Prostate and breast cancer in four Nordic countries: A comparison of incidence and mortality trends across countries and age groups 1975–2013

Abstract

In recent decades, management of prostate and breast cancer patients has changed considerably. The purpose of our study is to interpret patterns of prostate and breast cancer incidence and mortality in four Nordic countries across age groups and time periods. Prostate and breast cancer incidence and mortality data (1975-2013) were obtained from the NORDCAN database. Joinpoint regression models were used to identify changes in the trends. A more prominent increase in prostate than breast cancer incidence was observed. From the mid-1990s, mortality rates in patients below 75 years of age have decreased for both cancers in all four countries. The relative decline in breast cancer mortality from 1985-1989 to 2009-2013 were largest in women under 50 years of age, with reductions in mortality rates ranging from 38% in Finland to 55% in Denmark. In the age group 55-74 years, mortality rates for prostate cancer declined more than for breast cancer in all countries except Denmark, ranging from 14% in Denmark to 39% in Norway. The substantial decrease in breast cancer mortality in women below regular screening age and the reductions in mortality from both cancers in Denmark from the mid-1990s are consistent with beneficial contributions from improved treatment besides mammography screening and increased PSA testing. Alongside similar mortality decreases, the larger increases in prostate cancer incidence as compared to breast cancer indicate that a higher proportion of prostate cancer cases are overdiagnosed.

Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

“…The commercial availability of PSA testing from the middle to late 1980s led to intensive use of the test for early detection and diagnostics, and incidence rates rapidly increased, first in the United States and, within a few years, in greater Europe, notably in several Nordic countries, Australia, and Canada . These trends have been followed by declines as the pool of prevalent cases diminishes; in the United States, the 2012 recommendation against the routine use of PSA testing by the US Preventive Services Task Force may have partly driven trends downward in recent years (although this organization currently recommends that this decision should be an individual one), whereas incidence in the Nordic countries has either declined (Denmark, Finland, and Sweden) or has been stable (Norway) since the middle 2000s . However, rates are on the rise in countries where PSA testing became more widely used later, including the United Kingdom, Japan, Brazil, Costa Rica, and Thailand .…”

“…37,38 These trends have been followed by declines as the pool of prevalent cases diminishes; in the United States, the 2012 recommendation against the routine use of PSA testing by the US Preventive Services Task Force may have partly driven trends downward in recent years (although this organization currently recommends that this decision should be an individual one), 39 whereas incidence in the Nordic countries has either declined (Denmark, Finland, and Sweden) or has been stable (Norway) since the middle 2000s. 40 However, rates are on the rise in countries where PSA testing became more widely used later, including the United Kingdom, Japan, Brazil, Costa Rica, and Thailand. 37,38,41 Incidence is also rising in several African populations, including Kampala (Uganda) and in the black population of Harare (Zimbabwe), although, because the registry catchment areas comprise urban populations, it remains difficult to attribute the trends to changes in risk or to enhanced diagnostic capabilities and increased PSA testing.…”

Mortality and years of life lost due to breast cancer attributable to physical inactivity in the Brazilian female population (1990–2015)

“…A survey conducted in the Eastern Mediterranean Region analysed the trends of deaths and DALYs from 2005 to 2015 by different cancers and found that mortality and DALY rates due to breast cancer stabilized over a 10-year period 1 . In Denmark and Finland, a reduction in breast cancer mortality rates over 25 years (1985–1989 to 2009–2013) has been reported 15 , and in the U.S., there was a decline in breast cancer mortality rates from 1990 to 2009 in all ethnic groups 16 . From 1990 to 2015, public health policies were created in Brazil, which resulted in improvements in cancer screening and treatment services, such as the National Oncology Policy 17 .…”

Breast cancer survival trends in different stages and age groups – a population-based study 1989–2013

“…al. [16] showed that women under 50 years had a more profound drop in mortality than older patients. Notably, we observed a 40% increase in breast cancer diagnoses between 1989 and 2013.…”