The incidence and mortality trends of female breast cancer in Beijing, China: between 2004 and 2008

This study reported the trends in female breast cancer incidence and mortality rates in China, and analyzed the corresponding age-period-cohort effects. Data from 22 population-based cancer registries in China between 2003 and 2017 were analyzed. Age-standardized incidence rates (ASIR) and mortality rates (ASMR) were calculated using Segi's world standard population. Joinpoint regression was employed to evaluate trends, and age-period-cohort effects were examined using the intrinsic estimator method. The ASIR for female breast cancer exhibited a more rapid increase in rural areas compared to urban areas across all age groups. The most substantial increase was observed in the 20-34 age group in rural areas [annual percent change (APC)=9.0%, 95% confidence interval (CI): 7.0%-11.0%, P<0.001]. The ASMR for females under 50 years old remained stable from 2003 to 2017 in both urban and rural areas. However, the ASMR for females over 50 in rural areas and those over 65 in urban areas demonstrated a significant increase, with the most pronounced increase observed among females over 65 in rural areas (APC=4.9%, 95% CI: 2.8%-7.0%, P<0.001). Age-period-cohort analysis revealed increasing period effects and decreasing cohort effects for female breast cancer incidence and mortality rates in both urban and rural settings. Notably, the cohort effect for incidence displayed a slight upward trend for females born between 1983 and 1992 in rural areas. Our study revealed a rapid increase in breast cancer incidence among younger generations and an accelerated mortality rate in older populations residing in rural areas. To effectively address the growing burden of female breast cancer in China, it is essential to develop and implement targeted intervention strategies.

Background:The prevalence of childhood asthma has been increasing in China. This study aimed to compare the prevalence, diagnosis, and treatment of asthmatic children from urban and rural areas in Beijing, China.Methods:Schools, communities, and kindergartens were randomly selected by cluster random sampling from urban and rural areas in Beijing. Parents were surveyed by the same screening questionnaires. On-the-spot inquiries, physical examinations, medical records, and previous test results were used to diagnose asthmatic children. Information on previous diagnoses, treatments, and control of symptoms was obtained.Results:From 7209 children in rural areas and 13,513 children in urban areas who completed screening questionnaires, 587 children were diagnosed as asthma. The prevalence of asthma in rural areas was lower than in urban areas (1.25% vs. 3.68%, χ2 = 100.80, P < 0.001). The diagnosis of asthma in rural areas was lower than in urban areas (48.9% vs. 73.9%, χ2 = 34.6, P < 0.001). Compared with urban asthmatic children (56.5%), only 35.6% of rural asthmatic children received inhaled corticosteroids (P < 0.05). The use of bronchodilators was also lower in rural areas than in urban areas (56.5% vs. 66.4%, χ2 = 14.2, P < 0.01).Conclusion:The prevalence of asthma in children was lower in rural areas compared with children in the urban area of Beijing. A considerable number of children were not diagnosed and inadequately treated in rural areas.

Objective: To estimate the incidence and mortality of female breast cancer in China based on the cancer registration data in 2014, collected by the National Central Cancer Registry (NCCR), and to provide support data for breast cancer prevention and control in China. Methods: There were 449 cancer registries submitting female breast cancer incidence and deaths data occurred in 2014 to NCCR. After evaluating the data quality, 339 registries' data were accepted for analysis and stratified by areas (urban/rural) and age group. Combined with data on national population in 2014, the nationwide incidence and mortality of female breast cancer were estimated. Chinese population census in 2000 and Segi's population were used for age-standardized incidence/mortality rates. Results: Qualified 339 cancer registries covered a total of 288 243 347 populations (144 061 915 in urban and 144 181 432 in rural areas) in 2014. The morphology verified cases (MV%) accounted for 87.42% and 0.59% of incident cases were identified through death certifications only (DCO%), with mortality to incidence ratio of 0.24. The estimates of new breast cancer cases were about 278 900 in China in 2014, accounting for 16.51% of all new cases in female. The crude incidence rate, age-standardized rate of incidence by Chinese standard population (ASRIC), and age-standardized rate of incidence by world standard population (ASRIW) of breast cancer were 41.82/100 000, 30.69/100 000, and 28.77/100 000, respectively, with a cumulative incidence rate (0-74 age years old) of 3.12%. The crude incidence rates and ASRIC in urban areas were 49.94 per 100 000 and 34.85 per 100 000, respectively, whereas those were 31.72 per 100 000 and 24.89 per 100 000 in rural areas. The estimates of breast cancer deaths were about 66 000 in China in 2014, accounting for 7.82% of all the cancer-related deaths in female. The crude mortality rate, age-standardized rate of mortality by Chinese standard population(ASRMC) and age-standardized rate of mortality by world standard population (ASRMW) of breast cancer were 9.90/100 000, 6.53/100 000, and 6.35/100 000, respectively, with a cumulative mortality rate of 0.69%. The crude mortality rates and ASRMC in urban areas were 11.48 per 100 000 and 7.04 per 100 000, respectively, whereas those were 7.93 per 100 000 and 5.79 per 100 000 in rural areas. The incidence and mortality rates of breast cancer were higher in areas than those in rural areas. The age-specific incidence rates of breast cancer increased greatly after 20 years old and peaked at the age group of 55-60. The age-specific mortality rates increased rapidly with age, particularly after 25 years old. They remained at a relative stable level from 55 to 65 years of age, and then increased dramatically and peaked in the age group of 85 and above. Conclusions: Breast cancer is still one of the most common malignant tumor threatening to famale health in China. The disease is more prevalent in urban areas at the age group of 55-60. Comprehensive prevention and control strategies referring to local status and age groups should be carried out to reduce the burden of breast cancer.

Breast cancer is the most common cancer diagnosis in women. During the past 30 years, mortality of breast cancer in Chinese women showing a gradual upward trend, it has become the crucial death reasons of female. In 2014, there were 234 population-based cancer registries submitting their data of 2011 to the National Central Cancer Registry (NCCR) of China and 177 cancer registries' data were selected after quality evaluation. The selected cancer registries were classified as urban areas and rural areas, in each level. The crude incidence and mortality rates of female breast cancer were calculated by age-groups. Age-standardized rates were described by China and World standard population. And the national population data of China was used to combine with the cancer registries' data to estimate the female breast cancer burden in 2011 in China. The estimated number of female breast cancer cases was 248,620. The crude incidence rate, age-standardized rate by China and World population were 37.86 per 100,000, 28.51 per 100,000 and 26.65 per 100,000, respectively. The estimated number of female breast cancer death in 2011 of China was about 60,473. The crude, age-standardized mortalities by China population and World population were 9.21 per 100,000, 6.57 per 100,000 and 6.38 per 100,000, respectively. The incidence and mortality rates were both higher in urban areas than rural areas. Trend of age-specific incidence rates in urban and rural was similar, reaching peak at 55-59 years old. The trend of age-specific mortality rates was very similar before 60 between urban and rural areas, but after that, the urban areas curve was rapidly mounting as the age growing and much higher than rural. Breast cancer is still a major health burden for Chinese women especially in urban areas. Prevention strategies such as weight control, high-quality screening, diagnosis and treatment may help control the disease.

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

&lt;p&gt;Supplementary Table S1. Leading causes of death among females worldwide, 2012 Number of deaths for top ten causes of death among females worldwide Supplementary Table S2. Leading causes of death among females by world region, 2012 Number of deaths for top ten causes of death among females by world region Supplementary Table S3. Estimated number of new cancer cases and deaths among females by world area, 2012 Number of cancer cases and deaths for all cancer sites combined among females by world region Supplementary Figure S1. Female breast cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized breast cancer incidence rates among females and age-standardized breast cancer mortality rates among females Supplementary Figure S2. Female breast cancer incidence trends, age-standardized rate (world), select countries, 1973-2012 Observed age-standardized female breast cancer incidence rates, select countries, all ages, 1973-2012 Supplementary Figure S3. Female breast cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of breast cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S4. Cervical cancer incidence and mortality rates, age-standardized rate (world), 2012 Two world maps: age-standardized cervical cancer incidence rates and age-standardized cervical cancer mortality rates Supplementary Figure S5. Prevalence (%) of cervical HPV infection among women by region, all types combined, 1995-2009 World map of HPV prevalence (%) among women by world region Supplementary Table S6. Cervical cancer incidence trends, age-standardized rate (world), select countries, 1975-2007 Observed age-standardized cervical cancer incidence rates with a five-year moving average, select countries, all ages, 1975-2007 Supplementary Figure S7. Cervical cancer survivors diagnosed in last five years (through 2012 or latest available) World map: number of cervical cancer survivors diagnosed within the last five years, per 100,000 population Supplementary Figure S8. Uterine corpus cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized uterine corpus cancer incidence rates and age-standardized uterine corpus cancer mortality rates Supplementary Figure S9. Uterine corpus cancer mortality trends, age-standardized rate (world), select countries, 1990-2014 Observed age-standardized uterine corpus cancer mortality rates with a five-year moving average, select countries, all ages, 1990-2014 Supplementary Figure S10. Ovarian cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized ovarian cancer incidence rates and age-standardized ovarian cancer mortality rates Supplementary Figure S11. Ovarian cancer mortality trends, age-standardized rate (world), select countries, 1980-2014 Observed age-standardized ovarian cancer mortality rates with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S12. Colorectal cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S13. Colorectal cancer incidence trends, females, select countries, 1980-2014 Observed age-standardized colorectal cancer incidence rates among females with a five-year moving average, select countries, all ages, 1980-2014 Supplementary Figure S14. Colorectal cancer mortality trends, females, age-standardized rate (world), select countries, 1975-2014 Observed age-standardized colorectal cancer mortality rates among females with a five-year moving average, select countries, all ages, 1975-2014 Supplementary Figure S15. Lung cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized lung cancer incidence rates among females and age-standardized lung cancer mortality rates among females Supplementary Figure S16. Population using solid fuels for heating and/or cooking, 2013 World map: percent of the population using solid fuels by country Supplementary Figure S17. Adult female smoking prevalence, age 15+ years, 2013 World map: percent of adult females (age 15+ years) who smoke by country, 2013 Supplementary Figure S18. Female youth smoking prevalence, age 13-15 years, 2011 or latest available data World map: percent of female youth (age 13-15 years) who smoke by country, 2011 or latest available data Supplementary Figure S19. Liver cancer incidence and mortality rates, females, age-standardized rate (world), 2012 Two world maps: age-standardized liver cancer incidence rates among females and age-standardized liver cancer mortality rates among females Supplementary Figure S20. Hepatitis B virus prevalence, both sexes, from systematic review of studies 1957-2013 World map of HBV prevalence (%) among both sexes combined by country Supplementary Figure S21. Estimated hepatitis C virus prevalence, both sexes, 2005 World map of HCV prevalence (%) among both sexes combined by country Supplementary Figure S22. Liver cancer mortality trends, females, age-standardized rate (world), select countries, 1995-2014 Observed age-standardized liver cancer mortality rates among females with a five-year moving average, select countries, all ages, 1995-2014&lt;/p&gt;

Objective: We aimed to analyze the spatio-temporal trend of breast cancer incidence and mortality in Shandong Province from 2012 to 2023 and predict the development trend from 2024 to 2030. Methods: Data on the incidence and mortality of breast cancer in Shandong Province from 2012 to 2023 were obtained from the Shandong Cancer Registry. The incidence, age-specific incidence, mortality, and age-specific mortality in different years, as well as in urban and rural areas, were calculated, and the rates were standardized based on the age composition of the Chinese standard population in 2000. The average annual percent change (AAPC) rate was calculated using Joinpoint 4.8.0.1 software. The global and local spatial autocorrelation analysis were performed using GeoDa 1.12 software. The Bayesian age-period-cohort model was used to predict the trend of breast cancer incidence and mortality from 2024 to 2030. Results: From 2012 to 2023, the breast cancer age-standardized incidence rate (ASIR) showed an increasing trend. The ASIR increased from 30.48/100 000 in 2012 to 39.94/100 000 in 2023 (AAPC=2.59%, P<0.001). The ASIR of urban and rural females also showed an upward trend. Additionally, the ASIR in rural areas (AAPC=3.33%, P<0.001) increased more than that in urban areas (AAPC=1.83%, P=0.002). The incidence peak of breast cancer mainly concentrated in population aged 45-64 years, and with the increase of years, the incidence peak gradually moved forward. The age-standardized mortality rate (ASMR) showed a downward trend. The ASMR decreased from 6.89/100 000 in 2012 to 4.93/100 000 in 2023 (AAPC=-3.12%, P<0.001). The ASMR of urban and rural females also showed a downward trend (urban: AAPC=-3.56%, P=0.007; rural: AAPC=-2.72%, P<0.001). The spatial analysis showed that from 2015 to 2023, the clustering areas of breast cancer incidence and mortality in Shandong had changed significantly. In 2015, the "High-high clusters" of ASIR mainly included Wendeng District in Weihai City, Dongying District, Kenli District, Lijin County, Guangrao County in Dongying City, Tianqiao District, Shizhong District in Jinan City; In 2023, the "High-high clusters" mainly included Jiaxiang County, Liangshan County, Jinxiang County, Wenshang County, Rencheng District in Jining City, Hedong District in Linyi City, Guangrao County in Dongying City. In 2015, the "High-high clusters" of ASMR only included Wenshang County in Jining City. In 2023, the "High-high clusters" mainly included Laizhou County in Yantai City, Junan County and Yishui County in Linyi City, Gaotang County in Liaocheng City, Dongping County and Ningyang County in Taian City. The Bayesian age-period-cohort model predicted that the ASIR trend of breast cancer in Shandong tended to be smooth (AAPC=0.33%, P=0.001). However, the ASMR remained decreasing (AAPC=-4.68%, P<0.001). Conclusions: The breast cancer incidence in Shandong showed an increasing trend, and it is expected to be smooth by 2030. However, the mortality showed a continuous downward trend. The incidence peak was mainly in the population aged 45-64 years, with obvious regional differences. Targeted prevention and control measures should be taken for high-risk groups and areas in Shandong Province.

Trends in breast cancer incidence, survival, and mortality

Global international trends in female breast cancer incidence have been described previously but no comparable analysis of male breast cancer incidence rates has been conducted. We obtained male and female case and population data using Cancer Incidence in Five Continents (CI5). We calculated age-adjusted, sex-specific incidence rates and female-to-male incidence rate ratios (FMIRRs) and compared trends of such for the period 1988-2002. This analysis included 8,681 male breast cancer cases and 1.14 million female breast cancer cases. The highest male incidence rate was observed in Israel at 1.24 per 100,000 man-years, and the highest female incidence rate was observed in the United States at 90.7 per 100,000 woman-years. The lowest incidence rates for males (0.16) and females (18.0) were observed in Thailand. In general, male breast cancer incidence trends were variable; a minority of countries displayed evidence for an increase. In contrast, female incidence rates have been increasing in a majority of countries. The Pearson correlation coefficient (r) for male and female breast cancer incidence rates by country during 1988-2002 was 0.69. Male breast cancer rates were generally less than 1 per 100,000 man-years, in contrast to the much higher rates of female breast cancer, providing for an overall FMIRR of 122. The differences in both incidence rates and time trends between males and females may reflect sex differences in underlying risk factors, pathogenesis, and/or overdiagnosis. Conversely, the high correlation between male and female breast cancer incidences may indicate that both sexes share some common risk factors for breast cancer.

Female breast cancer incidence and mortality data for the duration of 2008, in China, retrieved from the National Central Cancer Registry, was analyzed. In 2008, there were 56 registries that submitted cancer registration data. Based on the criteria of data quality, a total of 41 registries' data met the requirement and were accepted for analysis. The incidence and mortality rates of breast cancer in females were calculated, including age specific rates, age-standardized rates, proportions, and cumulative rates, stratified by areas (urban/rural). The number of cases included from 41 registries was 66 138 784, with 32 798 187 of these cases found in women (25 898 251 in urban areas and 6 899 936 in rural areas). There were 15 625 new cases reported and 3414 deaths of women with breast cancer, resulting in a mortality to incidence ratio of 0.22. The morphological verified rate was 91.96%, and 0.43% of cases were identified by death certificate only. The crude cancer incidence rate in all areas was 47.64/100 000, and the Age-Standardized Incidence Rates by Chinese standard population, (ASIRC) and World standard population (ASIRW) were 25.26/100 000 and 31.71/100 000, respectively. The cumulative incidence rate (0-74 years old) was 3.44%. Both crude and adjusted incidence rates in urban areas were much higher than those in rural areas. The crude cancer mortality was 10.41/100 000, and the Age-Standardized Mortality Rates by Chinese standard population (ASMRC) and by World population (ASMRW) were 4.90/100 000 and 6.48/100 000, respectively. The cumulative mortality rate (0-74 years old) was 0.071%. Age-adjusted mortality rates in urban areas were also higher than in rural areas. Age specific incidence rates peaked in age group 50-54 in all areas (108.27/100 000) and in urban areas (119.68/100 000). It reached the peak in the 55-59 age group for rural women. Age specific mortalities rose with the increase of age for both women in urban and rural areas, with mortality rates of 76.16/100 000 and 23.73/100 000 in age groups of 85 and above, respectively. Breast cancer is the most common cancer diagnosed in Chinese women. Preventative measures, such as health education and screening, are needed in the general population, but especially for those in the high-risk group found in urban areas.

This study aims to report the epidemiological trends and provide updated estimates and lifetime risks for breast and cervical cancers among women in Guangdong province. A Bayesian age-period-cohort model was applied to project incidence and mortality rates for 2023. The adjusted for multiple primaries (AMP) method was used to calculate the lifetime risks of developing and dying from breast and cervical cancer. Joinpoint analysis was employed to describe the temporal trends. The age-standardized incidence rate (ASIR) of female breast cancer increased from 2012 to 2019 in Guangdong province, with a particularly pronounced increase noted in the rural areas. The ASIR for cervical cancer among women aged over 55 increased in both urban and rural areas, whereas a declining trend was observed among women under the age of 55. The age-standardized mortality rates (ASMRs) for both breast cancer and cervical cancer demonstrated upward trends among women aged over 55, while no significant trend in ASMR was found for women under 55 years. In 2023, the estimated incidence rates of breast cancer and cervical cancer would be 50.81/105 (ASIR would be 35.57/105) and 15.31/105 (ASIR would be 10.41/105) respectively, with corresponding mortality rates of 10.78/105 (ASMR would be 7.15/105) and 6.11/105 (ASMR would be 3.93/105) for these cancers. Breast cancer continues to pose a significant threat to women's health in both rural and urban areas of Guangdong, whereas cancer prevention and control programs for cervical cancer have shown positive impacts among the younger population. Greater emphasis should be placed on women aged over 55 to halt the rising mortality rates of both cancers within this population.