National and Subnational Incidence, Mortality, and Years of Life Lost Due to Breast Cancer in Iran: Trends and Age-Period-Cohort Analysis Since 1990.

Bahar Ataeinia,Farshad Farzadfar,Mahtab Rouhifard Khalilabad,Kimiya Gohari,Ali Sheidaei,Shohreh Naderimagham,Mahsima Shabani,Nazila Rezaei,Yosef Farzi,Erfan Ghasemi,Sahar Saeedi Moghaddam,Shahin Roshani

doi:10.3389/fonc.2021.561376

Abstract

Breast cancer is the most common cancer among women, causing considerable burden and mortality. Demographic and lifestyle transitions in low and low-middle income countries have given rise to its increased incidence. The successful management of cancer relies on evidence-based policies taking into account national epidemiologic settings. We aimed to report the national and subnational trends of breast cancer incidence, mortality, years of life lost (YLL) and mortality to incidence ratio (MIR) since 1990. As part of the National and Subnational Burden of Diseases project, we estimated incidence, mortality and YLL of breast cancer by sex, age, province, and year using a two-stage spatio-temporal model, based on the primary dataset of national cancer and death registry. MIR was calculated as a quality of care indicator. Age-period-cohort analysis was used to distinguish the effects of these three collinear factors. A significant threefold increase in age-specific incidence at national and subnational levels along with a twofold extension of provincial disparity was observed. Although mortality has slightly decreased since 2000, a positive mortality annual percent change was detected in patients aged 25–34 years, leading to raised YLLs. A significant declining pattern of MIR and lower provincial MIR disparity was observed. We observed a secular increase of breast cancer incidence. Further evaluation of risk factors and developing national screening policies is recommended. A descending pattern of mortality, YLL and MIR at national and subnational levels reflects improved quality of care, even though mortality among younger age groups should be specifically addressed.

Highlights

Cancer is a major health dilemma worldwide, responsible for more than 70 million deaths globally since 2010 and a barrier to increasing life expectancy and premature mortality decline in both developed and developing countries [1, 2]
From the overall 879% increase in new cases, 122.4% of change was attributable to population growth, 67.5% was attributable to age structure change and a considerable increase of 689.2% was caused by an increase in the age-specific incidence rates of breast cancer (Table S1)
A significant increase of breast cancer incidence was observed over the study period

Summary

Introduction

Cancer is a major health dilemma worldwide, responsible for more than 70 million deaths globally since 2010 and a barrier to increasing life expectancy and premature mortality decline in both developed and developing countries [1, 2]. Countries with high Socio-Demographic Index (SDI) still have higher breast cancer incidences, demographic and lifestyle transitions in low and low-middle SDI countries has given rise to increasing cancer incidence rates [1] In these regions, limited resources and lack of well-organized health policies can lead to inefficient diagnoses and treatment strategies, causing increased burden and mortality [6, 8, 9]. Other proper modalities for the younger population, including Magnetic Resonance Imaging (MRI), still need more studies on efficacy evaluation and might not be widely available or covered by insurance [15] Such issues highlight the need for fundamental alterations in the health system and a strict resource allocation in resource-limited regions. The Global Burden of Diseases (GBD) and global cancer incidence, mortality and prevalence (GLOBOCAN) studies provide valuable estimates on global and regional cancer epidemiology, they are not substitutes for PBCRs, especially at subnational levels [1, 16]

Objectives

Methods

Results

Discussion

Conclusion