First mammography screening participation and breast cancer incidence and mortality in the subsequent 25 years: population based cohort study

Background: Breast cancer (BC) is the most common malignancy in Mexican women since 2006, with a high number of cases reported in the more developed northern states. However, the analysis of national BC incidence in Mexico has not been previously reported. We sought to describe BC trends in Mexico using recent population-based data and to analyze geographical differences in BC incidence and mortality rates. Methods: This population-based retrospective cohort study included all incident BC cases registered in the National Epidemiological Surveillance System and all BC deaths registered by the National Institute of Statistics and Geography in Mexico from 2001 to 2011. Yearly populations were obtained from national census data. The age-standardized (AS) incidence rate of BC was calculated using the female population over 15 years of age and standardized to the World Standard Population. AS incidence rates were calculated for 3 geographic regions of the country (North, Center and South). Joinpoint regression analysis was performed to examine trends in BC incidence and mortality. We estimated annual percentage change (APC) using weighted least squares log-linear regression. Results: From 2001 to 2011, 69,651 new cases of BC were registered in Mexico. The AS incidence of BC significantly increased, rising from 14.2/100,000 person-years (PY) (Standard Error [SE] 0.23) in 2001, to 25.2/100,000 PY (SE 0.25) in 2011, with an APC of 5.9% (95% CI 4.1-7.7, p<0.05). Regional AS incidence rates were significantly increased in the Center and in the South, with a non-significant increase in the North (Table 1). For the same period, 48,817 deaths attributed to BC were registered. AS mortality rate also had a significant increase, rising from 14/100,000 PY (SE 0.23) in 2001 to 14.6/100,000 PY (SE 0.2) in 2011, with an APC of 0.4% (95% CI 0.1-0.7, p<0.05). Regional AS mortality rates were significantly increased in all three regions (Table 1). Table 1. Regional BC incidence and mortality ratesRegion2001 AS rate per 100,000 PY (SE)2011 AS rate per 100,000 PY (SE)APC% (95% CI)pSouthIncidence6.1 (0.42)16.57 (0.53)10.5 (6-15.2)<0.05Mortality7.8 (0.46)9.56 (0.43)2 (1-3.2)<0.05CenterIncidence12.9 (0.27)26.9 (0.33)7.6 (5.7-9.6)<0.05Mortality14 (0.29)14.4 (0.25)0.3 (0-0.6)<0.05NorthIncidence24.2 (0.64)26.8 (0.54)1 (-1.6-3.7)NSMortality17.6 (0.57)18.8 (0.48)0.7 (0-1.3)<0.05 Conclusions: BC trends in Mexico show a continuous increase in incidence and mortality from 2001 to 2011, which could reflect population growth, ageing, lifestyle modifications and changes in access to diagnosis and treatment. These changes could be an expression of epidemiological transition in developing countries such as Mexico. A significant growth in both incidence and mortality was found in both the Center and the South. In the North, incidence rates remained unchanged while mortality rates had a significant rise, which was comparable to that of the other regions. One possible unexplored explanation for this observation could be the recent wave of drug-related violence and high criminality rates in the north of the country, which may perhaps cause underreporting of cases and disrupt availability of medical attention and access to healthcare in an otherwise developed and wealthy region. Citation Format: Enrique Soto-Perez-de-Celis, Alejandro Mohar, Yanin Chavarri-Guerra. Recent changes in breast cancer incidence and mortality trends in Mexico: A population-based study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-07-15.

Mammography for Older Women?

Mammography screening for breast cancer-the UK Age trial.

ObjectiveTo test the efficacy of screening by clinical breast examination in downstaging breast cancer at diagnosis and in reducing mortality from the disease, when compared with no screening.DesignProspective, cluster randomised...

Screening mammography rates vary considerably by location in the United States, providing a natural opportunity to investigate the associations of screening with breast cancer incidence and mortality, which are subjects of debate. To examine the associations between rates of modern screening mammography and the incidence of breast cancer, mortality from breast cancer, and tumor size. An ecological study of 16 million women 40 years or older who resided in 547 counties reporting to the Surveillance, Epidemiology, and End Results cancer registries during the year 2000. Of these women, 53,207 were diagnosed with breast cancer that year and followed up for the next 10 years. The study covered the period January 1, 2000, to December 31, 2010, and the analysis was performed between April 2013 and March 2015. Extent of screening in each county, assessed as the percentage of included women who received a screening mammogram in the prior 2 years. Breast cancer incidence in 2000 and incidence-based breast cancer mortality during the 10-year follow-up. Incidence and mortality were calculated for each county and age adjusted to the US population. Across US counties, there was a positive correlation between the extent of screening and breast cancer incidence (weighted r = 0.54; P < .001) but not with breast cancer mortality (weighted r = 0.00; P = .98). An absolute increase of 10 percentage points in the extent of screening was accompanied by 16% more breast cancer diagnoses (relative rate [RR], 1.16; 95% CI, 1.13-1.19) but no significant change in breast cancer deaths (RR, 1.01; 95% CI, 0.96-1.06). In an analysis stratified by tumor size, we found that more screening was strongly associated with an increased incidence of small breast cancers (≤2 cm) but not with a decreased incidence of larger breast cancers (>2 cm). An increase of 10 percentage points in screening was associated with a 25% increase in the incidence of small breast cancers (RR, 1.25; 95% CI, 1.18-1.32) and a 7% increase in the incidence of larger breast cancers (RR, 1.07; 95% CI, 1.02-1.12). When analyzed at the county level, the clearest result of mammography screening is the diagnosis of additional small cancers. Furthermore, there is no concomitant decline in the detection of larger cancers, which might explain the absence of any significant difference in the overall rate of death from the disease. Together, these findings suggest widespread overdiagnosis.

Background: Breast cancer (BC) is considered a public health problem in countries of the Pan-American Health Organization (PAHO). Data from GLOBOCAN 2008 shows BC age-adjusted incidence and mortality rates of 57.1 and 13.7 per 100,000 inhabitants in the region. The aim of the present study is to evaluate the association between BC incidence and mortality rates with the human development index (HDI) in PAHO countries. Methods: This is an ecological analysis including 29 countries (PAHO) with reported data both in GLOBOCAN 2008 and in the 2013 United Nation Development Reports (UNDP). In alphabetical order the participant countries were Argentina, Bahamas, Barbados, Belize, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, United States of America, Uruguay and Venezuela. HDI is a composite statistic of life expectancy, education, and income and was analyzed as a continuous score. Age-adjusted BC incidence and mortality rates were taken from GLOBOCAN 2008 and log-transformed due to skewness. Pearson correlation and simple linear regression were performed using Stata 12 (Stata Corp., College Station, USA). Results: A positive correlation was found between HDI and log-transformed age-adjusted BC incidence and mortality rates. The correlation coefficient between HDI and BC incidence rate was 0.68 (p-value&amp;lt;0.001). The correlation with BC mortality rate was 0.49 (p-value = 0.007). Linear regression showed that an increase in one HDI unit lead to a gain of 3.51 points (se = 0.72; p-value&amp;lt;0.001) in the incidence rate and 2.14 points (se = 0.73; p&amp;lt;0.007) in the mortality rate. Conclusion: HDI inequities are important and should be considered in the analysis of the difference in BC incidence and mortality rates seen in PAHO countries. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-06.

Diagnosis of early breast cancer (EBC) in women by mammographic screening and postsurgical adjuvant endocrine therapy and chemotherapy (termed adjuvant therapy) began simultaneously in many countries in the 1990s. Subsequent breast cancer mortality declines were variously attributed to mammographic screening and/or adjuvant therapy. To determine the relative mortality reductions associated with these 2 interventions in women with EBC who had been exposed to both. This secondary analysis of cross-sectional studies assessed groups of women with invasive breast cancer in the State of Victoria, Australia, from January 1, 1982, to December 31, 2013, who were included in the Victorian Cancer Registry (VCR). The population consisted of participants in population-based studies of female breast cancer from 1986 to 2013 using data from 4 VCR population-based surveys of breast cancer treatment from 1986 to 1999; VCR data on breast cancer incidence, mortality, and TNM stage at diagnosis from 1986 to 2013; and Victorian mammographic screening program (BreastScreen Victoria) data from 1992 to 2007. Breast cancer incidence and mortality data were analyzed for all 76 630 women registered with invasive breast cancer with the VCR from January 1, 1982, to December 31, 2013, and breast cancer treatment and screening data were analyzed additionally for the groups of surveyed women as described above. Participation in BreastScreen Victoria and receipt of adjuvant therapy after surgery for EBC. Data were analyzed for associations between crude breast cancer mortality trends and uptake of adjuvant therapy and downstaging by mammographic screening. Of all 76 630 women registered with breast cancer with the VCR from January 1, 1982, to December 31, 2013. Joinpoint analyses of the time trend in crude mortality showed an increase from 31.6 per 100 000 women in 1982 to 34.3 per 100 000 women in 1994, with a single joinpoint at 1994, followed by a significant declining trend to 23.9 per 100 000 women in 2013 (annual percentage change, -1.3%; 95% CI, -1.6% to -0.9%). By 1999, 74% of all Victorian women with EBC (737 of 1001) had commenced adjuvant endocrine therapy, and 72% (187 of 260) of premenopausal and 29% (215 of 741) of postmenopausal women with EBC had commenced adjuvant chemotherapy. Crude incidence of advanced-stage breast cancer almost doubled from 12.2 per 100 000 women in 1986 to 23.9 per 100 000 women in 2013. This study found that mammographic screening did not downstage breast cancer in Victoria from advanced to early, so population mortality benefit is lacking. Adjuvant therapy uptake was associated with all of the decline in Victorian breast cancer mortality since 1994. Given these findings, monitoring the relative contributions of mammographic screening and adjuvant therapy for EBC to breast cancer mortality reductions in populations of women exposed to both should be mandatory.

Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials

Objective To estimate the incidence,mortality and 5-year prevalence of breast cancer in China,in 2008.Methods Data from 36 cancer registries and the Third National Death Survey in China (2004-2005) were used to estimate the incidence,mortality and 5-year prevalence of breast cancer in China in 2008.Mathematical models were used to predict the breast cancer incidence and mortality in the next 20 years.Results In 2008,the incidence of breast cancer was 169 452 (14.2％) with the incidence rate of 21.6/100 000,ranking the second among all the cancers.Deaths due to breast cancer was 44 908 (6.1％) with mortality as 5.7/100 000,which ranked the sixth among all the cancers.The 5-year prevalence rate of breast cancer in China was 120.8/100 000,taking up the proportion as 26.1％,ranking the first among all the cancers.Breast cancer was seen more frequently among people aged between 40 to 70.Our data on prediction showed that the incidence and mortality of breast cancer in China would gradually increase in the next 20 years.Conclusion Breast cancer was the second cause of incidence rates among all the cancers in China,with both increasing incidence and mortality.Population at most risk for breast cancer were those aged 40 to 70,who deserved special programs for prevention and control. Key words: Breast neoplasm; Incidence; Mortality; Prevalence

Trends in breast cancer incidence, survival, and mortality

Effect of mammographic screening from age 40 years on breast cancer mortality in the UK Age trial at 17 years' follow-up: a randomised controlled trial

BACKGROUND AND OBJECTIVES:Despite its relatively low incidence in Saudi Arabia, breast cancer has been the most common cancer among Saudi females for the past 12 consecutive years. The objective of this study was to report the results of the first national public breast cancer screening program in Saudi Arabia.METHODS:Women 40 years of age or older underwent breast cancer screening. Mammograms were scored using the Breast Imaging-Reporting and Data System (BI-RADS). Correlations between imaging findings, risk factors and pathological findings were analyzed.RESULTS:Between September 2007 and April 2008, 1215 women were enrolled. The median age was 45 years, and median body mass index was 31.6 kg/m2. Sixteen cases of cancer were diagnosed. No cancer was diagnosed in 942 women with R1/R2 scores, and only 1 case of cancer was diagnosed in 228 women with R0/R3 scores. However, among 26 women with R4/R5 scores, 50% had malignant disease and 35% had benign lesions. No correlation was found between known risk factors and imaging score or cancer diagnosis.CONCLUSIONS:Public acceptance of the breast cancer screening program was encouraging. Longitudinal follow-up will help in better determining the risk factors relevant to our patient population.

Breast cancer poses a serious public health concern throughout the world in both developed and developing nations. Recent data show a small decline in breast cancer mortality in the United States and Northern Europe where the disease has been a leading cause of death.' This reduction has been attributed in part to the early detection of breast cancer in addition to advances in clinical management. The decline in mortality has also been postulated to be due to a decreased risk in women developing breast cancer in the last 2 decades associated with increased fertility as part of the post-Second World War baby boom. 1 Despite these encouraging results, other European nations such as Spain, Portugal, Greece, Hungary, Poland and Italy have not reported a reduction in breast cancer mortality. The true reasons for these breast cancer trends, particularly across continents, remain perplexing to both epidemiologists and clinicians. Any observed variation of incidence and oncologic outcome between different populations and ethnic backgrounds may relate to the underlying biological behavior of breast cancer at the cellular and molecular level. Application of biomarker studies could therefore enhance the information obtained from classical study designs and further expand the areas of scientific inquiry to which epidemiology can contribute. This approach may yield important clues in breast cancer pathogenesis, develop potential preventive strategies, improve early detection and treatment of disease with distinctive protocols, tailored to the needs of individual target populations. Conclusions from the workshop on Multicultural Aspects of Breast Cancer Etiology in Washington DC by the Etiology working group of the National Action Plan on Breast Cancer (NAPBC) in March 1999 highlighted the importance of ethno-oncology that addresses the comparison of population groups with extreme differences in the rates of incidence, mortality and survival. 2 This article reviews the evidence for global multiethnic differences in breast cancer outcome and discusses the future clinical implications of ethno-oncology.

Introduction. Breast cancer is a serious medical and social challenge and the statistics around the world look daunting.Relevance. The incidence of breast cancer is increasing in most countries and this may be due to a number of reasons. First of all, it should be noted the improvement of diagnostic methods, in particular, mass mammographic screening, which allows detecting neoplasms at early stages, before the onset of clinical symptoms. As for mortality rates, in recent years, world statistics show a downward trend in rates.Goal. To analyze the incidence and mortality rates of breast cancer (BC) in the Moscow Region (MO) for the period from 2011 to 2018. The study of indicators in one of the regions of Russia – MO – is of great importance for determining and predicting the true needs of the population in specialized medical care.The purpose of the study was to analyze the incidence of breast cancer (breast cancer) in the Moscow Region (MO) for a period of time from 2011 to 2018.Materials and methods. Some data of the territorial cancer registry of the Ministry of Defense of the Russian Federation on the diagnosis and treatment of patients with breast cancer were used, which will make it possible to determine the needs of this cohort of patients in specialized care.Results. From 2011 to 2018, 26755 new cases of breast cancer were diagnosed in the Moscow Region. The analysis of the comparative stratification in breast cancer in the medical district made it possible to obtain statistically significant differences indicating an increase in the incidence in the period from 2015–2018 in comparison with the period of 2011–2014. The presented data also indicate a trend towards a decrease in the one-year mortality rate over 8 years: from 6.33% in 2011 to 5.32% in 2018. For the period from 2011 to 2018 (8 years) there is an increase in the number of patients with breast cancer who have been in the medical center under dispensary supervision for 5 years or more.Conclusions. Analysis of the data obtained on the indicators of morbidity and mortality from malignant neoplasms is of great importance for determining the needs of the population in specialized medical care.

Widespread use of screening mammography has been the mainstay of breast cancer prevention in the United States for the past 25 years. In this issue, the USPSTF has made major changes to its recomme...