Elsevier

The Lancet

Volume 378, Issue 9801, 22–28 October 2011, Pages 1461-1484
The Lancet

Articles
Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis

https://doi.org/10.1016/S0140-6736(11)61351-2Get rights and content

Summary

Background

Breast and cervical cancer are important causes of mortality in women aged ≥15 years. We undertook annual age-specific assessments of breast and cervical cancer in 187 countries.

Methods

We systematically collected cancer registry data on mortality and incidence, vital registration, and verbal autopsy data for the period 1980–2010. We modelled the mortality-to-incidence (MI) ratio using a hierarchical model. Vital registration and verbal autopsy were supplemented with incidence multiplied by the MI ratio to yield a comprehensive database of mortality rates. We used Gaussian process regression to develop estimates of mortality with uncertainty by age, sex, country, and year. We used out-of-sample predictive validity to select the final model. Estimates of incidence with uncertainty were also generated with mortality and MI ratios.

Findings

Global breast cancer incidence increased from 641 000 (95% uncertainty intervals 610 000–750 000) cases in 1980 to 1 643 000 (1 421 000–1 782 000) cases in 2010, an annual rate of increase of 3·1%. Global cervical cancer incidence increased from 378 000 (256 000–489 000) cases per year in 1980 to 454 000 (318 000–620 000) cases per year in 2010—a 0·6% annual rate of increase. Breast cancer killed 425 000 (359 000–453 000) women in 2010, of whom 68 000 (62 000–74 000) were aged 15–49 years in developing countries. Cervical cancer death rates have been decreasing but the disease still killed 200 000 (139 000–276 000) women in 2010, of whom 46 000 (33 000–64 000) were aged 15–49 years in developing countries. We recorded pronounced variation in the trend in breast cancer mortality across regions and countries.

Interpretation

More policy attention is needed to strengthen established health-system responses to reduce breast and cervical cancer, especially in developing countries.

Funding

Susan G Komen for the Cure and the Bill & Melinda Gates Foundation.

Section snippets

Background

Breast and cervical cancer are important reproductive health problems for women.1 Programmes to address the burden of both cancers have featured prominently in the discussions leading up to the UN High-level Meeting on Non-communicable Diseases.2, 3, 4 Reports in the media have focused on steady increases in breast cancer deaths in both the developing and developed world.5, 6, 7, 8, 9 Increasing policy attention to these diseases is in part fuelled by the potential of health systems to reduce

Methods

Our analytical strategy can be divided into four components: database development, modelling MI ratios, estimation of trends in mortality by age, and estimation of trends in incidence. We incorporated different data sources in a standardised approach to use all available information for every country (figure 1).

Results

Overall, the number of breast cancer cases has steadily increased by a factor of 2·6 from 641 000 (95% uncertainty intervals [UI] 610 000–750 000) cases to 1 643 000 (1 421 000–1 782 000) cases—an annual increase between 1980 and 2010 of 3·1%. For cervical cancer, the trend is less pronounced, increasing from 378 000 (256 000–489 000) to 454 000 (318 000–620 000)—an average annual increase of 0·6% during the same period. More than two-thirds of cases of breast cancer in 2010 were in women aged

Discussion

Worldwide, the incidence of breast cancer has increased at an annual rate of 3·1% and mortality from breast cancer has increased at an annual rate of 1·8%. Increases in the absolute number of cases and deaths are driven by the interaction of three distinct reasons: rising population numbers in women of at-risk age, population ageing such that the median age is rising in most regions, and changes in age-specific incidence and death rates. Cumulative incidence, which is affected only by changes

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