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

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 ≥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 ≥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 ≥70 year olds.

Female breast cancer mortality in Brazil and its regions

“…These factors have clearly contributed to the increased survival in breast cancer in Europe. 24 In the case of Brazil, difficulties accessing services for early diagnosis, delays in diagnosis and the time interval between diagnosis tests and suitable breast cancer treatment may be factors that compromise the progression of the disease. In a study of 68 women with breast cancer at a public hospital, delays were noted at various stages of the diagnosis and oncological treatment, especially in the interval between mammography and realization of the biopsy.…”

Breast cancer mortality in Spain: Has it really declined for all age groups?

“…This reduction in the rates of mortality such Spain as in Europe has been attributed to mammography screening, implementation of effective hormone treatments and chemotherapy, and progress in radiotherapy and surgery, these innovations have probably contributed to the observed improvements in breast cancer survival in Europe [1], although the contribution of each factor in the mortality improvement is unknown [14,19]. Studying mortality trends by age groups is of particular interest since any improvement in this mortality may entail great social and economic consequences, especially when developing specific health plans specifically aimed at these age groups.…”

Factors that influence mammography screening behaviour: A qualitative study of Greek women's experiences

“…For women with an average risk, mammography screening constitutes one of the most effective ways to detect cancer (McCaul et al 1999;Hoffken 2001;Kimberly et al 2003), and official global recommendations support its use. Even though the benefits of mammograms and particularly the mammography's efficacy related to reduction of mortality rates have been questioned by several researchers (Gotzsche et al 2000;Gotzsche 2004;Gotzsche et al 2009;Autier et al 2010;Jorgensen et al 2010), this has provoked adverse criticism from many who believe that screening saves lives (Dilhuydy et al 1997;Thornton 2001). Many others maintain that mammography screening reduces breast cancer mortality in women aged 50 to 74 years by approximately 26% (McCaul et al 1999;Hoffken 2001;Heath 2009;Savage 2009).…”