[Time trend of breast cancer incidence in Catalonia]

[Proportion of breast cancer in women aged 50 to 69 years from Girona, Spain, according to detection method]

BACKGROUND AND OBJECTIVE

The aim of this study was to determine the tumor stage, the proportion of cases and the age specific rate of breast cancer (BC) cases according to detection method.

MATERIAL AND METHOD

Cases of women aged 50 to 69 years diagnosed with BC in the Girona province during 1999-2006 were extracted from the population-based Girona Cancer Registry (n=1,254). BC was classified by detection method: screen-detected cancer, interval cancer and others. Proportion of cases and age-specific incidence were calculated according to detection method.

RESULTS

During the period 2002-2006, the proportion of screen-detected cancers, interval cancers and other cancers were 42.2%, 5.8% and 52.2%, respectively. After implementation of the early detection of breast cancer program (PDPCM), the incidence of screen-detected cases raised; thereafter, interval cancers also increased and the rate of other cancers decreased.

CONCLUSIONS

In the Girona province during the fully implemented PDPCM period (2002-2006), interval cancers represented a low proportion (5.8%) of women diagnosed with BC at 50 to 69 years old.

Trends in socioeconomic inequalities in cancer mortality in Barcelona: 1992-2003

BACKGROUND

The objective of this study was to assess trends in cancer mortality by educational level in Barcelona from 1992 to 2003.

METHODS

The study population comprised Barcelona inhabitants aged 20 years or older. Data on cancer deaths were supplied by the system of information on mortality. Educational level was obtained from the municipal census. Age-standardized rates by educational level were calculated. We also fitted Poisson regression models to estimate the relative index of inequality (RII) and the Slope Index of Inequalities (SII). All were calculated for each sex and period (1992-1994, 1995-1997, 1998-2000, and 2001-2003).

RESULTS

Cancer mortality was higher in men and women with lower educational level throughout the study period. Less-schooled men had higher mortality by stomach, mouth and pharynx, oesophagus, larynx and lung cancer. In women, there were educational inequalities for cervix uteri, liver and colon cancer. Inequalities of overall and specific types of cancer mortality remained stable in Barcelona; although a slight reduction was observed for some cancers.

CONCLUSION

This study has identified those cancer types presenting the greatest inequalities between men and women in recent years and shown that in Barcelona there is a stable trend in inequalities in the burden of cancer.

[Hereditary breast and ovarian cancer: primary and secondary prevention for BRCA1 and BRCA2 mutation carriers]

Ten years after the identification of the breast and ovarian cancer predisposition genes, BRCA1 and BRCA2, an emerging literature has explored the efficacy of strategies for primary as well as secondary prevention of breast and ovarian cancer in BRCA1 and BRCA2 mutations carriers. The integration of magnetic resonance imaging for breast cancer screening in BRCA carriers has achieved a higher sensibility of the screening, and an early detection of breast cancer. However, we don't have yet enough level of evidence that magnetic resonance imaging could reduce mortality in BRCA carriers. Because of the limitations of screening for ovarian cancer, bilateral prophylactic salpingo-oophorectomy has been established as one of the most effective strategies to prevent ovarian cancer in BRCA1 and BRCA2 mutation carriers. This strategy also has a favorable effect on the reduction of risk of breast cancer if is performed before the age of 50. The management of this patients must be individualized and multidisciplinary.

Time trends of breast cancer mortality in Spain during the period 1977-2001 and Bayesian approach for projections during 2002-2016

BACKGROUND

In recent decades, changes in breast cancer (BC) mortality trends have been observed across Europe. Our objective is to describe BC mortality trend in Spain during 1977-2001 and to estimate BC mortality projection in the period 2002-2016 using a Bayesian approach.

MATERIAL AND METHODS

An age-period-cohort (APC) analysis has been carried out in order to investigate the effect of the age, period and birth cohort on BC mortality in Spain during 1977-2001 and to estimate future trends for the period 2002-2016. A Bayesian APC model with an autoregressive structure for the age parameters has been used for projections of BC mortality.

RESULTS

BC mortality rates increased 2.18% per year during 1977-1991 followed by a significant fall after 1992 (estimated annual percent change = -2.67%; 95% confidence interval = -2.97, -2.31). Cohorts born before 1952 showed higher risk of death from BC than those born after this year. Projections showed an increase of mortality among women older than 50 years in the period 2002-2016 (range of increase = 10%-40%).

CONCLUSIONS

The decrease of BC mortality since 1992 could be attributable to BC down-staging due to early detection and effectiveness of cancer treatment. The effect of ageing on the female population, immigration and the increase of BC incidence observed in Spain could explain the increase in BC mortality predicted for the years to come among women older than 50 years. BC screening to the whole Spanish population and new treatments introduced in the last few years could modify the predictions of BC mortality. Future forecasting studies should be carried out considering these new factors in the natural history of BC in Spain.