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Baeyens-Fernández JA, Molina-Portillo E, Pollán M, Rodríguez-Barranco M, Del Moral R, Arribas-Mir L, Sánchez-Cantalejo Ramírez E, Sánchez MJ. Trends in incidence, mortality and survival in women with breast cancer from 1985 to 2012 in Granada, Spain: a population-based study. BMC Cancer 2018; 18:781. [PMID: 30068302 PMCID: PMC6090958 DOI: 10.1186/s12885-018-4682-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of breast cancer has increased since the 1970s. Despite favorable trends in prognosis, the role of changes in clinical practice and the introduction of screening remain controversial. We examined breast cancer trends to shed light on their determinants. METHODS Data were obtained for 8502 new cases of breast cancer in women between 1985 and 2012 from a population-based cancer registry in Granada (southern Spain), and for 2470 breast cancer deaths registered by the Andalusian Institute of Statistics. Joinpoint regression analyses of incidence and mortality rates were obtained. Observed and net survival rates were calculated for 1, 3 and 5 years. The results are reported here for overall survival and survival stratified by age group and tumor stage. RESULTS Overall, age-adjusted (European Standard Population) incidence rates increased from 48.0 cases × 100,000 women in 1985-1989 to 83.4 in 2008-2012, with an annual percentage change (APC) of 2.5% (95%CI, 2.1-2.9) for 1985-2012. The greatest increase was in women younger than 40 years (APC 3.5, 95%CI, 2.4-4.8). For 2000-2012 the incidence trend increased only for stage I tumors (APC 3.8, 95%CI, 1.9-5.8). Overall age-adjusted breast cancer mortality decreased (APC - 1, 95%CI, - 1.4 - - 0.5), as did mortality in the 50-69 year age group (APC - 1.3, 95%CI, - 2.2 - - 0.4). Age-standardized net survival increased from 67.5% at 5 years in 1985-1989 to 83.7% in 2010-2012. All age groups younger than 70 years showed a similar evolution. Five-year net survival rates were 96.6% for patients with tumors diagnosed in stage I, 88.2% for stage II, 62.5% for stage III and 23.3% for stage IV. CONCLUSIONS Breast cancer incidence is increasing - a reflection of the evolution of risk factors and increasing diagnostic pressure. After screening was introduced, the incidence of stage I tumors increased, with no decrease in the incidence of more advanced stages. Reductions were seen for overall mortality and mortality in the 50-69 year age group, but no changes were found after screening implementation. Survival trends have evolved favorably except for the 70-84 year age group and for metastatic tumors.
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Affiliation(s)
- José Antonio Baeyens-Fernández
- Departamento de Urgencias y Emergencias, Área de Gestión Sanitaria Noreste, Hospital Regional de Baza, Carretera de Murcia s/n, 18800 Baza, Spain
| | - Elena Molina-Portillo
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - Marina Pollán
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
- Environmental and Cancer Epidemiology Department, National Center of Epidemiology - Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - Rosario Del Moral
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
- Department of Radiotherapy and Oncology, Virgen de las Nieves University Hospital, Granada, Spain
| | - Lorenzo Arribas-Mir
- Centro de Salud La Chana, Área de Gestión Sanitaria Granada-Metropolitano, Granada, Spain
- Department of Epidemiology and Public Health, University of Granada, Granada, Spain
| | - Emilio Sánchez-Cantalejo Ramírez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - María-José Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
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Crocetti E, De Angelis R, Buzzoni C, Mariotto A, Storm H, Colonna M, Zanetti R, Serraino D, Michiara M, Cirilli C, Iannelli A, Mazzoleni G, Sechi O, Sanoja Gonzalez ME, Guzzinati S, Capocaccia R, Dal Maso L. Cancer prevalence in United States, Nordic Countries, Italy, Australia, and France: an analysis of geographic variability. Br J Cancer 2013; 109:219-28. [PMID: 23799856 PMCID: PMC3708570 DOI: 10.1038/bjc.2013.311] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/28/2013] [Accepted: 05/28/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The objectives of this study were to quantitatively assess the geographic heterogeneity of cancer prevalence in selected Western Countries and to explore the associations between its determinants. METHODS For 20 cancer sites, 5-year cancer prevalence, incidence, and survival were observed and age standardised for the mid 2000s in the United States, Nordic European Countries, Italy, Australia, and France. RESULTS In Italy, 5-year crude prevalence for all cancers was 1.9% in men and 1.7% in women, while it was ∼1.5% in all other countries and sexes. After adjustment for the different age distribution of the populations, cancer prevalence in the United States was higher (20% in men and 10% in women) than elsewhere. For all cancers combined, the geographic heterogeneities were limited, though relevant for specific cancers (e.g., prostate, showing >30% higher prevalence in the United States, or lung, showing >50% higher prevalence in USA women than in other countries). For all countries, the correlations between differences of prevalence and differences of incidence were >0.9, while prevalence and survival were less consistently correlated. CONCLUSION Geographic differences and magnitude of crude cancer prevalence were more strongly associated with incidence rates, influenced by population ageing, than with survival rates. These estimates will be helpful in allocating appropriate resources.
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Affiliation(s)
- E Crocetti
- Tuscany Cancer Registry, UO di Epidemiologia Clinica e Descrittiva, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via delle Oblate 2, 50141 Florence, Italy
| | - R De Angelis
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute (CNESPS), Istituto Superiore Sanità (ISS), Rome, Italy
| | - C Buzzoni
- Tuscany Cancer Registry, UO di Epidemiologia Clinica e Descrittiva, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via delle Oblate 2, 50141 Florence, Italy
- AIRTUM Database, Florence, Italy
| | - A Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, NCI, Bethesda, MD, USA
| | - H Storm
- Danish Cancer Society, Kræftens Bekæmpelse, Strandboulevarden 49, 2100 København Ø, Denmark
| | - M Colonna
- Isere Cancer Registry, Pavillon E, CHU GRENOBLE BP 217, 38043 Grenoble Cedex 9, France
| | - R Zanetti
- Registro Tumori Piemonte, Centro Prevenzione Oncologica (CPO) Piemonte A.S.O. San Giovanni Battista Molinette, Torino, Italy
| | - D Serraino
- Friuli Venezia Giulia Cancer Registry, Central Health Direction, Udine, Italy
| | - M Michiara
- Parma Province Cancer Registry, University Hospital Parma, Parma, Italy
| | - C Cirilli
- Modena Cancer Registry, Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | | | - G Mazzoleni
- Alto Adige/Sudtirol Cancer Registry, Bolzano, Italy
| | - O Sechi
- Cancer Registry of Sassari, Sassari, Italy
| | | | - S Guzzinati
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - R Capocaccia
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute (CNESPS), Istituto Superiore Sanità (ISS), Rome, Italy
| | - L Dal Maso
- Epidemiology and Biostatistics Unit, Scientific Directorate, Centro di Riferimento Oncologico IRCCS, Via Franco Gallini 2, 33081 Aviano, Pordenone, Italy
| | - AIRTUM Working group17
- Tuscany Cancer Registry, UO di Epidemiologia Clinica e Descrittiva, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via delle Oblate 2, 50141 Florence, Italy
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute (CNESPS), Istituto Superiore Sanità (ISS), Rome, Italy
- AIRTUM Database, Florence, Italy
- Surveillance Research Program, Division of Cancer Control and Population Sciences, NCI, Bethesda, MD, USA
- Danish Cancer Society, Kræftens Bekæmpelse, Strandboulevarden 49, 2100 København Ø, Denmark
- Isere Cancer Registry, Pavillon E, CHU GRENOBLE BP 217, 38043 Grenoble Cedex 9, France
- Registro Tumori Piemonte, Centro Prevenzione Oncologica (CPO) Piemonte A.S.O. San Giovanni Battista Molinette, Torino, Italy
- Friuli Venezia Giulia Cancer Registry, Central Health Direction, Udine, Italy
- Parma Province Cancer Registry, University Hospital Parma, Parma, Italy
- Modena Cancer Registry, Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
- Salerno Cancer Registry, Salerno, Italy
- Alto Adige/Sudtirol Cancer Registry, Bolzano, Italy
- Cancer Registry of Sassari, Sassari, Italy
- Sondrio Cancer Registry, Local Health Agency, Sondrio, Italy
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS, Padua, Italy
- Epidemiology and Biostatistics Unit, Scientific Directorate, Centro di Riferimento Oncologico IRCCS, Via Franco Gallini 2, 33081 Aviano, Pordenone, Italy
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Clavarezza M, Mustacchi G, Casadei Gardini A, Del Mastro L, De Matteis A, Riccardi F, Adamo V, Aitini E, Amoroso D, Marchetti P, Gori S, Carrozza F, Maiello E, Giotta F, Dondi D, Venturini M. Biological characterization and selection criteria of adjuvant chemotherapy for early breast cancer: experience from the Italian observational NEMESI study. BMC Cancer 2012; 12:216. [PMID: 22672524 PMCID: PMC3433340 DOI: 10.1186/1471-2407-12-216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 06/06/2012] [Indexed: 11/10/2022] Open
Abstract
Background International treatment guidelines recommend administration of adjuvant chemotherapy in early breast cancer based on clinical, prognostic and predictive parameters. Methods An observational study (NEMESI) was conducted in 63 Italian oncology centres in patients with early breast cancer. Age, performance status, concomitant disease, menopausal status, histology, tumor dimension (pT), axillary lymph node status (pN), grading (G), estrogen and progesterone receptor (ER and PgR), proliferative index (ki67 or MIB-1), human epidermal growth factor receptor 2 (HER2) and type of adjuvant treatment were recorded. The primary objective of the study was to define parameters influencing the decision to prescribe adjuvant chemotherapy and the type of chemotherapy. Results Data for 1894 patients were available. 69.0% postmenopausal, 67.0% pT1, 22.3% pTmic/pT1a/pT1b, 61.0% pN0, 48.7% luminal A, 18.1% luminal B, 16.1% HER2 positive, 8.7% triple negative, 8.4% unknown. 57.8% received adjuvant chemotherapy: 38.1% of luminal A, 67.3% luminal B, 88.2% HER2-positive, 97.6% triple negative. Regimens administered: 9.1% CMF-like, 48.8% anthracyclines, 38.4% anthracyclines plus taxanes, 3.7% taxanes alone. Increasing pT/pN and, marginally, HER2-positive were associated with the prescription of anthracyclines plus taxanes. Suboptimal schedules (CMF-like or AC/EC or FEC-75) were prescribed in 37.3% receiving chemotherapy, even in HER2-positive and triple negative disease (36.5% and 34.0%, respectively). Conclusions This study showed an overprescription of adjuvant chemotherapy for early breast cancer, particularly referred to luminal A. pT, pN and, marginally, HER2 were the principal determinants for the choice of chemotherapy type. Suboptimal chemotherapy regimens were adopted in at least one third of HER2-positve and triple negative.
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