Global burden of breast cancer and attributable risk factors in 195 countries and territories, from 1990 to 2017: results from the Global Burden of Disease Study 2017

Abstract

Background: Statistical data on the incidence, mortality, and burden of breast cancer and the relevant risk factors are valuable for policy-making. We aimed to estimate breast cancer incidence, deaths, and disability-adjusted life years (DALYs) by country, gender, age group, and social-demographic status between 1990 and 2017.

Methods: We extracted breast cancer data from the 2017 Global Burden of Disease (GBD) study from 1990 through 2017 in 195 countries and territories. Data about the number of breast cancer incident cases, deaths, DALYs, and the age-standardized rates were collected. We also estimated the risk factors attributable to breast cancer deaths and DALYs using the comparative risk assessment framework of the GBD study.

Results: In 2017, the global incidence of breast cancer increased to 1,960,681 cases. The high social-development index (SDI) quintile included the highest number of breast cancer death cases. Between 2007 and 2017, the ASDR of breast cancer declined globally, especially in high SDI and high middle SDI countries. The related DALYs were 17,708,600 in 2017 with high middle SDI quintile as the highest contributor. Of the deaths and DALYs, alcohol use was the greatest contributor in most GBD regions and other contributors included high body mass index (BMI) and high fasting plasma glucose.

Conclusion: The increasing global breast cancer burden is mainly observed in lower SDI countries; in higher SDI countries, the breast cancer burden tends to be relieving. Therefore, steps against attributable risk factors should be taken to reduce breast cancer burden in lower SDI countries.

Keywords: Alcohol use; Breast cancer; Disability-adjusted life years; Global cancer burden; Incidence.

Fig. 1

Age-standardized breast cancer incidence (a), death (b), and DALY (c) rates globally (red lines with circles), and in social-demographic index high (green lines with squares), high middle (yellow lines with triangles), middle (purple lines with snowflakes), low middle (baby-blue lines with “+”), and low (navy-blue lines with hollow squares) quintiles

Fig. 2

The global disease burden of breast cancer for both genders in 195 countries and territories. a The ASR of breast cancer in 2017. b The relative incidences changes of breast cancer between 1990 and 2017. c The EAPC of breast cancer ASR from 1990 to 2017. Countries with an extreme number of cases or changes were lined out. ASR, age-standardized rate; EAPC, estimated annual percentage change

Fig. 3

The correlation of EAPC and breast cancer ASR in 1990 (a) and the correlation of breast cancer ASR in 2017 and SDI (b). a The size of circle is increased with breast cancer cases and one circle represents a specific country. The ρ indices and P value were derived from Pearson correlation analysis. b The blue line represents the average expected relationship between SDIs and ASRs for breast cancer based on values from all countries from 1990 to 2017. ASR, age-standardized rate; EAPC, estimated annual percentage change; SDI, social-demographic index

Fig. 4

The proportion of the three age groups for breast cancer incident cases between 1990 and 2017 globally, and in high, high middle, middle, low middle, and low SDI quintiles. The populations were divided into three age groups: 15–49 years, 50–69 years, and 70+ years

Fig. 5

a, b The breast cancer DALYs attributable to risk factors compared in 1990 and 2017, both genders, globally and by region. Only the overall DALYs and the most pronounced one attributable to specific risk factors (alcohol use, high body mass index, and high fasting plasma glucose) were presented. DALY, disability-adjusted life year

Fig. 6

The age-standardized rates of DALYs (a) and deaths (b) attributable to alcohol use, high body mass index, and high fasting plasma glucose from 1990 to 2017, both sexes