Mid-19th century Chinese medical portraits depict late-stage female breast tumours

The reason for these delayed diagnoses can be found by looking at the historical, medical, and cultural background of mid-19th century China.8 Despite the presence of public hospitals governed by the Imperial Court's Medical Department, patients preferred to be treated at home, assisted by family members.8 It was only in the late 19th century, when western hospitals were built, that a cultural and social shift began that lead to more patients being treated in hospital. In 2012, the International Association of Cancer Registries estimated that breast cancer was the most common cancer in Chinese women, with an age standardised rate (ASR) of 21·6 cases per 100 000 women.9,10 More specifically, data from the Chinese National Central Cancer Registry showed that breast cancer was the most common tumour among urban women and the fourth most common tumour in rural areas in 2008.8,9 A high incidence of breast cancer was found to occur in socioeconomically developed eastern coastal urban areas. An ASR of 46·6 cases per 100 000 women was reported in Guangzhou in 2012, the same area where Lam Qua's patients once lived.9 The last release of the GLOBOCAN database (International Association of Cancer Registries, September, 2018)10 further confirms that breast cancer in Chinese women (19·2% of total cases) is increasing (breast cancer represents 19·2% of all cancer cases in China), and due to the aging and growing population, and the rise in a westernised lifestyle, the burden is expected to rise in years to come.