Abstract
Longitudinal analysis investigates period (P), often as years. Additional scales of time are age (A) and birth cohort (C) Aim of our study was to use ecological APC analysis for women breast cancer incidence and mortality in Germany. Nation-wide new cases and deaths were obtained from Robert Koch Institute and female population from federal statistics, 1999–2008. Data was stratified into ten 5-years age-groups starting 20–24 years, ten birth cohorts starting 1939–43, and two calendar periods 1999–2003 and 2004–2008. Annual incidence and mortality were calculated: cases to 100,000 women per year. Data was analyzed using glm and apc packages of R. Breast cancer incidence and mortality increased with age. Secular rise in breast cancer incidence and decline in mortality was observed for period1999-2008. Breast cancer incidence and mortality declined with cohorts; cohorts 1950s showed highest incidence and mortality. Age-cohort best explained incidence and mortality followed by age-period-cohort with overall declining trends. Declining age-cohort mortality could be probable. Declining age-cohort incidence would require future biological explanations or rendered statistical artefact. Cohorts 1949–1958 could be unique in having highest incidence and mortality in recent time or future period associations could emerge relatively stronger to cohort to provide additional explanation of temporal change over cohorts.
Highlights
Western nations’ age-standardized incidence and mortality rates of breast cancer were 90–110 and 15–22 per 100,000 women, respectively, for the year 2010 [1]
AC fit had the lowest residual deviance with goodness of fit (AIC) similar to APC fit, suggesting AC fit could be the best fit for our study-specific cohort over time-period 1999–2008
We confirm secular decline in mortality of breast cancer in Germany from 1999 to 2008, which was best explained by age-cohort models followed by age-period-cohort models; concomitant absolute values showed a decrease
Summary
Western nations’ age-standardized incidence and mortality rates of breast cancer were 90–110 and 15–22 per 100,000 women, respectively, for the year 2010 [1]. Germany in 2009–10 reported age-standardized breast cancer incidence and mortality rates of 120 and 24 per 100,000 women, respectively [2]. Declining breast cancer mortality rates in Western nations have been reported consistently in literature, such as, in the late nineties [3], early 2000s [4, 5], 2011 [6], and recently in 2014 [7]. Rising trends in breast cancer incidence [10,11,12,13], with predicted future increase [13], and policy suggestion of prescient development of healthcare to absorb these demands [11, 13] have been reported. A recent prediction study reported on constancy in PLOS ONE | DOI:10.1371/journal.pone.0150723 March 2, 2016
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