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. 2018 Aug 2;18(1):781.
doi: 10.1186/s12885-018-4682-1.

Trends in incidence, mortality and survival in women with breast cancer from 1985 to 2012 in Granada, Spain: a population-based study

José Antonio Baeyens-Fernández  1 , Elena Molina-Portillo  2   3 , Marina Pollán  3   4 , Miguel Rodríguez-Barranco  2   3 , Rosario Del Moral  3   5 , Lorenzo Arribas-Mir  6   7 , Emilio Sánchez-Cantalejo Ramírez  2   3 , María-José Sánchez  2   3
Affiliations

Trends in incidence, mortality and survival in women with breast cancer from 1985 to 2012 in Granada, Spain: a population-based study

José Antonio Baeyens-Fernández et al. BMC Cancer. .

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.

Keywords: Breast; Cancer; Incidence; Mortality; Population-based; Registry; Spain; Stage; Survival; Trend.

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Conflict of interest statement

This paper is part of the doctoral thesis prepared by the first and corresponding author in the Inter-University Health Sciences Doctoral Program offered jointly by the University of Seville, the University of Jaen and the Andalusian School of Public Health.

The dataset of the population-based cancer registry is registered as stipulated by law according to the Spanish Data Protection Agency (Agencia Española de Protección de Datos. https://www.agpd.es). All data collected in the database for incidence and survival analysis were anonymous, and no ethical approval was required.

Mortality data were obtained from public database of the National Institute of Statistics, and were previously anonymized, so no ethical approval was required.

Not applicable.

The authors declare that they have no competing interests.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Age-specific incidence trends for breast cancer, 1985–2012. Joinpoint regression analysis of age-specific trends in breast cancer incidence rates per 100,000 for 1985–2012. APC estimates calculated by Joinpoint regression analysis. No change points were found. Population: 463816 women residing in Granada province (Source: 2011 population census for Granada, Statistics and Cartography Institute of Andalusia). * p < 0.05
Fig. 2
Fig. 2
Age-standardized trends in breast cancer incidence according to tumor stage, 2000–2012. Joinpoint regression analysis of age-standardized trends in breast cancer incidence rates per 100,000 (referred to the European Standard Population) according to tumor stage at diagnosis for 2000–2012. APC estimates calculated by Joinpoint regression analysis. No change points were found. Age-standardized rates referred to the European population. Population: 463816 women residing in Granada province (Source: 2011 population census for Granada, Statistics and Cartography Institute of Andalusia). * p < 0.05
Fig. 3
Fig. 3
Age-specific mortality trends for breast cancer, 1985–2012. Joinpoint regression analysis of age-specific trends in breast cancer incidence rates per 100,000 for 1985–2012. APC estimates calculated by Joinpoint regression analysis. No change points were found. Population: 463816 women residing in Granada province (Source: 2011 population census for Granada, Statistics and Cartography Institute of Andalusia). * p < 0.05
Fig. 4
Fig. 4
Age-standardized 1-, 3- and 5-year survival and net survival in women with breast cancer, 1985–2012. Estimates of observed survival calculated with the Kaplan–Meyer method, and net survival calculated with the Pohar–Perme method (cohort analysis) for 1985–2012 in 5-year periods and for the final 3-year period from 2000 to 2012. Period analysis was used instead of cohort analysis for the last 3-year period. Age-standardized rates referred to the European population. Population: 463816 women residing in Granada province (Source: 2011 population census for Granada, Statistics and Cartography Institute of Andalusia)
Fig. 5
Fig. 5
Five-year age-specific net survival in women with breast cancer, 1985–2012. Estimates of net survival calculated with the Pohar–Perme method (cohort analysis) for 1985–2012 in 5-year periods and for the final 3-year period from 2000 to 2012. Period analysis was used instead of cohort analysis for the last 3-year period. Population: 463816 women residing in Granada province (Source: 2011 population census for Granada, Statistics and Cartography Institute of Andalusia)
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