A population-based study of breast cancer prevalence in Australia: predicting the future health care needs of women living with breast cancer

Abstract

Background: Breast cancer places a heavy burden on the Australian healthcare system, but information about the actual number of women living with breast cancer and their current or future health service needs is limited. We used existing population-based data and innovative statistical methods to address this critical research question in a well-defined geographic region.

Methods: Breast cancer data from the New South Wales (NSW) Central Cancer Registry and PIAMOD (Prevalence and Incidence Analysis MODel) software were used to project future breast cancer prevalence in NSW. Parametric models were fitted to incidence and survival data, and the modelled incidence and survival estimates were then used to estimate current and future prevalence. To estimate future healthcare requirements the projected prevalence was then divided into phases of care according to the different stages of the survivorship trajectory.

Results: The number of women in NSW living with a breast cancer diagnosis had increased from 19,305 in 1990 to 48,754 in 2007. This number is projected to increase further to 68,620 by 2017. The majority of these breast cancer survivors will require continued monitoring (31,974) or will be long-term survivors (29,785). About 9% will require active treatment (either initial therapy, or treatment for subsequent metastases or second cancer) and 1% will need end of life care due to breast cancer.

Conclusions: Extrapolating these projections to the national Australian population would equate to 209,200 women living with breast cancer in Australia in 2017, many of whom will require active treatment or post-treatment monitoring. Thus, careful planning and development of a healthcare system able to respond to this increased demand is required.

Figure 1

Pathways of the breast cancer survivorship journey.

Figure 2

Comparison of Age-Period-Cohort incidence models and observed age-standardised incidence rates for breast cancer in NSW Australia.

Figure 3

Observed breast cancer incidence in NSW Australia for 1972–2007, and projected incidence for 2008–2017.

Figure 4

Comparison of fitted five-year breast cancer relative survival with observed for 1972–2007 and projected survival for 2008–2017 in NSW Australia.

Figure 5

Comparison of fitted crude breast cancer incidence and mortality with observed crude incidence and mortality for 1972–2007 and projected incidence and mortality for 2008–2017 in NSW Australia.