Female Breast Cancer Mortality Research Articles

Causal effects and metabolites mediators between immune cell and risk of breast cancer: a Mendelian randomization study

Introduction: The incidence and mortality of female breast cancer remain high, and the immune microenvironment of breast cancer has undergone significant alterations. However, the impact of blood immune cell levels on the risk of breast cancer is not fully understood. Therefor this study aims to investigate the causal relationship between blood immune cell levels and the risk of breast cancer.Methods: A Mendelian randomization (MR) analysis was employed to assess the causal relationship between immune cells and the risk of breast cancer, as along with their potential mediating factors. Genetic statistics of metabolites breast cancer and immune cells were obtained from the GWAS Catalog, while the genome-wide association study (GWAS) statistics of breast cancer were extracted from the UK biobank. Two-sample MR analysis were performed using inverse-variance weighted (IVW) to ascertain the causal association between immune cells and the risk of breast cancer. Furthermore, 1,400 metabolites were analyzed for their mediating role between immune cells and the risk of breast cancer.Results: MR analysis through IVW method revealed that genetically predicted CD24+ CD27+ B cells were associated with a decreased risk of breast cancer (OR = 0.9978, 95% CI: 0.996–0.999, p = 0.001), while IgD- CD38+ B cells were linked to an increased risk of breast cancer (OR = 1.002, 95% CI: 1.001–1.004, p = 0.005). Additional CD14+ CD16+ monocytes were associated with an increased risk of breast cancer (OR = 1.000, 95% CI: 1.000–1.001, p = 0.005). Mediation analysis revealed a positive causal relationship between IgD- CD38+ B cells and Glycerate levels, with the latter also exhibiting a positive causal relationship with the risk of breast cancer (p < 0.05). Conversely, IgD- CD38+ B cells displayed a negative causal relationship with Succinoyltaurine levels, and the latter also demonstrated a negative causal relationship with the risk of breast cancer (p < 0.05).Conclusion: This MR study provides novel genetic evidence supporting a causal relationship between IgD- CD38+ B cells and the risk of BC. Moreover, it is identified that IgD- CD38+ B cells contribute to an increased risk of BC through both positive and negative mediation effects involving Glycerate and Succinoyltaurine.

Geographical Variation in Social Determinants of Female Breast Cancer Mortality Across US Counties

Breast cancer mortality is complex and traditional approaches that seek to identify determinants of mortality assume that their effects on mortality are stationary across geographic space and scales. To identify geographic variation in the associations of population demographics, environmental, lifestyle, and health care access with breast cancer mortality at the US county-level. This geospatial cross-sectional study used data from the Surveillance, Epidemiology, and End Results (SEER) database on adult female patients with breast cancer. Statistical and spatial analysis was completed using adjusted mortality rates from 2015 to 2019 for 2176 counties in the US. Data were analyzed July 2022. County-level population demographics, environmental, lifestyle, and health care access variables were obtained from open data sources. Model coefficients describing the association between 18 variables and age-adjusted breast cancer mortality rate. Compared with a multivariable linear regression (OLS), multiscale geographically weighted regression (MGWR) relaxed the assumption of spatial stationarity and allowed for the magnitude, direction, and significance of coefficients to change across geographic space. Both OLS and MGWR models agreed that county-level age-adjusted breast cancer mortality rates were significantly positively associated with obesity (OLS: β, 1.21; 95% CI, 0.88 to 1.54; mean [SD] MGWR: β, 0.72 [0.02]) and negatively associated with proportion of adults screened via mammograms (OLS: β, -1.27; 95% CI, -1.70 to -0.84; mean [SD] MGWR: β, -1.07 [0.16]). Furthermore, the MGWR model revealed that these 2 determinants were associated with a stationary effect on mortality across the US. However, the MGWR model provided important insights on other county-level factors differentially associated with breast cancer mortality across the US. Both models agreed that smoking (OLS: β, -0.65; 95% CI, -0.98 to -0.32; mean [SD] MGWR: β, -0.75 [0.92]), food environment index (OLS: β, -1.35; 95% CI, -1.72 to -0.98; mean [SD] MGWR: β, -1.69 [0.70]), exercise opportunities (OLS: β, -0.56; 95% CI, -0.91 to -0.21; mean [SD] MGWR: β, -0.59 [0.81]), racial segregation (OLS: β, -0.60; 95% CI, -0.89 to -0.31; mean [SD] MGWR: β, -0.47 [0.41]), mental health care physician ratio (OLS: β, -0.93; 95% CI, -1.44 to -0.42; mean [SD] MGWR: β, -0.48 [0.92]), and primary care physician ratio (OLS: β, -1.46; 95% CI, -2.13 to -0.79; mean [SD] MGWR: β, -1.06 [0.57]) were negatively associated with breast cancer mortality, and that light pollution was positively associated (OLS: β, 0.48; 95% CI, 0.24 to 0.72; mean [SD] MGWR: β, 0.27 [0.04]). But in the MGWR model, the magnitude of effect sizes and significance varied across geographical regions. Inversely, the OLS model found that disability was not a significant variable for breast cancer mortality, yet the MGWR model found that it was significantly positively associated in some geographical locations. This cross-sectional study found that not all social determinants associated with breast cancer mortality are spatially stationary and provides spatially explicit insights for public health practitioners to guide geographically targeted interventions.

Geospatial Associations between Female Breast Cancer Mortality Rates and Environmental Socioeconomic Indicators for North Carolina.

In North Carolina, over 6000 women will be diagnosed with breast cancer yearly, and over 1000 will die. It is well known that environmental conditions contribute greatly to health outcomes, and many of these factors include a geographic component. Using death data records from 2003-2019 extracted from North Carolina Vital Statistics Dataverse, a spatial database was developed to map and analyze female breast cancer mortality rates at the ZIP code scale in North Carolina. Thirty-nine hot spots and thirty cold spots of age-adjusted death rates were identified using the Getis-Ord analysis. Two-tailed t-tests were run between each cohort for environmental socioeconomic-related factors associated with breast cancer progression and mortality. The median age and household income of individuals who resided in ZIP codes with the highest breast cancer mortality were significantly lower than those who lived in ZIP codes with lower breast cancer mortality. The poverty rate, percentage of SNAP benefits, and the percentage of minorities were all significantly higher (p < 0.05, p < 0.001, and p < 0.001) in ZIP codes with high breast cancer rates. High-quality (ZIP code) granular cancer data were developed for which detailed analysis can be performed for future studies.

Time trend on breast cancer mortality: How are we allocating physicians to deal with the disease in men and women in Brazil?

e22532 Background: Female breast cancer (FBC) is a well-known public health issue worldwide. However, male breast cancer (MBC) is a rare condition, which might be overlooked by public health authorities and clinicians alike. Methods: Ecological study conducted with secondary data from 2008-2020 to examine the relationship between the amount of doctors per inhabitant on FBC and MBC mortality in Brazil and its federative regions. All data were gathered from Brazil’s public health system. For each cancer, mortality was analyzed by age and standardized by the World Health Organization’s population. The number of physicians was obtained from the Unified Health System and was calculated as the rate per 100,000 inhabitants. Linear regression was performed using stepwise selection/backward elimination. Results: Despite not reaching statistical significance, the total amount of physicians that work in the Unified Health System (UHS) was positively associated with MBC mortality (β 0.00003, IC95% -5,77 x 10-6; 0.00007, p = 0.097), whereas there was a clear trend on FBC mortality reduction over the years (β -0.157, IC95% -0.2355;, p &lt; 0.001) and with higher number of gynecologists (β -0.0400, IC95% -0.577; -0.2236, p &lt; 0.001). Also, FBC mortality rates were positively associated with higher availability of physicians in general (β 0.0088, IC95% 0.0079; 0.0098, p &lt; 0.001) in the UHS. Conclusions: Trends on FBC and MBC mortality rates differ in Brazil. Whereas higher mortality was associated with a greater amount of doctors per inhabitant, perhaps due to more diagnosis, trends on lower mortality rates were found only for FBC – in those cases, it was associated with more gynecologists available. For both neoplasms, there was no association between mortality rates and the amount of clinical oncologists nor primary care physicians available in the country. [Table: see text]

Breast cancer: Global patterns of incidence, mortality, and trends.

10528 Background: The global burden of cancer incidence and mortality including that of female breast cancer continues to increase largely because of the growth and aging of the population and adoption of western lifestyle behaviors that increase cancer risk. In this study, we summarize the current burden, trends, and survivorship of female breast cancer that account for nearly 12% of the cancer burden worldwide. Methods: Estimates of incidence and mortality in the year 2020 were obtained from Global Cancer Observatory (GLOBOCAN) database. GLOBOCAN provides country-specific estimates of cancer incidence, mortality, and prevalence for 185 countries or territories and 36 cancer types by age group and sex. For US rates, data from Surveillance, Epidemiology, and End Results (SEER) program were assessed. Rates are age-standardized (ASRs) (per 100,000 person-years) using the 1966 Segi-Doll World Standard Population. Geographic variability was assessed using 20 predefined world regions, and the 4-tier Human Development Index (HDI). Finally, we provide a prediction of the future burden of female breast cancer in 2040 based on demographic projections. Results: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in females worldwide, with an estimated 2.3 million new cancer cases (1 in 4 new cancer cases) and 685,000 cancer deaths (1 in 6 deaths) in 2020. Breast cancer incidence rates varied by nearly 4-fold across WHO areas. The highest incidence rates (per 100,000) were found in Australia/New Zealand (95.5), Western Europe (90.7), and Northern America (89.4), while the lowest rates were in South-Central Asia (26.2), Middle and Eastern Africa (33), and Central America (39.5). In contrast, the highest breast cancer mortality rates were recorded in Melanesia (37.5), Polynesia and Western Africa (22.3), and the Caribbean (18.9), while the lowest rates were found in Eastern Asia (9.8), Central America (10.4), and Australia/New Zealand (12.1), a 2.8-fold difference. In the United States, the age-standardized breast cancer incidence rate (per 100,000) increased from 106 (1975) to 142 (1999), decreased to 128 (2004), and then slowly increased to 137 (per 100,000) in 2019. Similar broad temporal trend patterns were observed in other western countries. Incidence rates are rising in South America, Africa, and Asia where rates were historically low. Worldwide, an estimated 2,964,197 new female breast cancer cases are projected to occur in 2040, a 31% increase from the corresponding 2,260,127 cases in 2020. Conclusions: There is significant variation in female breast cancer incidence and mortality rates worldwide. Breast cancer incidence is increasing at different rates in various regions of the world. Mortality rates in many high HDI countries have been on the decline, in contrast to increasing rates in low HDI countries. This study also shows a substantial increase in new breast cancer diagnoses over the next two decades.

Spatial and temporal epidemiological analysis on the mortality rate of female breast cancer in Suzhou, China: 2006–2020

Objective: The epidemiological trend and spatial distribution of female breast cancer mortality in Suzhou were analyzed, so as to provide a scientific basis for the prevention and treatment of breast cancer. Materials and Methods: The annual trend of female breast cancer mortality data from 2006 to 2020 years was analyzed. The spatial autocorrelation analysis was carried out by Moran’s I method of GeoDa software to explore its regional aggregation. Results: The average annual crude mortality rate (CR) of breast cancer in Suzhou was 8.54 per 100 000 from 2006 to 2020, while the age-standardized mortality rate (ASMR) was 7.38 per100 000. The annual change percentage (APC) of CR in the recent 15 years was 1.98% (1.30–2.66%), which was statistically significant (P&lt;0.001). The annual change trend of ASMR was decreased slightly (APC=−0.95%, P=0.04). Spatial analysis indicated that there was a certain clustering of breast cancer in Suzhou. The CR of female breast cancer in Suzhou showed an upward trend, but ASMR decreased slightly. Conclusion: Health promotion and education should be strengthened in the areas with a high incidence of female breast cancer death in Suzhou, and the participation rate of breast cancer screening should be further improved.

Impact of Two-level Spatial Structure Model in Spatio-temporal Hospitalization of Female Breast Cancer Patients in Nigeria

This paper investigated the impact of two-level spatial structure model in spatio-temporal hospitalization of female breast cancer in Nigerian Health-care areas and States. The objective is to measure the relative contribution of each of the model parameters. The model has been fitted using full Laplace approximation strategy to an observational hospital-based female breast cancer mortality data from 2009 to 2016. The study explained risk variations across health-care areas and State-levels. The results showed that the State-level captured higher risk than the health-care area-level (24.18% against 17.60%). Furthermore, assessing each health-care area performance, six (6) health-care areas with large population States showed higher risk. The study recommended o further research on the risk factors responsible for the significant high risk in these health-care areas.

Trends in Incidence Rates, Mortality Rates, and Age-Period-Cohort Effects of Female Breast Cancer - China, 2003-2017.

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.

Abstract IA015: The Alaska Native Tumor Registry: Fifty years of cancer surveillance data for Alaska Native people

Abstract Background: Cancer is the leading cause of death among Alaska Native (AN) people. Indigenous people throughout the Circumpolar North experience different patterns of cancer incidence and mortality. The Alaska Native Tumor Registry (ANTR) was established for cancer surveillance among Alaska Native and American Indian (ANAI) people living in Alaska, with data available going back to 1969. Every 5 years, the ANTR releases a comprehensive report on cancer among AN people; latest study provides 50 years of cancer surveillance data. Methods: Cancer data were collected by the ANTR a population-based central cancer registry that records information on AN people. The ANTR has been collecting cancer information according to NCI SEER Program standards since 1969, and has been a full member of the SEER Program since 1999. Five-year annual-average age-adjusted incidence rates were calculated for time-periods ranging 1969–2018. AN data was compared with data for US whites (SEER 9). Mortality rates were calculated for 1994–2018 using data from the National Center for Health Statistics. Results: An estimated 144,274 Alaska Native/American Indian people resided in Alaska in 2015, comprising 19.5% of the Alaskan population. During 2014–2018, there were 2,401 cases of invasive cancer among AN people. The most commonly diagnosed cancers were colorectal (405 cases, 17% of all cancers), lung (373 cases, 16 cancers), and female breast (340 cases, 14% of all cancers). The majority of cancers (40%) were diagnosed at local stage, with 24% diagnosed at regional stage, and 30% at distant stage. However, the pattern varied by cancer site. Among colorectal cancers, just over one third were diagnosed at local and regional stages each, with one quarter diagnosed at distant stage. Over half of lung cancers were diagnosed at distant stage. Among the leading cancers, lung cancer mortality was 1.3 times higher among AN people, and colorectal cancer 2.8 times higher among AN people. Female breast cancer mortality rates were not significantly different between AN people and US White population. Conclusion: Lung cancer was the leading cause of cancer death, followed by colorectal and female breast cancers. These leading cancers are screenable, and preventable through lifestyle modifications. These data provide important information to support cancer prevention and control among AN people. Cancer surveillance has been a valuable tool throughout the Circumpolar North to support reducing the burden of cancer among Indigenous populations. Citation Format: Elena Roik. The Alaska Native Tumor Registry: Fifty years of cancer surveillance data for Alaska Native people [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA015.

Time tracking and multidimensional influencing factors analysis on female breast cancer mortality: Evidence from urban and rural China between 1994 to 2019.

BackgroundThere are huge differences in female breast cancer mortality between urban and rural China. In order to better prevent breast cancer equally in urban and rural areas, it is critical to trace the root causes of past inequities and predict how future differences will change. Moreover, carcinogenic factors from micro-individual to macro-environment also need to be analyzed in detail. However, there is no systematic research covering these two aspects in the current literature.MethodsBreast cancer mortality data in urban and rural China from 1994 to 2019 are collected, which from China Health Statistical Yearbook. The Age-Period-Cohort model is used to examine the effects of different age groups, periods, and birth cohorts on breast cancer mortality. Nordpred project is used to predict breast cancer mortality from 2020 to 2039.ResultsThe age effect gradually increases and changes from negative to positive at the age of 40–44. The period effect fluctuates very little and shows the largest difference between urban and rural areas in 2019. The birth cohort effect gradually decreases with urban-rural effects alternating between strong and weak. In the predicted results, the urban-rural mortality gap becomes first narrow and then wide and shows a trend of younger death.ConclusionsFrom the perspective of a temporal system, the changing trend of breast cancer mortality is highly consistent with the history of social and economic structural changes in China. From the perspective of the theory of social determinants of health, individuals, families, institutions and governments need to participate in the prevention of breast cancer.

Spatio-temporal trend of female breast cancer mortality in Shandong Province from 1970 to 2013

The mortality of female breast cancer in Shandong Province has increased since the 1970. The differential decomposition analysis found that the slight decline in the crude mortality of breast cancer among women was entirely due to non-demographic factors during the 1970-1990, and the significant increase in the crude mortality was due to a combination of demographic and non-demographic factors since the 1990. The contribution rate of demographic factor has gradually increased from 53.5% in 2004-2005 to 59.5% in 2011-2013, while that of non-demographic factor has decreased from 46.5% to 40.5%. The women aged 45-64 years old were the major population of female breast cancer deaths, accounting for 40%-60% of total breast cancer deaths in different times, and then the mortality in female aged 55-64 years old increased rapidly, with increases of 52.12%, 115.19% and 29.01% in 2011-2013 over the 1970-1974, 1990-1992 and 2004-2005, respectively (Z=-7.342,P<0.001). Compared with 1970-1974, the age-standardized mortality rate of rural women increased by 41.86% in 2011-2013 (Z=-17.933, P<0.001), and that of urban women increased by 18.62% in 2011-2013 (Z=-25.642, P<0.001). The age-standardized mortality rate of breast cancer in urban women was higher than that in rural women in different times (all P<0.05). The spatial scan analysis found that eastern Shandong Province was found to be a sustained high-risk area for death, and other high-risk areas were transferred from north to southwest of Shandong between 1970 and 2013.

Trends in female breast cancer incidence, mortality, and survival in Austria, with focus on age, stage, and birth cohorts (1983–2017)

Breast cancer (BC) is the most commonly diagnosed malignant disease and the leading cause of cancer death in women in Austria. We investigated overall and subgroup-specific female breast cancer rates to provide a comprehensive analysis of trends over several decades. Incidence, mortality, and survival, as well as age-, stage-, and birth cohort-specific incidence were analysed using nationwide cancer registry data on 163,694 cases of female breast cancer in Austria (1983–2017). Annual percentage changes were estimated using joinpoint regression. BC incidence underwent linear increases until 1997 and reversed with statistically non-significant declines until 2017. After initial increases in BC-specific mortality, rates were stable from 1989 through 1995 and started declining thereafter, although statistically non-significantly after 2011. Overall BC-specific survivals, as well as survivals according to the calendar period of diagnosis, increased throughout the observation period. Incidence in younger women (aged 44 and lower) showed linear increases, whereas for women aged 45 and higher mostly stable or decreasing rates were observed. Localised BC incidence increased markedly and started declining only in 2012. Distant disease-BC incidence decreased through the whole observation period and incidence of regionalised BC started declining in 2000. Birth cohort-specific incidence peaked in women born between 1935 and 1949 (ages 45–74). In conclusion, the incidence of BC in younger women is increasing, while overall female BC incidence and mortality are stable with non-significant declines. Further, increases in the incidence of early-stage BC (localised) seem disproportionately high in comparison to more modest decreases in late-stage BC incidence (regionalised and distant disease).

Breast Cancer Mortality Trends and Predictions to 2030 and Its Attributable Risk Factors in East and South Asian Countries

BackgroundAmidst the rising breast cancer burden in Asia, we aim to predict the future mortality risk due to breast cancer and identify the risk-attributable deaths for breast cancer among East and South Asian countries.MethodsWe used country-level data to predict the trends in the next decade relating to female breast cancer mortality by employing data from 1990 to 2019 from the Global Burden of Disease 2019 study. We used the stochastic mortality modeling and prediction techniques to forecast the age-specific and risk-attributable breast cancer mortality trends at the regional and national levels of East and South Asia.ResultsThe number of deaths caused by the breast cancer is predicted to increase in East and South Asian countries in the next decade (2020–2030). Age-standardized death rate (ASDR) of breast cancer is predicted to increase by 7.0% from 9.20/100,000 (95% CI: 6.04–12.12) in 1990 to 9.88/100,000 (95% CI: 7.12–11.4) in 2030 in East Asia, and about 35% increase from 13.4/100,000 (95% CI: 9.21–16.02) in 1990 to 18.1/100,000 (95% CI: 13.23–21.10) in 2030 in South Asia. At the national level, the highest percent change in ASDR between 1990 and 2030 was reported in Pakistan (a 62% increase) and Nepal (a 47% increase). The highest percent change in breast cancer mortality between 2020 and 2030 for females of age group 80–84 years was observed in Pakistan [21.6, (95% CI, 20.6–94.7)], followed by Afghanistan [13.3 (4.0–80.8)], and Nepal [36.6 (11.1–125.7)] as compared to the other countries. In the females of aged 50–80 years, the predicted death rates were associated with high body mass index, high-fasting plasma glucose, and diet high in red meat, across the majority of countries under study. Furthermore, reductions in percent change in mortality rates occurred in several countries with increases in sociodemographic index (SDI), notably across high SDI countries.ConclusionBreast cancer mortality risk varies substantially across East and South Asian countries with higher mortality risk in low/middle SDI countries. Early detection using screening, awareness among females and health workers, and cost-effective and timely treatment of patients with breast cancer is vital in stemming the tide of breast cancer in the next decade.

Mapping of Female Breast Cancer Incidence and Mortality Rates to Socioeconomic Factors Cohort: Path Diagram Analysis.

ObjectivesBreast cancer is the leading cause of death in women around the world. Its occurrence and development have been linked to genetic factors, living habits, health conditions, and socioeconomic factors. Comparisons of incidence and mortality rates of female breast cancer are useful approaches to define cancer-related socioeconomic disparities.MethodsThis was a retrospective observational cohort study on breast cancer of women in several developed countries over 30 years. Effects of socioeconomic factors were analyzed using a path diagram method.ResultsWe found a positive, significant association of public wealth on incidence and mortality of breast cancer, and the path coefficients in the structural equations are −0.51 and −0.39, respectively. The unemployment rate (UR) is critical and the path coefficients are all 0.2. The path coefficients of individual economic wealth to the rates of breast cancer are 0.18 and 0.27, respectively.ConclusionThe influence of social pressure on the incidence and mortality of breast cancer was not typical monotonous. The survival rate of breast cancer determined by the ratio of mortality rate to incidence rate showed a similar pattern with socioeconomic factors.

Global and regional trends in incidence and mortality of female breast cancer and associated factors at national level in 2000 to 2019.

Background:Female breast cancer (FBC) has become the most prevalent malignancy worldwide. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of FBC.Methods:FBC incidence and mortality in 60 selected countries by cancer registry data integrity in 2020 were estimated from the GLOBOCAN database, and their association with the human development index (HDI) was further evaluated. Trends of age-standardized rates of incidence and mortality in 60 countries from 2000 through 2019 were evaluated by joinpoint regression analysis using data of Global Burden of Disease 2019. The association between potential behavioral, metabolic, and socioeconomic risk factor exposure at the nation level retrieved from the World Bank and Global Health Observatory and the incidence and mortality of FBC were evaluated by multivariate linear regression.Results:FBC incidence and mortality varied greatly in the 60 included countries. Higher incidence and mortality rates were typically observed in countries with higher HDIs and vice versa. During 2000 to 2019, significantly increasing trends in incidence and mortality were observed in 26 (average annual percent changes [AAPCs], 0.35–2.96) and nine countries (AAPC, 0.30–1.65), respectively, while significantly decreasing trends in both incidence and mortality were observed in 22 countries, most of which were high-HDI countries. Among the population aged ≥40 years, there were 26 and 11 countries showing significantly increased trends in incidence and mortality, respectively. Ecological analysis showed that countries with higher prevalence rates of high cholesterol and higher health expenditures were more likely to have higher FBC incidence, and countries with higher rates of obesity and poorer universal health coverage were more likely to have higher FBC mortality.Conclusions:Despite decreased or stabilized FBC incidence and mortality rates were observed in some countries with high HDI over the past decades, disease burden became even severer in developing countries, especially for the population aged ≥40 years. Effective targeted preventive programs are strongly encouraged to reduce the FBC disease burden worldwide.

Moderate Altitude Residence Reduces Male Colorectal and Female Breast Cancer Mortality More Than Incidence: Therapeutic Implications?

Simple SummaryLiving at moderate altitudes has been reported to be associated with health benefits, including reduced mortality from male colorectal and female breast cancer. The aim of this study was to evaluate altitude-dependent incidence rates and to compare them with mortality rates of those cancers. We further explored whether altitude-associated differences in lifestyle behaviour exist. Analyses including all incidence cases and deaths over a 10-year observation period of an Alpine country (Austria) revealed that the age-standardized incidence and mortality rates of male colorectal cancer decreased by 24.0% and 44.2%, and that of female breast cancer by 6.5% and 26.2%, from the lowest (<251 m) to the highest (1000–2000) altitude level. The population-based survey indicated higher physical activity levels and lower body mass index for both sexes living at a moderate altitude compared to those living below 251 m. These observations may, in certain cases, support decision making when changing residence.Background: Living at moderate altitude may be associated with health benefits, including reduced mortality from male colorectal and female breast cancer. We aimed to determine altitude-dependent incidence and mortality rates of those cancers and put them in the context of altitude-associated lifestyle differences. Methods: Incidence cases and deaths of male colorectal cancer (n = 17,712 and 7462) and female breast cancer (n = 33,803 and 9147) from altitude categories between 250 to about 2000 m were extracted from official Austrian registries across 10 years (2008–2017). Altitude-associated differences in health determinants were derived from the Austrian Health Interview Survey (2014). Results: The age-standardized incidence and mortality rates of male colorectal cancer decreased by 24.0% and 44.2%, and that of female breast cancer by 6.5% and 26.2%, respectively, from the lowest to the highest altitude level. Higher physical activity levels and lower body mass index for both sexes living at higher altitudes were found. Conclusions: Living at a moderate altitude was associated with a reduced incidence and (more pronounced) mortality from colorectal and breast cancer. Our results suggest a complex interaction between specific climate conditions and lifestyle behaviours. These observations may, in certain cases, support decision making when changing residence.

Geographical and socioeconomic inequalities in female breast cancer incidence and mortality in Iran: A Bayesian spatial analysis of registry data.

BackgroundIn Iran, trends in breast cancer incidence and mortality have generally been monitored at national level. The purpose of this study is to examine province-level disparities in age-standardised breast cancer incidence versus mortality from 2000 to 2010 and their association with socioeconomic status.MethodsIn this study, data from Iran’s national cancer and death registry systems, and covariates from census and household expenditure surveys were used. We estimated the age-standardised incidence and mortality rates in women aged more than 30 years for all 31 provinces in the consecutive time intervals 2000–2003, 2004–2007 and 2008–2010 using a Bayesian spatial model.ResultsMean age-standardised breast cancer incidence across provinces increased over time from 15.0 per 100,000 people (95% credible interval 12.0,18.3) in 2000–2003 to 39.6 (34.5,45.1) in 2008–2010. The mean breast cancer mortality rate declined from 10.9 (8.3,13.8) to 9.9 (7.5,12.5) deaths per 100,000 people in the same period. When grouped by wealth index quintiles, provinces in the highest quintile had higher levels of incidence and mortality. In the wealthiest quintile, reductions in mortality over time were larger than those observed among provinces in the poorest quintile. Relative breast cancer mortality decreased by 16.7% in the highest quintile compared to 10.8% in the lowest quintile.ConclusionsBreast cancer incidence has increased over time, with lower incidence in the poorest provinces likely driven by underdiagnoses or late-stage diagnosis. Although the reported mortality rate is still higher in wealthier provinces, the larger decline over time in these provinces indicates a possible future reversal, with the most deprived provinces having higher mortality rates. Ongoing analysis of incidence and mortality at sub-national level is crucial in addressing inequalities in healthcare systems and public health both in Iran and elsewhere.

Abstract PS7-09: Achievability of 2030 sustainable development goals in breast cancer control

Abstract Background The United Nations Sustainable Development Goals (SDGs) target a one-third reduction in non-communicable disease (NCD) mortality between the years 2015 and 2030. Cancer accounts for 22% of NCD deaths, and breast cancer is the leading global cause of female cancer mortality, despite its high survivability. Therefore, reducing female breast cancer mortality is critical to any nation’s achievement of this goal. However, sex-based disparities in healthcare are evident in lower-resource settings, and lack of infrastructure for breast cancer control leads to greater underdiagnosis in low- and lower middle-income countries (LICs &amp; LMICs). Mortality may be a biased indicator due to the impact of differing incidence rates. Therefore, the mortality-to-incidence ratio (MIR) was examined as a practical indicator of breast cancer control. We projected mortality and MIR for women with breast cancer in 195 countries to quantify progress in breast cancer control and assess the feasibility of achieving the 2030 NCD mortality target of the SDGs. Methods We used data on incidence and mortality rates for female breast cancer reported by The Global Burden of Disease Study 2017 for the years between 2000-2017. For each country, we projected mortality rate and MIR for female breast cancer by national income level from 2018-2030 using generalized linear mixed-effects models. We stratified our results by country’s Gross National Income per Capita (GNI/capita) and income group as defined by the World Bank. Findings Between 2017 and 2030, global breast cancer mortality is projected to increase by 12.4% from 19.02 (95% confidence interval [CI]: 17.36-20.64) to 21.38 ( 95% prediction interval [PI]: 19.03-23.93), while MIR is projected to decrease by 10.3% from 0.404 (95% CI: 0.385-0.425) to 0.362 (95% PI: 0.342-0.383). In 2017, MIR was 2.22 times higher in low-income countries (LICs) and 1.71 times higher in lower-middle income countries (LMICs) than in high income countries (HICs). Although MIR is projected to decrease between 2017 and 2030 across all income groups (15.9% in HICs, 10.61% in UMICs, 3.66% in LMICs, 10.2% in LICs), 2030 MIR is projected to be 2.37 times higher in LICs and 1.96 times higher in LMICs when compared to HICs. Interpretation Use of mortality to measure progress towards SDGs can be misleading in the context of breast cancer control. Simultaneously increasing mortality and incidence may still imply improvement, if mortality is increasing at a slower rate than incidence. Therefore, MIR is a better indicator of progress in breast cancer control. The decreasing global breast cancer MIR from 2015 to 2030, despite increasing mortality, indicates that global progress is being made in breast cancer. Despite globally decreasing MIR, the disparity between HICs and LICs may increase between now and 2030 in the absence of significant resource-stratified policy reform. Citation Format: Gizem Sultan Nemutlu, Ethan Thayumanavan, Barri Blauvelt, Jagpreet Chhatwal. Achievability of 2030 sustainable development goals in breast cancer control [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-09.

Breast Cancer Mortality Rates Have Stopped Declining in U.S. Women Younger than 40 Years.

Background National Center for Health Statistics (NCHS) data for U.S. women have shown a steady decline in breast cancer mortality rates since 1989. Purpose To analyze U.S. breast cancer mortality rates by age decade in women aged 20-79 years and in women aged 20-39 years and women aged 40-69 years. Materials and Methods The authors conducted a retrospective analysis of (a) female breast cancer mortality rates from NCHS data for 1969-2017 for all races and by race and (b) age- and delay-adjusted invasive breast cancer incidence rates from the Surveillance, Epidemiology, and End Results program. Joinpoint analysis was used to determine trends in breast cancer mortality, invasive breast cancer incidence, and distant-stage (metastatic) breast cancer incidence rates. Results Between 1989 and 2010, breast cancer mortality rates decreased by 1.5%-3.4% per year for each age decade from 20 to 79 years (P < .001 for each). After 2010, breast cancer mortality rates continued to decline by 1.2%-2.2% per year in women in each age decade from 40 to 79 years (P < .001 for each) but stopped declining in women younger than 40 years. After 2010, breast cancer mortality rates demonstrated nonsignificant increases of 2.8% per year in women aged 20-29 years (P = .11) and 0.3% per year in women aged 30-39 years (P = .70), results attributable primarily to changes in mortality rates in White women. A contributing factor is that distant-stage breast cancer incidence rates increased by more than 4% per year after the year 2000 in women aged 20-39 years. Conclusion Female breast cancer mortality rates have stopped declining in women younger than 40 years, ending a trend that existed from 1987 to 2010. Conversely, mortality rates have continued to decline in women aged 40-79 years. Rapidly rising distant-stage breast cancer rates have likely contributed to ending the decline in mortality rates in women younger than 40 years. © RSNA, 2021 Online supplemental material is available for this article.

PCN174 Achievability of the 2030 United Nations Sustainable Development Goals in Breast Cancer Control

Sustainable Development Goals (SDGs) target a one-third reduction in non-communicable disease (NCD) mortality between 2015-2030. Cancer accounts for 22% of NCD deaths, and breast cancer is the leading cause of female cancer mortality. Therefore, reducing female breast cancer mortality is critical. We projected health outcomes for women with breast cancer in 195 countries to quantify progress towards the 2030 target of the SDGs. We used data on incidence and mortality rates for female breast cancer reported by The Global Burden of Disease Study 2017 between 2000–2017. We projected mortality rate and MIR by national income level, as defined by the World Bank, for 2018-2030 using generalized linear mixed-effects models. Between 2017 and 2030, global breast cancer mortality is projected to increase by 12.4% from 19.02 (95% confidence interval [CI]: 17.36–20.64) to 21.38 (95% prediction interval [PI]: 19.03–23.93), while MIR is projected to decrease by 10.3% from 0.404 (95% CI: 0.385–0.425) to 0.362 (95% PI: 0.342–0.383). In 2017, MIR was 2.22 times higher in low-income countries (LICs) and 1.71 times higher in lower middle-income countries (LMICs) than in high-income countries (HICs). Although MIR is projected to decrease by 2030 across all income groups (15.9% in HICs, 10.61% in upper middle-income countries, 3.66% in LMICs, 10.2% in LICs), 2030 MIR is projected to be 2.37 and 1.96 times higher in LICs and LMICs, respectively, than MIR in HICs. MIR is a better indicator than mortality to measure progress towards SDGs for breast cancer control. The decreasing global breast cancer MIR from 2015 to 2030, despite increasing mortality, indicates that global progress is being made in breast cancer. However, disparities across income levels will remain notable in the absence of significant resource-stratified policy reform.