Abstract
IntroductionIncidence of breast cancer is increasing around the world and it is still the leading cause of cancer mortality in low- and middle-income countries. We utilized Swedish nationwide registers to study breast cancer incidence and case fatality to disentangle the effect of socioeconomic position (SEP) and immigration from the trends in native Swedes.MethodsA nation-wide cohort of women in Sweden was followed between 1961 and 2007 and incidence rate ratio (IRR) and hazard ratio (HR) with 95% confidence intervals (CIs) were estimated using Poisson and Cox proportional regression models, respectively.ResultsIncidence continued to increase; however, it remained lower among immigrants (IRR = 0.88, 95% CI = 0.86 to 0.90) but not among immigrants' daughters (IRR = 0.97, 95% CI = 0.94 to 1.01) compared to native Swedes. Case fatality decreased over the last decades and was similar in native Swedes and immigrants. However, case fatality was significantly 14% higher if cancer was diagnosed after age 50 and 20% higher if cancer was diagnosed in the most recent years among immigrants compared with native Swedes. Women with the highest SEP had significantly 20% to 30% higher incidence but had 30% to 40% lower case fatality compared with women with the lowest SEP irrespective of country of birth. Age at immigration and duration of residence significantly modified the incidence and case fatality.ConclusionsDisparities found in case fatality among immigrants by age, duration of residence, age at immigration and country of birth emphasize the importance of targeting interventions on women that are not likely to attend screenings or are not likely to adhere to the therapy suggested by physicians. The lower risk of breast cancer among immigrant women calls for more knowledge about how the lifestyle factors in these women differ from those with high risk, so that preventative measures may be implemented.
Highlights
Incidence of breast cancer is increasing around the world and it is still the leading cause of cancer mortality in low- and middle-income countries
In this large, nation-wide cohort study among women with diagnosis of invasive neoplasm of the breast in Sweden, we found that women with the most education, as an indicator of socio-economic position, had statistically, significantly 20% to 30% higher incidence of breast cancer, but 30% to 40% better breast cancer survival compared with women with the lowest educational level irrespective of country of birth
We found immigrant women overall had a lower incidence of breast cancer than native Swedes with the lowest risk, almost half that of native Swedes, observed among women born in China, South Korea, Thailand, Viet Nam, Turkey and Chile
Summary
Incidence of breast cancer is increasing around the world and it is still the leading cause of cancer mortality in low- and middle-income countries. Migration from low- to high-incidence countries, if migration takes place at young ages [6,7], has been shown to influence both incidence and mortality from breast cancer. Differences found in these studies might be explained by differences in biologic and pathologic characteristics of cancer, quality of medical care, such as delays in follow-up after abnormal screening, and disparities in the receipt of cancer treatment
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