Abstract
BackgroundBreast cancer is the most frequently diagnosed cancer in women and the leading cause of cancer death among females worldwide. In recent decades, breast cancer death rates have been stable or decreasing in more developed regions; however, this has not been observed in less developed regions. This study aims to evaluate inequalities in the burden of female breast cancer in Brazil including an analysis of interregional and interstate patterns in incidence, mortality and disability-adjusted life years (DALYs) rates from 1990 to 2017, and mortality-to-incidence ratio (MIR), and their association with the Socio-demographic Index (SDI).MethodsUsing estimates from the global burden of disease (GBD) study, we applied a spatial exploratory analysis technique to obtain measurements of global and local spatial correlation. Percentage changes of breast cancer incidence, mortality, and DALYs rates between 1990 and 2017 were calculated, and maps were developed to show the spatial distribution of the variables. Spatial panel models were adjusted to investigate the association between rates and SDI in Brazilian states.ResultsIn Brazil, while breast cancer mortality rate have had modest reduction (−4.45%; 95% UI: −6.97; −1.76) between 1990 and 2017, the incidence rate increased substantially (+39.99%; 95% UI: 34.90; 45.39). Breast cancer incidence and mortality rates in 1990 and 2017 were higher in regions with higher SDI, i.e., the most developed ones. While SDI increased in all Brazilian states between 1990 and 2017, notably in less developed regions, MIR decreased, more notably in more developed regions. The SDI had a positive association with incidence rate and a negative association with MIR.ConclusionSuch findings suggest an improvement in breast cancer survival in the period, which may be related to a broader access to diagnostic methods and treatment. This study also revealed the inequality in breast cancer outcomes among Brazilian states and may guide public policy priorities for disease control in the country.
Highlights
Breast cancer is the most frequently diagnosed cancer in women and the leading cause of cancer death among females worldwide
Data sources All analyses were carried out using data of global burden of disease study 2017 (GBD 2017), coordinated by the Institute for Health Metrics and Evaluation (IHME) that estimated the burden of diseases, injuries, and risk factors for 195 countries and territories and at the subnational level for a subset of countries [19]
Death rates were stable in the period, some states had an increase in mortality, mainly in the Northeast region, with the largest increases in the states of Rio Grande do Norte (+27.56%; 95% Uncertainty interval (UI): 13.04; 44.00) and Alagoas (+28.97%; 95% uncertainty intervals (95% UI): 12.37; 47.11)
Summary
Breast cancer is the most frequently diagnosed cancer in women and the leading cause of cancer death among females worldwide. Breast cancer death rates have been stable or decreasing in more developed regions; this has not been observed in less developed regions. This study aims to evaluate inequalities in the burden of female breast cancer in Brazil including an analysis of interregional and interstate patterns in incidence, mortality and disability-adjusted life years (DALYs) rates from 1990 to 2017, and mortality-to-incidence ratio (MIR), and their association with the Socio-demographic Index (SDI). The range in mortality rates between world regions is lower than for incidence rates as a result of better survival of breast cancer in developed regions. Breast cancer incidence in Argentina, Brazil, and Uruguay, for instance, reached levels similar to those of other countries of very high economic development, such as the USA and Canada. While Uruguay and Argentina had some of the highest breast cancer mortality rates in the world, Guatemala and Nicaragua had the lowest rates [6]
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