Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database

Philippe Autier, Mathieu Boniol, Carlo La Vecchia, Lars Vatten, Anna Gavin, Clarisse Héry, Mary Heanue, Philippe Autier, Mathieu Boniol, Carlo La Vecchia, Lars Vatten, Anna Gavin, Clarisse Héry, Mary Heanue

Abstract

Objective: To examine changes in temporal trends in breast cancer mortality in women living in 30 European countries.

Design: Retrospective trend analysis. Data source WHO mortality database on causes of deaths Subjects reviewed Female deaths from breast cancer from 1989 to 2006

Main outcome measures: Changes in breast cancer mortality for all women and by age group (<50, 50-69, and >or=70 years) calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in all age mortality began to change.

Results: From 1989 to 2006, there was a median reduction in breast cancer mortality of 19%, ranging from a 45% reduction in Iceland to a 17% increase in Romania. Breast cancer mortality decreased by >or=20% in 15 countries, and the reduction tended to be greater in countries with higher mortality in 1987-9. England and Wales, Northern Ireland, and Scotland had the second, third, and fourth largest decreases of 35%, 29%, and 30%, respectively. In France, Finland, and Sweden, mortality decreased by 11%, 12%, and 16%, respectively. In central European countries mortality did not decline or even increased during the period. Downward mortality trends usually started between 1988 and 1996, and the persistent reduction from 1999 to 2006 indicates that these trends may continue. The median changes in the age groups were -37% (range -76% to -14%) in women aged <50, -21% (-40% to 14%) in 50-69 year olds, and -2% (-42% to 80%) in >or=70 year olds.

Conclusions: Changes in breast cancer mortality after 1988 varied widely between European countries, and the UK is among the countries with the largest reductions. Women aged <50 years showed the greatest reductions in mortality, also in countries where screening at that age is uncommon. The increasing mortality in some central European countries reflects avoidable mortality.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form and declare no financial or non-financial interests that may be relevant to the submitted work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787658/bin/autp696690.f1_default.jpg
Fig 1 Temporal trends in breast cancer mortality in European countries. Countries have been grouped in graphs according to percentage change in mortality from 1989 to 2006. (Five-year smoothing was applied on Iceland and Luxembourg rates to avoid unstable trends because of small population size)
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787658/bin/autp696690.f2_default.jpg
Fig 2 Percentage changes in breast cancer mortality in European countries during 1989-2006 according to the mean breast cancer mortality in 1987-9

References

    1. Hermon C, Beral V. Breast cancer mortality rates are levelling off or beginning to decline in many western countries: analysis of time-trends, age-cohort and age-period models of breast cancer mortality in 20 countries. Br J Cancer 1996;73:955-60.
    1. Levi F, Bosetti C, Lucchini F, Negri E, La Vecchia C. Monitoring the decrease in breast cancer mortality in Europe. Eur J Cancer Prev 2005;14:497-502.
    1. European Commission. Cancer screening in the European Union. Report on the implementation of the council recommendation on cancer screening. First report. 2008. .
    1. Coebergh JW, Albreth T. Should the EU also wage war against cancer? And if so, how? Eur J Cancer 2008;44:1341-4.
    1. Micheli A, Coebergh JW, Mugno E, Massimiliani E, Sant M, Oberaigner W, et al. European health systems and cancer care. Ann Oncol 2003;14 (suppl 5):v41-60.
    1. Jonsson B, Wilking N. A global comparison regarding patient access to cancer drugs. Ann Oncol 2007;18(suppl 3):1-74S.
    1. Autier P, Ouakrim DA. Determinants of the number of mammography units in 31 countries with significant mammography screening. Br J Cancer 2008;99:1185-90.
    1. World Health Organization. Mortality database. World Health Organization, 2009.
    1. Mathers CD, Ma Fat D, Inoue M, Rao C, Lopez A. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Org 2005;83:171-7.
    1. Lutz JM, Pury P, Fioretta G, Raymond L. The impact of coding process on observed cancer mortality trends in Switzerland. Eur J Cancer Prev 2004;13:77-81.
    1. Waterhouse J, Muir C, Correa P, Powel J, eds. Cancer incidence in five continents. Vol III. IARC scientific publication number 15. World Health Organization, 1976.
    1. National Cancer Institute. Joinpoint regression program, version 3.4.2. 2009. .
    1. Doll R, Peto R. The causes of cancer. Oxford University Press, 1981.
    1. Nystrom L, Larsson LG, Rutqvist LE, Lindgren A, Linqdvist M, Ryden S, et al. Determination of cause of death among breast cancer cases in the Swedish randomized mammography screening trials. A comparison between official statistics and validation by an endpoint committee. Acta Oncol 1995;34:145-52.
    1. Berrino F, De Angelis R, Sant M, Rosso S, Bielska-Lasota M, Coebergh JW, et al. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncol 2007;8:773-83.
    1. Does the UK really have an effective cancer plan? Lancet Oncol 2007;8:747.
    1. Cancer treatment: not just a question of costs. Lancet 2007;369:1665.
    1. Jonsson B. Being NICE is not the problem! Eur J Cancer 2009;45:1100-2.
    1. Héry C, Ferlay J, Boniol M, Autier P. Changes in breast cancer incidence and mortality in middle-aged and elderly women in 28 countries with Caucasian majority populations. Ann Oncol 2008;19:1009-18.
    1. Héry C, Ferlay J, Boniol M, Autier P. Quantification of changes in breast cancer incidence and mortality since 1990 in 35 countries with Caucasian-majority populations. Ann Oncol 2008;19:1187-94.
    1. Autier P, Boniol M, Héry C, Masuyer E, Ferlay J. Cancer survival statistics should be viewed with caution. Lancet Oncol 2007;8:1050-2.
    1. Biesheuvel C, Barratt A, Howard K, Houssami N, Irwig L. Effects of study methods and biases on estimates of invasive breast cancer over-detection with mammography screening: a systematic review. Lancet Oncol 2007;8:1129-38.
    1. Fracheboud J, Otto SJ, van Dijck JA, Broeders MJ, Verbeek AL, de Koning HJ. Decreased rates of advanced breast cancer due to mammography screening in The Netherlands. Br J Cancer 2004;91:861-7.
    1. Jemal A, Ward E, Thun MJ. Recent trends in breast cancer incidence rates by age and tumor characteristics among US women. Breast Cancer Res 2007;9:R28.
    1. Chiu C, Morrell S, Page A, Rickard M, Brassil A, Taylor R. Population-based mammography screening and breast cancer incidence in New South Wales, Australia. Cancer Causes Control 2006;17:153-60.
    1. McPherson K, Steel CM, Dixon JM. ABC of breast diseases. Breast cancer epidemiology, risk factors, and genetics. BMJ 2000;321:624-8.
    1. Veronesi U, Boyle P, Goldhirsch A, Orecchia R, Viale G. Breast cancer. Lancet 2005;365:1727-41.
    1. Kumle M. Declining breast cancer incidence and decreased HRT use. Lancet 2008;372:608-10.
    1. Barnett GC, Shah M, Redman K, Easton DF, Ponder BA, Pharoah PD. Risk factors for the incidence of breast cancer: do they affect survival from the disease? J Clin Oncol 2008;26:3310-6.
    1. Zahl PH, Mæhlen J, Welch HG. The natural history of invasive breast cancers detected by screening mammography. Arch Intern Med 2008;168:2311-6.
    1. Jørgensen KJ, Gøtzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. BMJ 2009;339:b2587.
    1. Morrell S, Barratt A, Irwig L, Howard K, Biesheuvel C, Armstrong B. Estimates of overdiagnosis of invasive breast cancer associated with screening mammography. Cancer Causes Control 2010;21:275-82.
    1. Burke JP, Power C, Gorey TF, Flanagan F, Kerin MJ, Kell MR. A comparative study of risk factors and prognostic features between symptomatic and screen detected breast cancer. Eur J Surg Oncol 2008;34:149-53.
    1. Day NE, Williams DR, Khaw KT. Breast cancer screening programmes: the development of a monitoring and evaluation system. Br J Cancer 1989;59:954-8.
    1. Autier P, Héry C, Haukka J, Boniol M, Byrnes G. Advanced breast cancer and breast cancer mortality in randomized controlled trials on mammography screening. J Clin Oncol 2009;27:5919-23.
    1. National Evaluation Team for Breast Cancer Screening. National evaluation of breast cancer screening in the Netherlands. 11th evaluation report. NETB, 2005.
    1. McCann J, Stockton D, Day N. Breast cancer in East Anglia: the impact of the breast screening programme on stage at diagnosis. J Med Screen 1998;5:42-8.
    1. Hofvind S, Sorum R, Thoresen S. Incidence and tumor characteristics of breast cancer diagnosed before and after implementation of a population-based screening program. Acta Oncol 2008;47:225-31.
    1. Vervoort MM, Draisma G, Fracheboud J, van de Poll-Franse LV, de Koning HJ. Trends in the usage of adjuvant systemic therapy for breast cancer in the Netherlands and its effect on mortality. Br J Cancer 2004;91:242-7.
    1. Sukel MP, van de Poll-Franse LV, Nieuwenhuijzen GA, Vreugdenhil G, Herings RM, Coebergh JW, et al. Substantial increase in the use of adjuvant systemic treatment for early stage breast cancer reflects changes in guidelines in the period 1990-2006 in the southeastern Netherlands. Eur J Cancer 2008;44:1846-54.
    1. Women’s Health Council. Breast cancer treatments: a review of the bio-medical evidence. 2008.
    1. Valentini M, Mari E, Belfiglio M, Nicolucci A. Is adjuvant tamoxifen used optimally in the treatment of breast cancer? Results of an Italian survey. Ann Oncol 1999;10:789-93.
    1. Abadie C, Aminot I, Dupuy E, Degré A. Breast cancer II. [An evaluation of the diagnostic and therapeutic decisions in Aquitaine in 1999.] Rev Méd Assurance Maladie 2002;33:267-75.
    1. Fritsch B, Ostermann M, Thorn, Seiller F, Fischer B, Weill G. [Assessment of management practices for women with early-stage breast cancer.] La Presse Médicale 2007;36:1712-20.
    1. Madhavan KS, Murray PA. A UK survey of tamoxifen prescribing and oestrogen receptor status. Breast 2002;11:265-6.
    1. Early Breast Cancer Trialists’ Collaborative Group. Effects of adjuvant tamoxifen and of cytotoxic therapy on mortality in early breast cancer: an overview of 61 randomised trials among 28,896 women. N Engl J Med 1988;319:1681-92.
    1. Klug SJ, Hetzer M, Blettner M. Screening for breast and cervical cancer in a large German city: participation, motivation and knowledge of risk factors. Eur J Public Health 2005;15:70-7.
    1. Spyckerelle Y, Kuntz C, Giordanella JP, Ancelle-Park R. Pratiques de la mammographie chez les femmes de 35 à 75 ans: étude descriptive dans la population consultant les centres d’examens de santé. Bulletin du Cancer 2002;89:957-62.
    1. August DA, Rea T, Sondak VK. Age-related differences in breast cancer treatment. Ann Surg Oncol 1994;1:45-52.
    1. Eaker S, Dickman PW, Bergkvist L, Holmberg L. Differences in management of older women influence breast cancer survival: results from a population-based database in Sweden. PLoS Med 2006;3:e25.
    1. Siebel MF, Muss HB. The influence of aging on the early detection, diagnosis, and treatment of breast cancer. Curr Oncol Rep 2005;7:23-30.
    1. Bernardi D, Errante D, Galligioni E, Crivellari D, Bianco A, Salvagno L, et al. Treatment of breast cancer in older women. Acta Oncol 2008;47:187-98.
    1. NHS Cancer Screening Programmes. NHS breast screening programme. 2006. .
    1. Bradburn MJ, Altman DG, Smith P, Fentiman IS, Rubens RD. Time trends in breast cancer survival: experience in a single centre, 1975-89. Br J Cancer 1998;77:1944-9.
    1. Pisani P, Forman D. Declining mortality from breast cancer in Yorkshire, 1983-1998: extent and causes. Br J Cancer 2004;90:652-6.
    1. Morris E, Haward RA, Forman D. The impact of the Calman-Hine report: analysis of breast and colorectal cancer surgical workloads and the degree of surgical site specialization in the Yorkshire region of the UK, 1990-2000. Eur J Cancer Care 2007;16:150-5.
    1. Morris E, Haward RA, Gilthorpe MS, Craigs C, Forman D. The impact of the Calman-Hines report on the processes and outcomes of care for Yorkshire’s breast cancer patients. Ann Oncol 2008;19:284-91.
    1. Monaghan P, Murray L, Donnelly M, et al. Breast cancer services—a population-based study of service reorganization. J Public Health 2005;27:171-5.
    1. World Health Organization. WHO statistical information system. 2009. .
    1. Sobotka T. Re-emerging diversity: rapid fertility changes in Central and Eastern Europe after the collapse of the communist regimes. Population 2003;58:451-86.
    1. Ray-Coquard I, Philip T, de Laroche G, Froger X, Suchaud JP, Voloch A, et al. Persistence of medical change at implementation of clinical guidelines on medical practice: a controlled study in a cancer network. J Clin Oncol 2005;23:4414-23.
    1. Swedish Organised Service Screening Evaluation Group. Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data. Cancer Epidemiol Biomarkers Prev 2006;15:45-51.
    1. Swedish Organised Service Screening Evaluation Group. Reduction in breast cancer mortality from organized service screening with mammography: 2. Validation with alternative analytic method. Cancer Epidemiol Biomarkers Prev 2006;15:52-6.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner