Breast Cancer Mortality In Europe Research Articles

Health Care Accessibility and Breast Cancer Mortality in Europe.

Background: Breast cancer is the most common cause of death, due to malignant neoplasms in women worldwide. The nature of the symptoms associated with breast cancer depends on the stage of the disease. In this case, any cancerous changes in the initial phase of the disease can only be detected during imaging tests. Participation in mammography screening can reduce breast cancer mortality by up to 40%, if only 70% of the eligible population participates in preventive programs. The purpose of the study was to assess the impact of accessibility to health care resources on breast cancer mortality. Methods: Eurostat aggregated health care data was extracted. Hierarchical cluster analysis of average breast cancer mortality identified four groups of countries with similar mortality rates and trends. The data was then analyzed, in terms of access to health care. Results: It was observed that the higher the financial expenditure on health care and the better the health care accessibility, the lower the mortality rates of breast cancer. Conclusions: There are examples indicating that the studied elements are not the only factors affecting the improvement of population health. The authors would like to emphasize the need to influence lifestyle factors, direct cancer risk, and introduce a multidisciplinary approach to breast cancer prevention.

Trends and predictions to 2020 in breast cancer mortality in Europe

ObjectivesWe analyzed trends in mortality from breast cancer in women in 36 European countries and the European Union (EU) over the period 1970–2014, and predicted numbers of deaths and rates to 2020. Materials and methodsWe derived breast cancer death certification data and population figures from the World Health Organization and Eurostat databases. We obtained 2020 estimates using a joinpoint regression model. ResultsOverall, EU breast cancer mortality rates (world standard) declined from 17.9/100,000 in 2002 to 15.2 in 2012. The predicted 2020 rate is 13.4/100,000. The falls were largest in young women (20–49 years, −22% between 2002 and 2012). Within the EU, declines were larger in the United Kingdom (UK) and other northern and western European countries than in most central and eastern Europe. The UK has the second lowest predicted breast cancer mortality rate in 2020 (after Spain), starting from the highest one in 1970. Breast cancer mortality is predicted to rise in Poland, where the predicted 2020 rate is 15.3/100,000. We estimated that about 32,500 breast cancer deaths will be avoided in 2020 in the EU as compared to the peak rate of 1989, and a total of 475,000 breast cancer deaths over the period 1990–2020. ConclusionThe overall favourable breast cancer mortality trends are mainly due to a succession of improvements in the management and treatment of breast cancer, though early diagnosis and screening played a role, too. Improving breast cancer management in central and eastern Europe is a priority.

The turn of the gradient? Educational differences in breast cancer mortality in 18 European populations during the 2000s.

This study aims to investigate the association between educational level and breast cancer mortality in Europe in the 2000s. Unlike most other causes of death, breast cancer mortality tends to be positively related to education, with higher educated women showing higher mortality rates. Research has however shown that the association is changing from being positive over non-existent to negative in some countries. To investigate these patterns, data from national mortality registers and censuses were collected and harmonized for 18 European populations. The study population included all women aged 30-74. Age-standardized mortality rates, mortality rate ratios, and slope and relative indexes of inequality were computed by education. The population was stratified according to age (women aged 30-49 and women aged 50-74). The relation between educational level and breast cancer mortality was predominantly negative in women aged 30-49, mortality rates being lower among highly educated women and higher among low educated women, although few outcomes were statistically significant. Among women aged 50-74, the association was mostly positive and statistically significant in some populations. A comparison with earlier research in the 1990s revealed a changing pattern of breast cancer mortality. Positive educational differences that used to be significant in the 1990s were no longer significant in the 2000s, indicating that inequalities have decreased or disappeared. This evolution is in line with the "fundamental causes" theory which stipulates that whenever medical insights and treatment become available to combat a disease, a negative association with socio-economic position will arise, independently of the underlying risk factors.

The turn of the gradient? Educational differences in breast cancer mortality in Europe in the 2000s

The turn of the gradient? Educational differences in breast cancer mortality in Europe in the 2000s

Mammography for Older Women?

Mammography for Older Women?

Patterns of breast cancer mortality trends in Europe

ObjectivesTo identify patterns of variation in breast cancer mortality in Europe (1980–2010), using a model-based approach. MethodsMortality data were obtained from the World Health Organization database and mixed models were used to describe the time trends in the age-standardized mortality rates (ASMR). Model-based clustering was used to identify clusters of countries with homogeneous variation in ASMR. ResultsThree patterns were identified. Patterns 1 and 2 are characterized by stable or slightly increasing trends in ASMR in the first half of the period analysed, and a clear decline is observed thereafter; in pattern 1 the median of the ASMR is higher, and the highest rates were achieved sooner. Pattern 3 is characterised by a rapid increase in mortality until 1999, declining slowly thereafter. ConclusionThis study provides a general model for the description and interpretation of the variation in breast cancer mortality in Europe, based in three main patterns.

The Impact of Mammographic Screening on Breast Cancer Mortality in Europe: A Review of Observational Studies

To assess the impact of population-based mammographic screening on breast cancer mortality in Europe, considering different methodologies and limitations of the data. We conducted a systematic literature review of European trend studies (n = 17), incidence-based mortality (IBM) studies (n = 20) and case-control (CC) studies (n = 8). Estimates of the reduction in breast cancer mortality for women invited versus not invited and/or for women screened versus not screened were obtained. The results of IBM studies and CC studies were each pooled using a random effects meta-analysis. Twelve of the 17 trend studies quantified the impact of population-based screening on breast cancer mortality. The estimated breast cancer mortality reductions ranged from 1% to 9% per year in studies reporting an annual percentage change, and from 28% to 36% in those comparing post- and prescreening periods. In the IBM studies, the pooled mortality reduction was 25% (relative risk [RR] 0.75, 95% confidence interval [CI] 0.69-0.81) among invited women and 38% (RR 0.62, 95% CI 0.56-0.69) among those actually screened. The corresponding pooled estimates from the CC studies were 31% (odds ratio [OR] 0.69, 95% CI 0.57-0.83), and 48% (OR 0.52, 95% CI 0.42-0.65) adjusted for self-selection. Valid observational designs are those where sufficient longitudinal individual data are available, directly linking a woman's screening history to her cause of death. From such studies, the best 'European' estimate of breast cancer mortality reduction is 25-31% for women invited for screening, and 38-48% for women actually screened. Much of the current controversy on breast cancer screening is due to the use of inappropriate methodological approaches that are unable to capture the true effect of mammographic screening.

The Impact of Mammographic Screening on Breast Cancer Mortality in Europe: A Review of Trend Studies

Analysing trends in population breast cancer mortality statistics appears a simple method of estimating the effectiveness of mammographic screening programmes. We reviewed such studies of population-based screening in Europe to assess their value. A literature review identified 17 papers, of which 12 provided quantitative estimates of the impact of screening. Due to differences in comparisons and outcome measures, no pooled estimate of effectiveness was calculated. Comparisons included breast cancer mortality before and after the introduction of screening, trends in early and late starting areas and trends in age groups affected and unaffected by screening. Studies that calculated the percentage annual change after the start of screening found reductions of 1-9% per year (1%, 2.3-2.8% and 9% for those with adequate follow-up). Of studies that compared mortality in time periods before and after introduction of screening, three single country studies all had adequate follow-up and estimated mortality reductions ranging from 28% to 36%. Limitations of studies of population mortality rates include the inability to exclude deaths in women with breast cancer diagnosed before invitation to screening, diluting any observable impact of screening, and the gradual implementation of screening in a country or region. Although analysing population breast cancer mortality rates over time can be a first step in examining changes following the introduction of screening, this method is of limited value for assessment of screening impact. Other methods and individual data are necessary to properly quantify the effect.

The decline in breast cancer mortality in Europe: An update (to 2009)

We updated trends in breast cancer mortality in Europe up to the late 2000’s. In the EU, age-adjusted (world standard population) breast cancer mortality rates declined by 6.9% between 2002 and 2006, from 17.9 to 16.7/100,000. The largest falls were in northern European countries, but more recent declines were also observed in central and eastern Europe. In 2007, all major European countries had overall breast cancer rates between 15 and 19/100,000. In relative terms, the declines in mortality were larger at younger age (−11.6% at age 20–49 years between 2002 and 2007 in the EU), and became smaller with advancing age (−6.6% at age 50–69, −5.0% at age 70–79 years). The present report confirms and further quantifies the persisting steady fall in breast cancer mortality in Europe over the last 25–30 years, which is mainly due to advancements in the therapy.

Monitoring the decrease in breast cancer mortality in Europe

Trends in mortality from breast cancer over the period 1970-2000 were analysed for 38 European countries and the European Union (EU). Age-standardized mortality rates were computed by the direct method, and joinpoint analysis was used to identify significant changes in rates. A favourable pattern in breast cancer mortality in the 25 countries of the EU (as defined in May 2004) was observed after 1989, leading to a fall in overall rates from 21.3/100,000 in 1990 to 18.9 in 2000. The annual percentage change in the EU was -2.1% between 1995 and 2000. Most northern European countries, including several Scandinavian countries and the UK, but also some central and southern European countries like Germany, Poland, the Czech Republic, Austria, Switzerland, Italy and Spain showed appreciable falls in rates (i.e. between 8 and 19% in the last 5 calendar years). The declines were larger below age 50, approaching 20% in several countries. The falls were smaller in France, Greece, Portugal and most eastern European countries. In the Russian Federation, all-age breast cancer mortality increased from 16.1 to 17.3/100,000 (+7.5% over the last 5 calendar years). These patterns reflect converging trends in breast cancer rates across Europe, which can be related to the more uniform reproductive and lifestyle habits. The fall in breast cancer mortality observed in most European countries over the last decade has to be attributed to earlier detection and improved treatment, although the definite reasons for the different trends in various countries remain at least in part unclear.

The fall in breast cancer mortality in Europe

Between 1981 and 1997, breast cancer mortality at age 20–69 years has decreased by 22% in the UK and 19% in the USA, and a 25% decline has been projected to the year 2000 [1]. In the European Union as a whole, overall age-standardised mortality from breast cancer declined by 7% between 1988 and 1996 [2]. Since the largest advances in breast cancer diagnosis and treatment have been obtained in women below the age of 70 years, and the adoption of various interventions responsible for some reduction in breast cancer mortality has not been homogeneous across various European countries [2], it is therefore of interest to consider recent trends in breast cancer mortality in different countries and in separate age groups. Data were abstracted from the World Health Organization (WHO) database, re-coded according to the Ninth Revision of the International Classification of Diseases (ICD), and standardised by quinquennia of age using the world standard population [3], for comparative purposes with other areas of the world. The pattern of trends described was in any case similar using the European standard population. Table 1 gives age-standardised breast cancer death certification rates around 1988 and 1998 in three separate age groups (20–49, 50–69, 70–79 years) for 32 European countries, and in the European Union (EU) as a whole. In all Western European countries, except Belgium (whose data, were not available after 1994), breast cancer mortality at age 20–49 years declined. The overall decline in the EU was 16.3%, from 12.3 to 10.3/ 100 000, and most countries — including the largest ones — had a rate close to 10/100 000. The decline was larger in the UK, but the absolute value in 1998 (11.6) was still comparatively high. The pattern was inconsistent for the Eastern European countries considered (i.e. former non-market economy European countries), which however had considerably lower breast cancer rates in the 1980s [3]. Likewise, in the age group 50–69 years, most Western European countries, except Norway, showed a fall in breast cancer mortality, for an average of 8.6% in the European Union (from 73.1 to 66.8/100 000). France, Germany and Italy had rates very close to 65/100 000, while the UK showed a larger decline, but still had a higher death rate (74.4). In Eastern Europe, rates started from lower values, but were generally stable or upwards. At age 70–79 years, the overall decline in the EU was 4%, from 116.5 to 111.8/100 000. France, Germany and Italy had rates between 101.9 and 115.3, while the UK had a larger decline ( 15.1%), but still a higher absolute value in 1998 (129.0). Fig. 1 gives a global figure of trends in breast cancer mortality at age 20–69 years in 22 selected European countries, providing meaningful and comparable data from the early 1960s onwards, plus the Russian Federation and Ukraine for which data were available since the early 1980s. Fig. 2 gives comparable data for the whole EU, and six selected Eastern European countries providing meaningful data since the early 1986s. The former Czechoslovakia, since 1992, includes the Czech Republic and Slovakia; data for other Eastern European countries were not available in a comparable format in the 1980s. In the EU, breast cancer mortality rates at age 20–69 years rose from 23.8/100 000 in 1960–1964 to reach a peak of 29.7 in 1985–1989, and subsequently fell to 27.3, i.e. a rate comparable to that registered in the mid-1970s. In Eastern Europe, comparable rates rose from 14.4 in 1960–1964 to 24.1 in 1990–1994, and subsequently stabilised in 1995–1997 (24.2/100 000). Table 2 gives breast cancer mortality rates for the same geographical areas and selected calendar periods and at age 70 years or over, and 20–69 years, over the

Age, Cohort-of-Birth, and Period-of-Death Trends in Breast Cancer Mortality in Europe

Age, Cohort-of-Birth, and Period-of-Death Trends in Breast Cancer Mortality in Europe

Stat Bite: Breast Cancer Mortality in Europe

Stat Bite: Breast Cancer Mortality in Europe