of social concern using big data analysis and explored the factors affecting surgical selection.Our study results will provide better supportive evidence and data references to improve social cognition and acceptance of breast reconstruction.

2.Methods

2.1.Research objective

Using Baidu and Google,two representative Internet search engines used in China and the United States,respectively,Chinese and American social groups who were concerned about breast cancer and breast reconstruction were identified.

2.2.Research content and methods

Breast cancer and breast reconstruction were used as search keywords for the Chinese and American groups.On Baidu and Google,we first searched and analyzed the search heat and distribution characteristics of the above keywords,and conducted an investigation to compare the attention characteristics of Chinese and American people towards breast cancer and breast cancer reconstruction according to age,sex,ethnic group,medical/economic development,religion,and search frequency of related words.Ultimately,we aimed to identify ways to improve awareness towards breast reconstruction after breast cancer surgery in the Chinese population.

3.Results

3.1.Long-term or short-term social cognition for breast cancer and breast reconstruction in Chinese and American populations

According to the search results based on the representative search engine Baidu in China,we found that over a long period(approximately 5 years based on search engine restrictions),the domestic population had a high search volume for breast cancer,while the search index for breast reconstruction was very low (Fig.1).A short-term (a period of nearly 9 months)search index analysis also showed that the domestic population maintained a sustained focus on breast cancer while the search volume for breast reconstruction after breast cancer was disproportionately low.These data support that domestic awareness of breast reconstruction after breast cancer surgery is weak and substantially lower than that for breast cancer.

Fig.1.Long-term and short-term search heats for breast cancer and breast reconstruction in the Chinese population.(A)Long-term(nearly 5 years)search heat results for breast cancer and breast reconstruction in the Chinese population.(B)Short-term(nearly 9 month)search heat results for breast cancer and breast reconstruction in Chinese population.

Fig.2.Long-term and short-term search heats for breast cancer and breast reconstruction in the US population.(A)Long-term(nearly 10 years)search heat results for breast cancer.(B) Long-term (approximately 10 years) search heat results for breast reconstruction.(C) Short-term (approximately 9 months in 2020) search heat results for breast cancer.(D) Short-term (approximately 9 months in 2020) search heat results for breast reconstruction.

For the US population(Fig.2),the Google search index showed that the long-term search heat of breast cancer had obvious cyclical changes.The peak search volume observed in October every year over the past 10 years might be related to the breast cancer publicity month.The search volume of breast reconstruction in the United States exhibited no obvious long-term regular change,and a significant search peak was observed only from 2013 to 2014.Google search index for breast cancer and breast reconstruction over the past 9 months showed similar synchronous changes.In addition,the long-term and short-term search volumes of breast cancer and breast reconstruction were similar,suggesting that the American population had a higher level of cognition and attention for breast reconstruction after breast cancer surgery.

3.2.Regional distribution characteristics of internet search heat on breast cancer and breast reconstruction in China and the USA

As observed in the Baidu search(Fig.3A),breast cancer search heat in densely populated provinces of China was high.The coastal provinces and Sichuan province presented a high search level,while the search heat in the northwest and northeast China and Yunnan and Guizhou provinces was low.For breast reconstruction after breast cancer surgery,the provinces with high search heat were mainly concentrated in coastal areas with better economy and more population.According to the Google search engine analysis (Fig.3B),in the past year,breast cancer had a relatively average search volume in the entire United States,and there was no obvious geographical difference.However,it can also be observed from the regional distribution map that a high attention towards breast reconstruction was present in coastal cities,while it was low in central and western regions.

3.3.Cognitive characteristics of the Chinese population regarding breast cancer and reconstruction-related searching data

The people who searched for breast cancer in China were mostly 20-50 years of age.Both men and women paid attention to the search information on breast cancer.On the other hand,women aged 20-39 years comprised the primary population that searched for breast reconstruction,while men’s attention to breast reconstruction was almost nil (Fig.4A).Search keywords focused on breast cancer-related symptoms,types,and treatment,while breast reconstruction-related search keywords were almost missing(Fig.4B).

3.4.Cognitive characteristics of the American population regarding breast cancer and reconstruction-related searching data

The attention of patients with breast cancer in different areas of breast reconstitution can be roughly estimated according to the ratio of search heat for breast reconstruction and breast cancer.For example,if the proportion for the US is 1:33,then every 33 breast cancer searches will be accompanied by one breast reconstruction search.African Americans paid lower attention to breast reconstruction than other ethnic groups.However,Asian and European Americans paid more attention to breast reconstruction than other ethnic groups,reaching approximately 1.5%;South Americans showed an intermediate level of attention(Fig.5A).In addition,the attention to breast reconstruction after breast cancer surgery among people in economically developed areas was significantly higher than that among people in underdeveloped areas (Fig.5B).Interestingly,people living in areas with medium-grade medical facilities paid more attention to breast reconstruction than living in areas with poor-or high-grade medical facilities (Fig.5C).Religious beliefs also affected the social population’s attention to breast reconstruction.Christian populations paid more attention to breast reconstruction than Islamic populations (Fig.5D).Regionally,American people paid more attention to breast reconstruction.The feature of search word frequency showed that people paid more attention to the words related to surgery,such as implants,flaps,pain,and scars.Those who did not choose breast reconstruction gave their family and life a higher profile,including social words such as love,child,house,friend,and baby (Fig.5E).Therefore,the difference of attention content will lead them to make different choices.

Fig.3.Characteristics of regional distribution of network attention on breast cancer and breast reconstruction in China and the United States.(A) Regional distribution of searching attention in China on breast cancer and breast reconstruction.(B)Regional distribution of searching attention in the United States on breast cancer and breast reconstruction.

4.Discussion

Breast cancer has become a major problem and is a threat to women’s health worldwide.As representative countries in the East and West,the attention of the community from China and the United States to breast cancer and related issues represent the global trend to a large extent.Unlike the United States,modified radical mastectomy is still the main surgical treatment for breast cancer in China.1In a previous multicenter clinical analysis,we found that breast cancer patients in China have an insufficient understanding of breast reconstruction.It has been found that young individuals who are economically well-off are more willing to undergo breast reconstruction.2However,this study provides information only about the general attitude of the patients visiting the hospital.In contrast,many patients cannot make good use of the consultation routine provided by the hospital to obtain enough information to decide whether to receive the reconstruction or not.Therefore,it must be noted that the results of this clinical investigation do not represent the preference of the entire population towards breast reconstruction after breast cancer surgery.Recently,with the increase in the popularity of the Internet and the rapid development of technology,it has become common for people to use search engines to obtain medical information.The search volume can better represent a population’s awareness of a certain problem.Furthermore,many patients search for solutions to their clinical problems and obtain relevant information through online searches.To date,no Internet-based research has been conducted on breast reconstruction concerns in China and other countries.In this study,we used Baidu and Google,two representative search engines used in China and the United States,respectively,to investigate and analyze the characteristics of data search.We found that the long-term and short-term search heat of Chinese patients with breast cancer were similar to those of the corresponding population in the United States.However,the search for breast reconstruction was far less than that for breast cancer.In the past year,the search index of breast cancer and breast reconstruction through Google search for the US population had been in sync,suggesting that the American population has been receiving long-term multi-channel education and that breast reconstruction has been considered as a part of breast cancer treatment of breast cancer.It has been reported that the proportion of breast reconstruction surgery after breast cancer surgery in Western countries is 50%or more.3,4Each year in October,the Google search index for breast cancer increases significantly,which is related to the“Breast Cancer Awareness Month”observed in October.People pay more attention to information about breast cancer in October;thus,the search volume is greatly improved.This can also serve as a reference for disease education in the Chinese population;further,drawing the public’s attention to breast cancer will help increase breast cancer awareness.The search attention of the American population for breast reconstruction increased significantly in 2013,which corresponds to the time period during which international film star Angelina Jolie publicly announced her experience with breast resection and reconstruction.To some extent,this shows the importance of public figures and media in improving a population’s understanding of breast reconstruction and promoting breast reconstruction.In addition,we also searched and analyzed the characteristics of information available on the Internet in China through media channels such as WeChat and Weibo.We found that many domestic media platforms shared information about breast cancer prevention and precautions and rarely provided information on subsequent breast reconstruction.Only a few hospitals or public interest organizations have worked on promoting information about breast reconstruction after breast cancer surgery.This proves that there is still great room for improvement in the efforts made and methods used to publicize and educate the population about breast reconstruction after breast cancer surgery in China;furthermore,it will be important to work alongside the media going forward.

Fig.4.Internet search characteristics of breast cancer and breast reconstruction in the Chinese population.(A) Search characteristics referring to age (left) and sex(right).(B) The distribution of search keywords on breast cancer and breast reconstruction.

In the follow-up geographical analysis,the American population’s attention towards breast cancer was not found to be affected by geography(Fig.3A).This may be related to a better medical insurance system in the United States.In addition,the improvement in breast cancer education in the United States also contributes to the enthusiasm seen in the American population for searching for breast cancer.However,according to the regional distribution map in Fig.3B,it can be seen that breast reconstruction received more attention in the coastal areas of the United States and low attention in some areas of the Midwest.This may be related to many factors,such as economy,availability of medical treatment,culture,climate,and social conservatism.The domestic population of China has low awareness about medical procedures,and most of the regions with low search intensity were concentrated in provinces with sparse populations.

The economic development in these provinces is relatively low.In addition,the individuals who paid more attention to breast reconstruction in China were mainly concentrated in the coastal areas,which have good economic foundations and are densely populated,such as Guangdong,Jiangsu,Zhejiang,Shanghai,Beijing,Tianjin,and Hebei.The level of medical care available in these provinces is also high compared to that in other provinces in China;for example,the Henan Province,an inland province with a large population,showed a high number of searches for breast reconstruction.In these east coastal provinces of mainland China,a developed economic and social status seems to provide the population with a large number of channels of information as well as an openminded attitude toward the progression of reconstructive surgery.Interestingly,Fujian exhibited a low level of online attention to breast reconstruction,though its social and economic development is high.This may be attributed to the conservative social culture and ideas of this province.According to our analysis,we believe that the characteristics of the regional searches in China and the United States reflect that the attention of the respective communities to breast reconstruction after breast cancer is largely affected by the level of socioeconomic development,which may be related to the better medical standards in these areas,the popularization of ordinary and Internet media,and the greater number of channels for access of disease information to the population.This is consistent with the results of our previous multicenter clinical questionnaire survey.

Fig.5.Internet search characteristics for breast cancer and breast reconstruction in the US population.(A) Search characteristics based on race.(B) Search characteristics based on economic development of regions.(C)Search characteristics based on medical conditions.(D)Search characteristics based on religious beliefs.(E)Differences according to word frequency.

We also investigated the characteristics of breast cancer and breast reconstruction in China and the United States.We found that people in China use the Internet for information on breast cancer and breast reconstruction;it was also noted that men have an increased enthusiasm about obtaining information about breast cancer.This may be because breast cancer may develop in men as well;alternatively,they may have concerns related to the disease affecting their families.However,breast cancer-related search hotspots are more focused on breast cancer itself,along with its complications and general treatment,whereas breast reconstruction is rarely involved.In the United States,the population’s attention to breast reconstruction after breast cancer surgery is affected by ethnicity,economic and medical development levels,religious beliefs,and other factors.Asian and European populations were found to be most concerned about breast reconstruction,which could be related to their traditional beliefs and the pursuit of beauty.Additionally,patients with breast cancer are less likely to accept their physical defects.Furthermore,the regional economic situation is an important factor affecting the decision to perform breast reconstruction.For populations that pay attention to breast reconstruction and live in areas with average medical conditions,it may be speculated that they have more free time,a relatively high acceptance of medical information,and more energy and willingness to search.In areas with highly developed medical infrastructure,patients may have other modes of obtaining and understanding the relevant information on breast reconstruction;thus,the number of searches was not high.In terms of religious aspects,because of the relatively conservative attitude toward women in Islam,the attention paid to breast reconstruction was relatively low.

In previous decades,the economic and social status in China has undergone rapid and obvious developments.Individuals in China are more motivated toward the maintenance of health and quality of life after a medical intervention.The use and spread of the Internet has provided more routes of information to the people of China.This has made information acquisition easier and has helped them overcome the limitations of regional and social development.Although the concerns regarding breast reconstruction in most inland provinces are still limited,greater attention among the Chinese population could be predicted with technological and information advances in the future,similar to the existing process in the United States.

5.Conclusion

The above information shows that,compared to the Western society represented by the United States,the attention and concern of the Chinese population toward breast reconstruction after breast cancer surgery is low.In addition to the publicity and education provided by hospitals,social and online media still have great room for improvement.Moreover,in economically poor and less developed areas,providing the necessary social assistance and education may be an effective way to improve the rates of breast reconstruction after breast cancer surgery.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Competing interests

The authors declare no conflicts of interest.

Authors’ contributions

Guo S:Conceptualization,Funding acquisition,Methodology,Software,Writing-Original draft.Hu X:Conceptualization,Funding acquisition,Methodology,Project administration,Writing-Reviewing and Editing,Supervision.Shao Z:Data curation,Investigation,Resources.Wang H:Validation,Investigation,Visualization.Fang Q:Funding acquisition,Writing-Original draft,Visualization.Li N:Software,Validation.

Acknowledgements

This work was supported by grants from the National Natural Science Foundation of China (grant no.:81901958) and Zhejiang Provincial National Natural Science Foundation of China (grant nos.:LY18H150004,LY19H150004,and LY20H150010).