Background Breast Cancer Incidence Research Articles

Exploring the effectiveness of molecular subtypes, biomarkers, and genetic variations as first-line treatment predictors in Asian breast cancer patients: a systematic review and meta-analysis

BackgroundBreast cancer incidence has been on the rise significantly in the Asian population, occurring at an earlier age and a later stage. The potential predictive value of molecular subtypes, biomarkers, and genetic variations has not been deeply explored in the Asian population. This study evaluated the effect of molecular subtype classification and the presence or absence of biomarkers and genetic variations on pathological complete response (pCR) after neoadjuvant treatment in Asian breast cancer patients.MethodsA systematic search was conducted in MEDLINE (PubMed), Science Direct, Scopus, and Cochrane Library databases. Studies were selected if they included Asian breast cancer patients treated with neoadjuvant chemotherapy and contained data for qualitative or quantitative analyses. The quality of the included studies was assessed using the Newcastle Ottawa Scale. Following the random effects model, pooled odds ratios or hazard ratios with 95% confidence intervals for pCR were analysed using Review Manager Software. Heterogeneity between studies was assessed using Cochran’s Q-test and I2 test statistics.ResultsIn total, 19,708 Asian breast cancer patients were pooled from 101 studies. In the neoadjuvant setting, taxane-anthracycline (TA) chemotherapy showed better pCR outcomes in triple-negative breast cancer (TNBC) (p<0.0001) and human epidermal growth factor receptor 2 enriched (HER2E) (p<0.0001) than luminal breast cancer patients. Similarly, taxane-platinum (TP) chemotherapy also showed better pCR outcomes in TNBC (p<0.0001) and HER2E (p<0.0001). Oestrogen receptor (ER)-negative, progesterone receptor (PR)-negative, HER2-positive and high Ki-67 were significantly associated with better pCR outcomes when treated with either TA or TP. Asian breast cancer patients harbouring wildtype PIK3CA were significantly associated with better pCR outcomes when treated with TA in the neoadjuvant setting (p=0.001).ConclusionsIn the neoadjuvant setting, molecular subtypes (HER2E and TNBC), biomarkers (ER, PR, HER2, HR, Ki-67, nm23-H1, CK5/6, and Tau), and gene (PIK3CA) are associated with increased pCR rates in Asian breast cancer patients. Hence, they could be further explored for their possible role in first-line treatment response, which can be utilised to treat breast cancer more efficiently in the Asian population. However, it needs to be further validated with additional powered studies.Systematic review registrationPROSPERO CRD42021246295.

Exploring the geospatial epidemiology of breast cancer in Iran: identifying significant risk factors and spatial patterns for evidence-based prevention strategies

BackgroundBreast Cancer (BC) is a formidable global health challenge, and Iran is no exception, with BC accounting for a significant proportion of women’s malignancies. To gain deeper insights into the epidemiological characteristics of BC in Iran, this study employs advanced geospatial techniques and feature selection methods to identify significant risk factors and spatial patterns associated with BC incidence.MethodsUsing rigorous statistical methods, geospatial data from Iran, including cancer-related, sociodemographic, healthcare infrastructure, environmental, and air quality data at the provincial level, were meticulously analyzed. Age-standardized incidence rates (ASR) are calculated, and different regression models are used to identify significant variables associated with BC incidence. Spatial analysis techniques, including global and local Moran's index, geographically weighted regression, and Emerging hotspot analysis, were utilized to examine geospatial patterns, identify clustering and hotspots, and assess spatiotemporal distribution of BC incidence.ResultsThe findings reveal that BC predominantly affects women (98.03%), with higher incidence rates among those aged 50 to 79. Isfahan (ASR = 26.1) and Yazd (ASR = 25.7) exhibit the highest rates. Significant predictors of BC incidence, such as marriage, tertiary education attainment rate, physician-to-population ratio, and PM2.5 air pollution, are identified through regression models.ConclusionThe study's results provide valuable information for the development of evidence-based prevention strategies to reduce the burden of BC in Iran. The findings underscore the importance of early detection, health education campaigns, and targeted interventions in high-risk clusters and adjacent regions. The geospatial insights generated by this study have implications for policy-makers, researchers, and public health practitioners, facilitating the formulation of effective BC prevention strategies tailored to the unique epidemiological patterns in Iran.

Understanding the contribution of lifestyle in breast cancer risk prediction: a systematic review of models applicable to Europe

BackgroundBreast cancer (BC) is a significant health concern among European women, with the highest prevalence rates among all cancers. Existing BC prediction models account for major risks such as hereditary, hormonal and reproductive factors, but research suggests that adherence to a healthy lifestyle can reduce the risk of developing BC to some extent. Understanding the influence and predictive role of lifestyle variables in current risk prediction models could help identify actionable, modifiable, targets among high-risk population groups.PurposeTo systematically review population-based BC risk prediction models applicable to European populations and identify lifestyle predictors and their corresponding parameter values for a better understanding of their relative contribution to the prediction of incident BC.MethodsA systematic review was conducted in PubMed, Embase and Web of Science from January 2000 to August 2021. Risk prediction models were included if (i) developed and/or validated in adult cancer-free women in Europe, (ii) based on easily ascertained information, and (iii) reported models’ final predictors. To investigate further the comparability of lifestyle predictors across models, estimates were standardised into risk ratios and visualised using forest plots.ResultsFrom a total of 49 studies, 33 models were developed and 22 different existing models, mostly from Gail (22 studies) and Tyrer-Cuzick and co-workers (12 studies) were validated or modified for European populations. Family history of BC was the most frequently included predictor (31 models), while body mass index (BMI) and alcohol consumption (26 and 21 models, respectively) were the lifestyle predictors most often included, followed by smoking and physical activity (7 and 6 models respectively). Overall, for lifestyle predictors, their modest predictive contribution was greater for riskier lifestyle levels, though highly variable model estimates across different models.ConclusionsGiven the increasing BC incidence rates in Europe, risk models utilising readily available risk factors could greatly aid in widening the population coverage of screening efforts, while the addition of lifestyle factors could help improving model performance and serve as intervention targets of prevention programmes.

Preventative therapy for breast cancer: a clinical experience

BackgroundBreast Cancer incidence in the UK is estimated to rise to 71,000 per year by 2035. Preventative strategies could significantly reduce this. Preventative therapy reduces women’s risk of oestrogen receptor positive breast cancer, but uptake remains low. Having established a preventative therapy clinic as part of a wider breast cancer prevention project, we explored qualitative data to inform future preventative efforts.MethodWomen aged 30 to 60 who had benign diagnoses at a symptomatic breast clinic or were under mammographic surveillance in the moderate risk family history clinic were invited to participate in the study. Those who expressed an interest and completed an initial questionnaire had their breast cancer risk calculated using the IBIS risk calculator. Those at increased risk were invited to a consultation about preventative therapy.Results182 women were identified as increased risk (≥ 17% lifetime or ≥ 3% 10-year risk NICE guidelines: Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer, 20131) of whom 91 women (50%) would not have been identified by family history criteria alone. 96% attended a risk/prevention consultation and all eligible women accepted screening mammography but only 14 (8%) women requested a preventative therapy prescription during the duration of the study. Reluctance to take medication and inconvenient time of life were common reasons for declining preventative therapy. Despite this, the majority were grateful for breast cancer risk and prevention information.ConclusionsWomen at increased risk of breast cancer accept additional screening but are reluctant to take preventative therapy. This suggests that stratified screening methods using risk calculations would have high uptake. Raising awareness of preventative therapy is important and the breast cancer community has yet to find the optimum timing and formula for discussing it and must accept women’s informed preferences above artificial targets.Registration numbersThe PIONEER study was granted Health Research Authority (HRA) ethical approval by the Westminster Ethics Committee. IRAS project ID 265619, ClinicalTrials.gov Identifier: NCT04574063. Recruitment began in September 2020 and was completed in October 2021.

National and subnational burden of female and male breast cancer and risk factors in Iran from 1990 to 2019: results from the Global Burden of Disease study 2019

BackgroundBreast cancer (BC) is one of the most burdensome cancers worldwide. Despite advancements in diagnostic and treatment modalities, developing countries are still dealing with increasing burdens and existing disparities. This study provides estimates of BC burden and associated risk factors in Iran at the national and subnational levels over 30 years (1990–2019).MethodsData on BC burden for Iran were retrieved from the Global Burden of Disease (GBD) study from 1990 to 2019. GBD estimation methods were applied to explore BC incidence, prevalence, deaths, disability-adjusted life years (DALYs), and attributable burden to risk factors based on the GBD risk factors hierarchy. Moreover, decomposition analysis was performed to find the contribution of population growth, aging, and cause-specific incidence in the total incidence change. Age-standardized rates (per 100,000 population) and 95% uncertainty intervals (UI) were reported based on sex, age, and socio-demographic index (SDI).ResultsAge-standardized incidence rate (ASIR) increased from 18.8 (95% UI 15.3–24.1)/100,000 in 2019 to 34.0 (30.7–37.9)/100,000 in 2019 among females and from 0.2/100,000 (0.2–0.3) to 0.3/100,000 (0.3–0.4) among males. Age-standardized deaths rate (ASDR) increased slightly among females from 10.3 (8.2–13.6)/100,000 in 1990 to 11.9 (10.8–13.1)/100,000 in 2019 and remained almost the same among males—0.2/100,000 (0.1–0.2). Age-standardized DALYs rate also increased from 320.2 (265.4–405.4) to 368.7 (336.7–404.3) among females but decreased slightly in males from 4.5 (3.5–5.8) to 4.0 (3.5–4.5). Of the 417.6% increase in total incident cases from 1990–2019, 240.7% was related to cause-specific incidence. In both genders, the BC burden increased by age, including age groups under 50 before routine screening programs, and by SDI levels; the high and high-middle SDI regions had the highest BC burden in Iran. Based on the GBD risk factors hierarchy, high fasting plasma glucose (FPG) and alcohol were estimated to have the most and the least attributed DALYs for BC among females, respectively.ConclusionsBC burden increased from 1990 to 2019 in both genders, and considerable discrepancies were found among different provinces and SDI quintiles in Iran. These increasing trends appeared to be associated with social and economic developments and changes in demographic factors. Improvements in registry systems and diagnostic capacities were also probably responsible for these growing trends. Raising general awareness and improving screening programs, early detection measures, and equitable access to healthcare systems might be the initial steps to tackle the increasing trends.

A prospective case–cohort analysis of plasma metabolites and breast cancer risk

BackgroundBreast cancer incidence rates have not declined despite an improvement in risk prediction and the identification of modifiable risk factors, suggesting the need to identify novel risk factors and etiological pathways involved in this cancer. Metabolomics has emerged as a promising tool to find circulating metabolites associated with breast cancer risk.MethodsUntargeted metabolomic analysis was done on prediagnostic plasma samples from a case–cohort study of 1695 incident breast cancer cases and a 1983 women subcohort drawn from Cancer Prevention Study 3. The associations of 868 named metabolites (per one standard deviation increase) with breast cancer were determined using Prentice-weighted Cox proportional hazards regression modeling.ResultsA total of 11 metabolites were associated with breast cancer at false discovery rate (FDR) < 0.05 with the majority having inverse association [ranging from RR = 0.85 (95% CI 0.80–0.92) to RR = 0.88 (95% CI 0.82–0.94)] and one having a positive association [RR = 1.14 (95% CI 1.06–1.23)]. An additional 50 metabolites were associated at FDR < 0.20 with inverse associations ranging from RR = 0.88 (95% CI 0.81–0.94) to RR = 0.91 (95% CI 0.85–0.98) and positive associations ranging from RR = 1.13 (95% CI 1.05–1.22) to RR = 1.11 (95% CI 1.02–1.20). Several of these associations validated the findings of previous metabolomic studies. These included findings that several progestogen and androgen steroids were associated with increased risk of breast cancer in postmenopausal women and four phospholipids, and the amino acids glutamine and asparagine were associated with decreased risk of this cancer in pre- and postmenopausal women. Several novel associations were also identified, including a positive association for syringol sulfate, a biomarker for smoked meat, and 3-methylcatechol sulfate and 3-hydroxypyridine glucuronide, which are metabolites of xenobiotics used for the production of pesticides and other products.ConclusionsOur study validated previous metabolite findings and identified novel metabolites associated with breast cancer risk, demonstrating the utility of large metabolomic studies to provide new leads for understanding breast cancer etiology. Our novel findings suggest that consumption of smoked meats and exposure to catechol and pyridine should be investigated as potential risk factors for breast cancer.

The effect of breast self-examination training on nursing students by using hybrid-based simulation on knowledge, skills, and ability to correctly evaluate pathological findings: Randomized Controlled Study

AimTo investigate the effectiveness of hybrid simulation-based training and classical-based training with the Miller pyramids' ability to evaluate students' knowledge, skills and pathologies in breast self-examination. BackgroundBreast cancer incidence is becoming more common among women in developed and developing countries. Nurses should be capable of evaluating breast self-examination knowledge, abilities and pathologies. MethodA randomized full experimental design was used. Two groups were formed: a hybrid simulation-based training group (n = 36) and a classical-based training group (n = 36)—students in the hybrid simulation-based group trained on a standardized patient with a wearable breast attachment. The classical-based training group received training on the breast model. The laboratory performance of the students was evaluated one week after the training. Their performance on the standardized patient was evaluated against the checklist in the clinical setting one week after the laboratory. Before and after the training, each student's knowledge of basic and Application steps was evaluated. Students completed the self-description form regarding the clinical process after the clinical performance. All participants received 60 min of theoretical and 60 min of demonstration training. While the students in the hybrid simulation-based training group completed the 55-minute simulation training, the students in the Classic-based training group practised on the desktop breast model for 10 min. The hybrid simulation-based training group received 175 min of total training time, whereas the classical-based training group received 130 min. ResultsCompared with classical-based training, teaching BSE with hybrid simulation-based training raised students' total knowledge score, application step score, skill score and pathological evaluation score (p < 0.05). Students who trained using hybrid simulation-based training experienced low levels of anxiety but increased levels of excitement and motivation (p < 0.05). The education and counselling scores of students who received hybrid simulation -based simulation training were higher than those who received classical-based training (p < 0.05). There was no statistically significant difference between the groups' BSE mean pre-test basic knowledge scores (p = 0.186). BSE mean application steps knowledge scores difference (pre-test-post-test) of the groups was found to be statistically significant (p < 0.001) ConclusionThe ability to accurately evaluate breast self-examination on knowledge, skills and pathological findings of students in the hybrid simulation-based training group was higher than in the classical-based training group. Besides, the students' perceived communication, education and counselling efficiency in the hybrid simulation-based training group were higher compared with the classical-based training group.

Paradoxes of breast cancer incidence and mortality in two corners of Europe

BackgroundBreast cancer incidence is rising globally, while mortality rates show a geographical heterogenous pattern. Early detection and treatment have been proven to have a profound impact on breast cancer prognosis. The aim of his study was to compare breast cancer incidence, mortality, and survival rates in two contrasting corners of Europe, Sweden and Crete, to better understand cancer determinants with focus on disease burden and sociocultural factors.MethodsBreast cancer data from Sweden and Crete was derived from registries. Incidence and mortality were expressed as Age-Standardized Incidence Rates (ASIR), Age-Standardized Mortality Rates (ASMR).FindingsBreast cancer incidence has for decades risen in Sweden and on Crete. In 2019, ASIR was 217.5 in Sweden and 58.9 on Crete, (p < 0.001). Mortality rates showed opposite trends. ASMR in Sweden was reduced from 25.5 to 16.8 (2005-2019) while on Crete, ASMR increased from 22.1 to 25.3. A successive rise in survival rate in Sweden with a 5-year survival rate of 92% since 2015, but a converse development on Crete with 85% 5-year survival rate the same year.InterpretationThe incidence of breast cancer is slowly rising in both studied regions, but mortality increases on Crete in contrast to Sweden with sinking mortality rates. The interpretation of these findings is that differences in health care systems and health policies including differences in early detection like screening programs and early treatment, as well as sociocultural factors in the two countries might play an important role on the differences found in breast cancer burden.

Inflammatory biomarkers and risk of breast cancer among young women in Latin America: a case-control study

BackgroundBreast cancer incidence is increasing rapidly in Latin America, with a higher proportion of cases among young women than in developed countries. Studies have linked inflammation to breast cancer development, but data is limited in premenopausal women, especially in Latin America.MethodsWe investigated the associations between serum biomarkers of chronic inflammation (interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), leptin, adiponectin) and risk of premenopausal breast cancer among 453 cases and 453 matched, population-based controls from Chile, Colombia, Costa Rica, and Mexico. Odds ratios (OR) were estimated using conditional logistic regression models. Analyses were stratified by size and hormonal receptor status of the tumors.ResultsIL-6 (ORper standard deviation (SD) = 1.33 (1.11–1.60)) and TNF-α (ORper SD = 1.32 (1.11–1.58)) were positively associated with breast cancer risk in fully adjusted models. Evidence of heterogeneity by estrogen receptor (ER) status was observed for IL-8 (P-homogeneity = 0.05), with a positive association in ER-negative tumors only. IL-8 (P-homogeneity = 0.06) and TNF-α (P-homogeneity = 0.003) were positively associated with risk in the largest tumors, while for leptin (P-homogeneity = 0.003) a positive association was observed for the smallest tumors only.ConclusionsThe results of this study support the implication of chronic inflammation in breast cancer risk in young women in Latin America. Largest studies of prospective design are needed to confirm these findings in premenopausal women.

Incidence of breast cancer subtypes in immigrant and non-immigrant women in Norway

BackgroundBreast cancer incidence differs between non-immigrants and immigrants from low- and middle-income countries. This study investigates whether immigrants also have different subtype-specific incidences.MethodsWe used national health registries in Norway and calculated subtype-specific incidence rate ratios (IRRs) for invasive breast cancer among women aged 20–75 and 20–49 years between 2005 and 2015. Immigrant groups were classified by country of birth broadly defined based on WHO regional groupings. Subtype was defined using estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (HER2) status as luminal A-like (ER+ PR+ HER2-), luminal B-like/HER2- (ER+ PR- HER2-), luminal B-like/HER2+ (ER+ PR any HER2+), HER2+ (ER-PR-HER2+) and triple-negative breast cancer (TNBC) (ER-PR-HER2-).ResultsCompared to non-immigrants, incidence of the luminal A-like subtype was lower in immigrants from Sub-Saharan Africa (IRR 0.43 95% CI 0.28–0.66), South East Asia (IRR 0.63 95% CI 0.51–0.79), South Asia (IRR 0.67 95% CI 0.52–0.86) and Eastern Europe (IRR 0.86 95% CI 0.76–0.99). Immigrants from South Asia had higher rates of HER2 + tumors (IRR 2.02 95% CI 1.26–3.23). The rates of TNBC tended to be similar regardless of region of birth, except that women from South East Asia had an IRR of 0.54 (95% CI 0.32–0.91).ConclusionsWomen from Eastern Europe, Sub-Saharan Africa and Asia had different subtype-specific incidences compared to women from high-income countries (including non-immigrants). These differences in tumor characteristics between immigrant groups should be taken into consideration when planning preventive or screening strategies.

Integration of breast cancer care in a middle-income country: learning from Suandok Breast Cancer Network (SBCN)

BackgroundBreast cancer incidence in Northern Thailand has shown a continuous increase since records began in 1983. In 2002 the urgency of the situation prompted Maharaj Nakorn Chiang Mai Hospital to initiate the Suandok Breast Cancer Network (SBCN).MethodsThe SBCN is a not-for-profit organization in the university hospital which serves as a training and education center and provides highly specialized medical care for patients in Chiang Mai and in 5 provinces of northern Thailand, with the key mission of improving breast cancer care. The short-term goal was to overcome the barriers to engagement with breast cancer and its treatment and the long-term goal was to increase the overall survival rate of breast cancer patients in our region.ResultsWe enrolled breast cancer patients treated at Maharaj Nakorn Chiang Mai Hospital between January 2006 and December 2015 and divided into 2 cohorts: 1485 patients who were diagnosed from 2006 to 2009 (cohort 1: early implementation of SBCN) and 2383 patients who were diagnosed from 2010 to 2015 (cohort 2: full implementation of SBCN). Criteria to measure improved cancer waiting time (CWT) would include: time to diagnosis, time to surgery, and time to radiotherapy. The 5-year overall survival (OS) of the cohort 2 was higher than that in cohort 1, at 73.8 (72.0–75.5) compared to 71.5 (69.2–73.7) (p-value = 0.03).ConclusionsReasons behind the success of project include the uniformity of care encouragement, service network development and timely access to each step of breast cancer management. The model used in SBCN could be adopted as a learning guide to improve healthcare access and outcome for breast cancer patients in low- to middle-income countries.

Breast cancer risk stratification for mammographic screening: A nation-wide screening cohort of 24,431 women in Singapore.

BackgroundBreast cancer incidence is increasing in Asia. However, few women in Singapore attend routine mammography screening. We aim to identify women at high risk of breast cancer who will benefit most from regular screening using the Gail model and information from their first screen (recall status and mammographic density).MethodsIn 24,431 Asian women (50–69 years) who attended screening between 1994 and 1997, 117 developed breast cancer within 5 years of screening. Cox proportional hazard models were used to study the associations between risk classifiers (Gail model 5‐year absolute risk, recall status, mammographic density), and breast cancer occurrence. The efficacy of risk stratification was evaluated by considering sensitivity, specificity, and the proportion of cancers identified.ResultsAdjusting for information from first screen attenuated the hazard ratios (HR) associated with 5‐year absolute risk (continuous, unadjusted HR [95% confidence interval]: 2.3 [1.8–3.1], adjusted HR: 1.9 [1.4–2.6]), but improved the discriminatory ability of the model (unadjusted AUC: 0.615 [0.559–0.670], adjusted AUC: 0.703 [0.653–0.753]). The sensitivity and specificity of the adjusted model were 0.709 and 0.622, respectively. Thirty‐eight percent of all breast cancers were detected in 12% of the study population considered high risk (top five percentile of the Gail model 5‐year absolute risk [absolute risk ≥1.43%], were recalled, and/or mammographic density ≥50%).ConclusionThe Gail model is able to stratify women based on their individual breast cancer risk in this population. Including information from the first screen can improve prediction in the 5 years after screening. Risk stratification has the potential to pick up more cancers.

Palbociclib in combination with aromatase inhibitors in patients ≥ 75 years with oestrogen receptor-positive, human epidermal growth factor receptor 2 negative advanced breast cancer: A real-world multicentre UK study

BackgroundBreast cancer incidence increases with age and real-world data is essential to guide prescribing practices in the older population. The aim of this study was to collect large scale real-world data on tolerability and efficacy of palbociclib + AI in the first line treatment of ER+/HER2-advanced breast cancer in those aged ≥75 years. Methods14 cancer centres participated in this national UK retrospective study. Patients aged ≥75 years treated with palbociclib + AI in the first line setting were identified. Data included baseline demographics, disease characteristics, toxicities, dose reductions and delays, treatment response and survival data. Multivariable Cox regression was used to assess independent predictors of PFS, OS and toxicities. Results276 patients met the eligibility criteria. The incidence of febrile neutropenia was low (2.2%). The clinical benefit rate was 87%. 50.7% of patients had dose reductions and 59.3% had dose delays. The 12- and 24- month PFS rates were 75.9% and 64.9%, respectively. The 12- and 24- month OS rates were 85.1% and 74.0%, respectively. Multivariable analysis identified PS, Age-adjusted Charlson Comorbidity Index (ACCI) and number of metastatic sites to be independent predictors of PFS. Dose reductions and delays were not associated with adverse survival outcomes. Baseline ACCI was an independent predictor of development and severity of neutropenia. ConclusionPalbociclib is an effective therapy in the real-world older population and is well-tolerated with low levels of clinically significant toxicities. The use of geriatric and frailty assessments can help guide decision making in these patients.

Intersectional social-economic inequalities in breast cancer screening in India: analysis of the National Family Health Survey

BackgroundBreast cancer incidence rates are increasing in developing countries including India. With 1.3 million new cases of cancer been diagnosed annually, breast cancer is the most common women’s cancer in India. India’s National Family Health Survey (NFHS-4) data 2015–2016 shows that only 9.8% of women between the ages of 15 and 49 had ever undergone breast examination (BE). Further, access to screening and treatment is unequally distributed, with inequalities by socio-economic status. It is unclear, however, if socio-economic inequalities in breast examination are similar across population subgroups.MethodsWe compared BE coverage in population sub-groups categorised by place of residence, religion, caste/tribal groups, education levels, age, marital status, and employment status in their intersection with economic status in India. We analysed data for 699,686 women aged 15–49 using the NFHS-4 data set conducted during 2015–2016. Descriptive (mean, standard errors, and confidence intervals) of women undergoing BE disaggregated by dimensions of inequality (education, caste/tribal groups, religion, place of residence) and their intersections with wealth were computed with national weights using STATA 12. Chi-square tests were performed to assess the association between socio-demographic factors and breast screening. Additionally, the World Health Organisation’s Health Equity Assessment Toolkit Plus was used to compute summary measures of inequality: Slope index for inequality (SII) and Relative Concentration Indices (RCI) for each intersecting dimension.ResultsBE coverage was concentrated among wealthier groups regardless of other intersecting population subgroups. Wealth-related inequalities in BE coverage were most pronounced among Christians (SII; 20.6, 95% CI: 18.5–22.7), married (SII; 14.1, 95% CI: 13.8–14.4), employed (SII: 14.6, 95%CI: 13.9, 15.3), and rural women (SII; 10.8, 95% CI: 10.5–11.1). Overall, relative summary measures (RCI) were consistent with our absolute summary measures (SII).ConclusionsBreast examination coverage in India is concentrated among wealthier populations across population groups defined by place of residence, religion, age, employment, and marital status. Apart from this national analysis, subnational analyses may also help identify strategies for programme rollout and ensure equity in women’s cancer screening.

Global breast cancer incidence and mortality trends by region, age-groups, and fertility patterns.

BackgroundBreast cancer (BC) has been increasing globally, though it is unclear whether the increases are seen across all age groups and regions and whether changes in rates can be primarily attributed to decreasing fertility rates. We investigated age-specific trends in BC incidence and mortality from 1990 to 2017, worldwide and by region, and evaluated whether incidence trends are explained by decreases in fertility.MethodsWe used country-level data to examine trends in BC incidence and mortality rates from 1990 to 2017 by region and age group. Linear mixed models were used to estimate age-specific rates from baseline models of year and were compared to fertility-adjusted models for incidence.ResultsThe global BC mortality rate increased overall by 0.23% per year (95% CI=0.20, 0.25), with statistically significant increases in the under 50 and 70 and over age groups, and in 5 out of 7 regions. The global BC incidence rate increased overall by 1.44% per year (95% CI=1.42, 1.47), with statistically significant increases in all age groups, and in 6 out of 7 regions. After adjusting for fertility, the incidence annual percent change (APC) remained statistically significant (APC=0.84, 95% CI=0.81, 0.88), in all age groups, and in 6 of 7 regions.InterpretationThe global increase in BC mortality is seen in most age groups and regions. The global increase in BC incidence is seen in all age groups and is highest in women under 50; increases remained in most regions even after considering declining fertility rates.FundingBreast Cancer Research Foundation and National Cancer Institute.

Postmastectomy breast reconstruction in women aged 70 and older: An analysis of the National Cancer Database (NCDB)

BackgroundBreast cancer incidence in women aged ≥70 years is steadily increasing, and many are choosing to undergo postmastectomy breast reconstruction (PMBR). We aimed to identify factors associated with PMBR, describe reconstruction types, and assess postoperative mortality and re-admission rates in women ≥70 years of age. MethodsThe National Cancer Database (NCDB) was examined between 2004 and 2015 for women aged ≥70 years with breast cancer who underwent mastectomy. Statistical analysis was performed by χ2 tests and multivariate logistic regression to select the best models for predicting PMBR and if patients underwent contralateral prophylactic mastectomy (CPM) with reconstruction. ResultsA total 73,973 patients met inclusion criteria and 4,552 (6.1%) underwent PMBR, of which 25% had a CPM. 48% had implant reconstruction, 36.2% underwent autologous reconstruction, and 15.1% received combination reconstruction. PMBR was more likely to be performed in patients who were White, had fewer comorbidities, were treated in the Northeast metropolitan areas, and with lower tumor stage (P < .001). CPM was more likely to be performed in patients who were White and treated in community hospitals in rural areas in the South and West. (P < .05). Although 30-day readmission rates were higher in PMBR patients (3.5% vs 2.8%, P < .001), 30 and 90-day mortality rates were lower: 0.03 and 0.2% vs 0.3 and 0.9% (P < .001). ConclusionAlthough it is understandable that intrinsic tumor characteristics influence the role of PMBR, further research and interventions should be aimed to eliminate the differences that are seen in patient race and geographic location. Readmission and postop mortality rates are overall low and comparable to that of younger patients.

Breast Cancer messaging in Vietnam: an online media content analysis

BackgroundBreast cancer incidence is increasing in Vietnam with studies indicating low levels of knowledge and awareness and late presentation. While there is a growing body of literature on challenges faced by women in accessing breast cancer services, and for delivering care, no studies have sought to analyse breast cancer messaging in the Vietnamese popular media. The aim of this study was to investigate and understand the content of messages concerning breast cancer in online Vietnamese newspapers in order to inform future health promotional content.MethodsThis study describes a mixed-methods media content analysis that counted and ranked frequencies for media content (article text, themes and images) related to breast cancer in six Vietnamese online news publications over a twelve month period.ResultsMedia content (n = 129 articles & n = 237 images) sampled showed that although information is largely accurate, there is a marked lack of stories about Vietnamese women’s personal experiences. Such stories could help bridge the gap between what information about breast cancer is presented in the Vietnamese media, and what women in Vietnam understand about breast cancer risk factors, symptoms, screening and treatment.ConclusionsGiven findings from other studies indicating low levels of knowledge and women with breast cancer experiencing stigma and prejudice, more nuanced and in-depth narrative-focused messaging may be required.

Epidemiology of breast cancer in women based on diagnosis data from oncologists and senologists in Algeria

BackgroundBreast cancer (BC) is a major health issue threatening women's life. No reliable epidemiological data on BC diagnosed by oncologists/senologists are available in Algeria. MethodsThe BreCaReAl study, a non-interventional prospective cohort study, included adult women with confirmed BC in Algeria. Disease incidence, patients and disease characteristics, treatment patterns, and mortality rate were recorded up to 12 months of follow-up. ResultsOverall, 1,437 patients were analysed: median age was 48 [41;57] years and 337 (23.5%) women had a family history of BC. BC incidence was 22.3 (95% CI: 21.5; 23.2) cases per 100,000 inhabitants over 8 months. Delayed diagnosis was reported in 400 (29.2%) patients. First line of treatments were mainly chemotherapy and surgery. Twenty-eight serious adverse events were reported including 10 (37.0%) events which led to death. Mortality rate reached 3.2% at 12 months ConclusionA delayed diagnosis highlights the importance of implementing more effective screening strategies.

13P - Breast cancer distribution in East Azerbaijan, Iran: Results of population-based cancer registry

BackgroundBreast cancer (BC) is the third most common cancer in the world and is the most common cancer in Iran in both sexes. Worldwide, there will be about 2.1 million newly diagnosed female breast cancer cases in 2018, accounting for almost 1 in 4 cancer cases among women. The aim of this study was to provide recent data on the BC incidence and distribution in East Azerbaijan, Iran. MethodsEast Azerbaijan is the largest and most populous province in the northwest of Iran, which more than 95% of the population is of Azeri ethnicity. Data of the patients diagnosed with confirmed BC as registered in the East Azerbaijan population based cancer registry between 2015 and 2017, were linked to the main data sources. The age standardized incidence rates (ASIRs) for BC were estimated. ResultsWe had overall 1410 primary breast cancer cases during two years, in both sexes, which accounted 10.3% of cancer cases. The mean age of our patients was 51.07(±13.29), with the age range of 21 to 99 years old. About 98.2% of BC was female, and 1.7% of them were male. The most common morphology was ductal carcinoma (n = 1077, 76.4%), and most of our BC patient were in grade II of disease (35.9%). In 31.2% of patients had lymphatic Invasion, 17.8 % vascular invasion, and 8.7% of them had neural invasion. Also, our results showed that breast cancer was the most common cancer among female, with slightly increasing of ASRs from 31.1 to 31.7 per 100,000 women during 2 years. There were two age peaks of ASRs in women, first in approximately 45-55 years and second in 60-70 years old groups. ConclusionsWe observed slightly increase in incidence of BC, which might be explained by the improvement of compliance to the cancer registration, compared with previous reports of our region. However, the low tumor stages and improved knowledge and attitude of women to early diagnosis and screening, which we have recently addressed in our ongoing screening programs in the province, may have played important roles in these results. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

231P - The changing landscape of breast cancer incidence after treatment for Hodgkin’s disease

BackgroundBreast cancer (BC) incidence increases after treatment for Hodgkin’s disease (HD). Over time, radiation techniques (RT) have reduced in dose and irradiated volume, and fewer alkylating (and gonadotoxic) chemotherapy (CT) agents used. We investigated BC incidence in the context of treatment changes over almost 4 decades and known risk factors. MethodsPubMed abstracts were identified using search terms ‘Hodgkin disease’, ‘Breast neoplasm’ and ‘risk’. Articles in English between 01/01/1990-31/12/2018 reporting on risk of BC in HD survivors were included. Outcomes included relative risk (RR), standardized incidence ratio (SIR), absolute excess risk (AER), cumulative incidence (CI), hazard ratio (HR) and odds ratio (OR) of BC in HD survivors. Results30/245 articles were included. 6 report BC incidence alone (n=7573). Other factors were RT dose and volume, CT, age at HD and its proximity to menarche and menopause. 10 studies looked at 2 factors (n=34637), 7 at 3 factors (n=15253), 4 at 4 factors (n=5763), and 2 at 5 factors (n=6110). 1 study was on radiation volume only (n=734). SIR of BC ranged from 2.4-75.3; AER from 9.2-83.6/10,000 years; RR was 1.9-10.6. Variation is due to differences in cohort characteristics, and incomplete follow-up. BC incidence peaks 11-35 years post HD. Risk remains high at age 50-59 (SIR 3.8), when women are no longer annually screened. BC risk increases if RT is given within 6 months menarche (OR 5.52 (1.97–15.46). Earlier menopause reduces BC risk. BC risk increases linearly with increasing radiation dose. The OR can increase 11-fold with breast doses >40Gy compared to 0Gy. Mantle vs. mediastinal RT doubles HR. CT reduces the BC risk compared with RT alone. Newer RTs reduce BC risk; as a result, some studies demonstrate lower BC incidence in more recent treatment periods (SIR 3.2 in 1970s vs. 1.3 1990-2007). Other studies show no temporal change in incidence. ConclusionsReduction in BC risk from lower doses and volumes of RT may be offset by reduced CT gonadotoxicity from newer regimens and, therefore, the impact of treatment changes over 4 decades on BC incidence requires further investigation. Current guidelines on screening HD survivors need to be adapted to reflect the changes in treatment regimens. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.