P5-08-04 Overview of breast cancer mortality trends in the world

Authors

Pizot C, Boniol M, Boyle P, Autier P.

Body

Background: Since the 1990s, important changes in the detection and management of breast cancer have taken place. We analysed breast cancer mortality trends from 1989 to 2012 in 47 countries with data available for most years since 1987.

Methods: Breast cancer deaths and populations were extracted from the WHO mortality database. Age-standardised mortality rates were computed using the World standard population over the period 1987-2012 for women of all ages and for women aged [lt]50 years, 50-69 years and [ge]70 years. Percent changes in mortality trends were assessed over the period 1989-2012. Mortality rates are reported per 100,000 women. We constituted groups of comparable countries that are located in same region, have similar economic status and same mortality rates in 1987-89.

Results: Annual breast cancer mortality rates in 1987-89 ranged from 2.6 in South Korea to 29.3 in England and Wales (median rate of 18.5). In 2010-12, mortality rates ranged from 5.1 in South Korea to 18.4 in Denmark (median rate of 14.8). From 1989 to 2012 (23 years), declines in breast cancer mortality were observed in 39 out of 47 countries. Mortality changes ranged from a -45% reduction in England and Wales to a 79% increase in South Korea (median change of -28%). Mortality declines were more pronounced in countries with high mortality in 1987-89. In groups of comparable countries, sharp contrasts in mortality changes were observed, for instance -21% reduction in France against -37% reduction in Spain, or 5% increase in Latvia against -17% reduction in Slovakia. Although the mortality rates in 1987-89 were 20.9 in Australia and 27.4 in New Zealand, a mortality reduction of -38% was observed in both countries. Of note, in these groups of comparable countries, reductions in mortality were the same in countries that introduced mass breast screening around 1990 than in countries where breast screening was introduced in 2005 or after. Regarding age groups, the largest declines in mortality were observed in women less than 50 in all the countries except New Zealand and Hong Kong, and only three countries had an increased mortality in this age group (Brazil, Colombia, South Korea). Mortality changes in young women ranged from -59% reduction in Slovenia to 32% increase in South Korea (median change of -45%). Mortality changes in young women were not different in countries where breast screening before age 50 has always been uncommon (e.g., Norway, England and Wales) or is widespread since the late 1980[apos]s (e.g., the USA, Sweden). In women aged 50-69 years, mortality changes ranged from -49% reduction in England and Wales to 111% increase in South Korea (median change of -27%). In women aged 70 years or more, mortality changes ranged from a -33% reduction in the Netherlands to a 151% increase in South Korea (median of -11%).

Conclusions: Huge disparities in changes in breast cancer mortality rates are observed around the World, and across age groups. Downward trends in breast cancer mortality prevail in most of Europe, North America, Oceania, and in few countries of Latin America and Asia. The situation in high income Asian countries is not easy to interpret because access to efficient therapies is commonplace. There seems to be no discernible influence of screening on mortality trends.

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