National and Subnational Burden of Female Breast Cancer in Iran from 2010 to 2021.

Breast cancer (BC) is the most common cancer in women globally. The North Africa and Middle East (NAME) region is coping hard with the burden of BC. We aimed to present the latest epidemiology of BC and its risk factors in this region. We retrieved the data on BC burden and risk factors from the Global Burden of Disease Study 2019 to describe BC status in the 21 countries of the NAME region from 1990 to 2019. We explored BC incidence, prevalence, deaths, disability-adjusted life years (DALYs), and attributable burden to seven risk factors of female BC, namely, alcohol use, diet high in red meat, low physical activity, smoking, secondhand smoke, high body mass index, and high fasting plasma glucose. Decomposition analysis on BC incidence trend was done to find out the contributing factors to this cancer's growth. In 2019, there were 835,576 (95% uncertainty interval: 741,968 to 944,851) female and 10,938 (9,030 to 13,256) male prevalent cases of BC in the NAME region. This number leads to 35,405 (30,676 to 40,571) deaths among female patients and 809 (654 to 1,002) deaths in male patients this year. BC was responsible for 1,222,835 (1,053,073 to 1,411,009) DALYs among female patients in 2019, with a greater proportion (94.9%) of burden in years of life lost (YLLs). The major contributor to female BC incidence increase in the past three decades was found to be increase in age-specific incidence rates of BC (227.5%), compared to population growth (73.8%) and aging (81.8%). The behavioral risk factors were responsible for majority of attributable female BC burden (DALYs: 106,026 [66,614 to 144,247]). High fasting plasma glucose was found to be the risk factor with the largest effect (DALYs: 84,912 [17,377 to 192,838]) on female BC burden. The increasing incidence and burden of BC in the NAME region is remarkable, especially when considering limited resources in the developing countries of this region. Proper policies like expanding screening programs and careful resource management are needed to effectively manage BC burden.

AimAmong gynecological cancers, cervical cancer is the most common cause of cancer‐related death in developing countries. This study analyzes the incidence, mortality, and burden of cervical cancer using the Global Burden of Disease (GBD) 2019 study.Materials and MethodsThe GBD (2019) data on cervical cancer was extracted from the Global Health Data Exchange (GHDx) query tool. Age‐standardized rate (ASR) incidence, deaths, lost years of life (YLLs), years of life with disabilities (YLDs), and adjusted years of life with disabilities (DALYs) of cervical cancer in women were extracted. Data were extracted globally for 204 countries and groups based on a socio‐demographic index (SDI), World Health Organization (WHO) regions, continents, World Bank regions, and 22 GBD regions.ResultsThe higher standardized age incidence of cervical cancer is in lower SDI countries, Africa, the African region (According to the WHO), and Sub‐Saharan Africa (According to GBD regions). The highest deaths of ASR is in countries with low SDI, low‐income group, Africa, the African region (According to the World Health Organization), and Sub‐Saharan Africa (According to GBD regions). According to SDI classification, the highest DALYs ASR is in low SDI countries, World Bank Low‐income countries, African and then American continents, African region, Sub‐Saharan Africa, and then Latin America & Caribbean‐WB (Based on GBD regions).ConclusionIn 2019, incidence, mortality, and DALYs of cervical cancer mostly affected countries with lower socioeconomic status. Given that cervical cancer is highly preventable, access to screening services and the presence of trained and knowledgeable health care staff can reduce illness, suffering, and death caused by this malignancy. It is recommended to use the national and international potentials to reduce the incidence of this malignancy.

BackgroundBreast cancer is a widespread disease in women worldwide.AimWe aimed to explore the global epidemiological trends of female breast cancer (FBC) between 1990 and 2044.Methods and ResultsDisease burden, population, and socio‐demographic index (SDI) data were obtained from the Global Health Data Exchange (GHDx) database. We analyzed temporal trends, age differences, risk factors, and geographic patterns of FBC disease burden globally and explored the association between age‐standardized incidence rate (ASIR) of FBC and SDI. Bayesian age‐period‐cohort model was also performed to predict the changes in FBC incidence worldwide from 2020 to 2044. First, the global ASIR of FBC increased by 14.31% from 1990 to 2019 (95% Uncertainty Interval 4.75% to 23.98%). The death rate presented a falling trend. Second, alcohol use is the most‐highlighted risk factor for FBC in some high‐income regions such as Europe. A high fasting plasma glucose levels is the most prominent risk factor for FBC in Latin America and Africa. Third, the ASIR of the FBC increases with the SDI. Fourth, the incidence is expected to increase faster among women aged 35–60 years and fastest for those aged 50–54 years from 2020 to 2044. Countries with a high incidence of FBC that is expected to increase significantly include Barbados, Burkina Faso, Senegal, Monaco, Lebanon, Togo, and Uganda.ConclusionThe disease burden of FBC varies worldwide; the findings suggest attaching importance to the control of middle and low‐middle SDI regions. Public health as well as cancer prevention experts should pay more attention to regions and populations at an increased risk of developing FBC, focusing on their prevention and rehabilitation while conducting further epidemiological studies to investigate the risk factors of their increase.

BackgroundThere is no region-specific publication investigating the attributable burden of breast cancer, particularly among females. This article reported the burden of female breast cancer in the Middle East and North Africa (MENA) region, and its attributable risk factors between 1990 and 2019, by age, sex, and socio-demographic index (SDI).MethodsPublicly available data on the incidence, death and disability-adjusted life years (DALY) were retrieved from the Global Burden of Disease (GBD) 2019 study for the 21 countries and territories in MENA, between 1990 and 2019, along with 95% uncertainty intervals (UIs). The relationship between the burden of female breast cancer, in terms of DALYs, and the SDI were also assessed using Smoothing Spline models.ResultsIn 2019, the regional age-standardised incidence and death rates of female breast cancer were 37.5 and 15.2 per 100,000, which represent a 90.9 and 24.0% increase since 1990, respectively. In addition, in 2019 the regional age-standardised DALY rate was 472.7 per 100,000, which was 19.5% higher than in 1990. In 2019, the death rate increased steadily with advancing age, while the DALY rate increased steeply with age and reached its peak in the 70–74 age group. There was a positive association between SDI and the burden of breast cancer over the period 1990 to 2019. Moreover, in 2019 high fasting plasma glucose (6.9%) contributed to the largest proportion of attributable DALYs for female breast cancer in the MENA region.ConclusionsThere was a significant increase in the incidence rate of female breast cancer in MENA over the past three decades, although the death and DALY rates were both largely unchanged. Preventive programs targeting the major risk factors should be implemented in the region.

ObjectiveBreast cancer is one of the most common cancers in women worldwide. This study aims is to investigate the burden of breast cancer in Iran and its relationship with the Human Development Index (HDI) during 2009 to 2019.Study designThe present study is an observational study in Iran during the years 2009 to 2019. Data related to the incidence, mortality, Years of Life with Disability (YLD), Years of Life Lost (YLL) and Disability-Adjusted Life-Years (DALY) of breast cancer in Iran were extracted from the Global Burden of Disease 2019 (GBD-2019) website. Correlation tests are used to check the relationship between these indicators and the human development index.ResultsThe highest incidence rate of breast cancer in 2019 is related to the provinces of Gilan (29 per 100,000) and Tehran (28.55 per 100,000) and the highest rate of death from breast cancer is related to the provinces of Gilan (10.71 per 100,000). and Semnan (9.97 in 100,000). The results showed that there is a positive and significant correlation between DALY (r = 0.626, P < 0.0001), YLL (r = 0.611, P < 0.0001) and, YLD (r = 0.773, P < 0.0001) breast cancer with HDI index. There is a positive and significant correlation between the incidence (r = 0.794, P < 0.0001) and mortality (r = 0.503, P = 0.003) of breast cancer with the HDI index.ConclusionsConsidering that a positive correlation was observed between the incidence and burden of breast cancer and the human development index in the country, it is suggested to implement preventive measures such as public education programs to reduce the incidence and burden of breast cancer and the necessity of screening programs in areas with low human development index. It confirms the diagnosis of disease cases.

PurposeFemale breast cancer (BC) is the leading cause of cancer incidence and mortality in India, and accounted for 13.5% of new cancer cases and 10% of cancer-related deaths in 2020. This study aims to estimate and report the female BC burden in India at state level from 2012 to 2016 in terms of years of life lost, years lived with disability, and disability-adjusted life years (DALYs), and to project the burden for the year 2025.MethodsThe cancer incidence and mortality data from 28 population-based cancer registries were analysed. The mean mortality to incidence ratio was estimated, and mortality figures were adjusted for underreporting. The burden of female BC was estimated at national and subnational levels using Census data, World Health Organisation’s lifetables, disability weights, and the DisMod-II tool. A negative binomial regression is employed to project burden for 2025.ResultsThe burden of BC among Indian women in 2016 was estimated to be 515.4 DALYs per 100,000 women after age standardization. The burden metrics at state level exhibited substantial heterogeneity. Notably, Tamil Nadu, Telangana, Karnataka, and Delhi had a higher burden of BC than states in the eastern and north-eastern regions. The projection for 2025 indicates to a substantial increase, reaching 5.6 million DALYs.ConclusionThe female BC burden in India was significantly high in 2016 and is expected to substantially increase. Undertaking a multidisciplinary, context-specific approach for its prevention and control can address this rising burden.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10549-024-07264-3.

BackgroundFemale breast cancer stands as the prime type of cancer in the Kingdom of Saudi Arabia (KSA), with a high incidence and mortality rates. This study assessed the burden of female breast cancer in KSA by analyzing and forecasting its incidence, mortality, and disability-adjusted life years (DALYs).MethodsWe retrieved data from the Global Burden of Disease (GBD) about female breast cancer from 1990 to 2021. Time-series analysis used the autoregressive integrated moving average (ARIMA) model to forecast female breast cancer statistics from 2022 to 2026.ResultsFrom 1990 to 2021, KSA reported 77,513 cases of female breast cancer. The age groups with the highest number of cases are 45–49 years, followed by 40–44 years, 50–54 years, and 35–39 years. The analysis also showed fewer cases in the younger age groups, with the lowest number in the less than 20-year-old age group. From 1990 to 2021, KSA reported 19,440 deaths due to breast cancer, increasing from 201 cases in 1990 to 1,190 cases in 2021. The age-standardized incidence rate/100,000 of breast cancer increased from 15.4 (95% confidence interval (CI) 11.2–21.0) in 1990 to 46.0 (95%CI 34.5–61.5) in 2021. The forecasted incidence rate of female breast cancer will be 46.5 (95%CI 45.8–46.5) in 2022 and 49.6 (95%CI 46.8–52.3) in 2026. The age-standardized death rate per 100,000 Saudi women with breast cancer increased from 6.73 (95%CI 6.73–9.03) in 1990 to 9.77 (95%CI 7.63–13.00) in 2021. The forecasted female breast cancer death rate will slightly decrease to 9.67 (95%CI 9.49–9.84) in 2022 and to 9.26 (95%CI 8.37–10.15) in 2026. DALYs increased from 229.2 (95%CI 165.7–313.6) in 1990 to 346.1 (95%CI 253.9–467.2) in 2021. The forecasted DALYs of female breast cancer will slightly decrease to 343.3 (95%CI 337.2–349.5) in 2022 reaching 332.1 (95%CI 301.2–363.1) in 2026.ConclusionsFemale breast cancer is still a significant public health burden that challenges the health system in KSA, current policies and interventions should be fashioned to alleviate the disease morbidity and mortality and mitigate its future burden.

The aim of this cross-sectional study was to show the characteristics of breast cancer across a period of 15 years according to pathological records in Tehran, Iran. In the year 1985, a 20-year study was designed and developed in five major hospitals in Tehran to study the burden and characteristics of breast cancer in Iran. This study is based on the data collected from 1986 through 2000. SPSS version 13 was used for statistical analysis. In this study, 1612 female breast cancer records were reviewed. The mean age of patients was 47.95+/-12.42 years with a median of 47 years. Over the study period, the proportion of tumors diagnosed at T2 increased with a decline in the proportion of T3 cases. Similarly, the percentage of stage II cases at diagnosis increased, whereas stage III decreased. We detected a decrease in tumor size and downstaging of female breast cancer in Tehran, Iran. This can be attributed to the overall improvement in the level of health in Iran and also educational activities that teach women how to perform breast self-exam and when and why to ask for breast examination.

Male breast cancer: genetics, epigenetics, and ethical aspects

BackgroundFemale breast cancer, cervical cancer, uterine cancer, and ovarian cancer (FBCUO) pose a significant threat to global public health. Data from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021 provide critical insights that can guide the understanding and management of these cancers. Our study aims to offer comprehensive global, regional, and national estimates of the FBCUO cancer burden and its attributable risk factors from 1990 to 2021, as well as project future incidence trends up to 2050. These projections are essential for developing targeted prevention and control strategies, thereby informing more effective public health interventions.MethodsIncidence, age-standardised incidence rate (ASIR), deaths, age-standardised mortality rate (ASMR), disability-adjusted life years (DALYs), age-standardised rate of DALYs (ASDR), and the burden due to risk factors associated with FBCUO cancer were analysed from 1990 to 2021, and the Bayesian APC model was utilized for forecasting future epidemiological trajectories. All statistical analyses were performed using Join-point software (version 4.9.1.0).ResultsBetween 1990 to 2021, the global incidence, death, and DALYs, of female breast, cervical, uterine and ovarian cancer both to varying degrees of elevation. However, the ASMR and ASDR both showed a decreasing trend for FBCUO cancer. In 2021, diet high in red meat was a major risk factor for female breast cancer DALYs, but the attributable ASDR for diet high in red meat decreased from 1990 to 2021. Unsafe sex was the leading risk factor for cervical cancer DALYs, high body-mass index were the leading risk factor for uterine cancer and ovarian cancer. Projections indicate a global increase in the total number of female breast cancer and ovarian cancer cases from 2021 to 2050. In contrast, both cervical cancer and uterine cancer are expected to show downward trends over the same period.ConclusionsThe burden attributable to FBCUO cancers has increased significantly in female populations from 1990 to 2021, underscoring the urgent need for targeted measures to mitigate this trend. Meanwhile, Annual Percentage Change (APC) analysis indicates that the age-standardized incidence rates (ASIR) for female breast and ovarian cancers may continue to rise from 2022 to 2050. This projection highlights the importance of timely interventions to address these growing challenges.

Background & Aims This study evaluates the cost-effectiveness of Palbociclib in the second-line treatment of hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC) in Iran. Methods The present economic evaluation used a partitioned survival model (PSM). This model compares lifetime costs and disease outcomes among groups receiving different medication combinations containing Palbociclib, Fulvestrant, Everolimus, Ribociclib, and Abemaciclib as the second-line therapy for HR+/HER2- MBC. The model was conducted from Iran’s healthcare perspective, structured with 1-month cycles, and the evaluation time horizon in the base analysis was set to 180 cycles (15 years). Transition probabilities were extracted using the survival curves. The cost information was extracted based on the year 2020. The Quality Adjusted Life Years (QALY) was considered the final outcome unit, and the cost-effectiveness of different combinations is calculated as cost per QALY. The annual discount rate of 5% was considered for costs and QALYs. Two times Iran’s GDP per capita (800,000,000 IRR = US$5934) was used as the threshold. Finally, due to the uncertainty of some parameters, deterministic and probabilistic sensitivity analyses were carried out. Results The base case results showed that the highest cost was for the ‘Ribociclib+ Fulvestrant’ combination (US$89,629.56), and the lowest price was for the ‘Iranian Everolimus + Fulvestrant’ combination (US$10,740.09). ‘Palbociclib + Fulvestrant’ brings about the highest value of 1.456 incremental QALYs compared to other strategies. Finally, the ‘Iranian Palbociclib + Fulvestrant’ was the cost-effective combination, with an incremental cost-effectiveness ratio (ICER) of US$4,201 compared to other strategies. The base case results were supported by the probabilistic sensitivity analysis. Deterministic sensitivity analysis showed that the cost of Iranian Palbociclib has a threshold of US$582.99. Conclusions The ‘Iranian Palbociclib + Fulvestrant’ combination was cost-effective in second-line therapy for HR+ HER2- MBC in Iran.

Incidence of primary breast cancer in Iran: Ten-year national cancer registry data report

BackgroundSexually transmitted diseases (STDs) are prevalent globally and represent a significant public health challenge. This study aims to evaluate the most recent estimates of the burden of common sexually transmitted infections (STIs) at global, regional, and national levels, which will aid in the development of more effective prevention strategies.MethodsData for this study were obtained from the Global Burden of Disease (GBD) 2021 study via the Global Health Data Exchange (GHDx) query tool (https://vizhub.healthdata.org/gbd-results/). We extracted the data in accordance with GBD operational guidelines, selecting the most recent results from the 2021 GBD study. The latest GBD study results provided data on incidence, prevalence, and disability-adjusted life years (DALYs) for 21 regions and 204 countries. We extracted the number of cases, incidence, and age-standardized incidence of sexually transmitted diseases (STDs) by sex, age group, and location, following GBD usage guidelines. The data were categorized into five groups based on sociological demographic indices (SDIs).ResultsIn 2021, the total number of STDs was ~ 289.17 million, reflecting an increase of about 58.38% compared to 1990. While the total number of cases was higher in males, the increase was more pronounced in females. Syphilis exhibited the highest age-standardized rate (ASR) in Equatorial Guinea (EAPC 0.57, 95% CI [− 2.97, 4.24]). Trichomoniasis had the greatest ASR in Tanzania (EAPC − 1.24, 95% CI [− 4.97, 2.64]). Gonococcal (EAPC − 0.52, 95% CI [− 4.33, 3.44]) and chlamydial infections (EAPC − 0.52, 95% CI [− 4.33, 3.44]) showed the highest ASR in South Africa, while genital herpes (EAPC − 1.3, 95% CI [− 4.89, 2.44]) had the greatest ASR in Zimbabwe. HIV/AIDS had the highest ASR in Lesotho (EAPC − 0.33, 95% CI [− 3.99, 3.46]), and the combined ASR for HIV/AIDS and STIs was highest in South Africa (EAPC − 0.47, 95% CI [− 0.58, 0.37]).ConclusionThe burden of STDs remains high and has been steadily increasing; the burden of STIs is more severe in low SDI areas and among young and middle-aged people; the prevalence, incidence, and disability-adjusted years of STIs during the period 1990–2021 are attributable to three main factors: population, disease epidemiology, and aging.

BackgroundThis study aimed to examine the evolving trends in the global burden of low back pain (LBP) from 1990 to 2021 and predicted disease burden until 2035.Materials and methodsLBP-related data were obtained from the Global Health Data Exchange (GHDx) query tool. All estimates and their 95% uncertainty intervals (UIs) were generated using DisMod-MR 2.1, a Bayesian meta-regression tool in Global Burden of Disease, Injury, and Risk Factor Study (GBD) 2021. Data processing and visualization were conducted using The R Programming Language software version 4.3.2 and Joinpoint 4.7.ResultsIn 2021, approximately 628.8 million people worldwide were affected by LBP, with approximately 266.9 million new incident cases and age-standardized incidence rate (ASIR) of 3176.6 per 100,000. Compared with 1990, although the ASIR and age-standardized disability-adjusted life years rate (ASDALYsR) decreased, absolute numbers increased significantly. Projections for 2035 reveal a continued decline in ASIR and ASDALYsR for LBP. The LBP burden varied by the sociodemographic index quintile and GBD region, with the highest ASIR and ASDALYsR observed in Central Europe and the greatest decrease in East Asia. Globally, women bear a higher burden of LBP than men, with middle-aged populations experiencing the heaviest burden. Occupational ergonomic factors, high body mass index, and smoking remain the primary risk factors for LBP, with occupational ergonomic factors contributing the most to the overall burden.ConclusionDespite a projected decline in incidence, the global burden of LBP persists, exhibiting significant regional and gender disparities. To mitigate its future burden, precise and effective prevention and control strategies targeting high-risk factors are imperative.

Introduction: Soft Tissue and Other Extraosseous Sarcomas (STOES) represent a rare and heterogeneous group of malignancies with significant clinical challenges due to their complexity and aggressiveness. Despite their low prevalence, the global impact of STOES is substantial, necessitating a detailed examination of their epidemiology and disease burden. Methods: This comprehensive analysis utilized data from the Global Health Data Exchange (GHDx) covering the years 1990 to 2021. We assessed the incidence, prevalence, mortality, and Disability-Adjusted Life Years (DALYs) for STOES, categorized by location, sex, and socio-demographic indices. Statistical methods included Estimated Annual Percentage Change (EAPC), Spearman correlation analysis, and Bayesian age-period-cohort modeling. Findings: In 2021, STOES cases reached a global prevalence of 480,473, a significant increase from 1990. High Socio-Demographic Index (SDI) regions exhibited the highest age-standardized incidence and prevalence rates (ASIR and ASPR) at 2.05 and 10.61 per 100,000 population, respectively. Notably, significant increases were also observed in Central Asia, Central Europe, and Southern Sub-Saharan Africa. Males consistently showed higher disease rates than females. The decomposition analysis highlighted population growth and aging as primary drivers of the observed trends. Forecasting suggests a decline in the global STOES burden by 2030, though disparities will persist, particularly among males. Conclusion: The study reveals critical geographic and demographic disparities in the burden of STOES, underscoring the ongoing higher risk among males and in certain global regions. Despite projected declines in overall disease burden by 2030, substantial disparities are expected to persist, necessitating targeted public health interventions and robust policies to effectively mitigate these differences and enhance global health outcomes.