Global and regional trends in incidence and mortality of female breast cancer and associated factors at national level in 2000 to 2019

Abstract

Background: Female breast cancer (FBC) has become the most prevalent malignancy worldwide. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of FBC.

Methods: FBC incidence and mortality in 60 selected countries by cancer registry data integrity in 2020 were estimated from the GLOBOCAN database, and their association with the human development index (HDI) was further evaluated. Trends of age-standardized rates of incidence and mortality in 60 countries from 2000 through 2019 were evaluated by joinpoint regression analysis using data of Global Burden of Disease 2019. The association between potential behavioral, metabolic, and socioeconomic risk factor exposure at the nation level retrieved from the World Bank and Global Health Observatory and the incidence and mortality of FBC were evaluated by multivariate linear regression.

Results: FBC incidence and mortality varied greatly in the 60 included countries. Higher incidence and mortality rates were typically observed in countries with higher HDIs and vice versa. During 2000 to 2019, significantly increasing trends in incidence and mortality were observed in 26 (average annual percent changes [AAPCs], 0.35-2.96) and nine countries (AAPC, 0.30-1.65), respectively, while significantly decreasing trends in both incidence and mortality were observed in 22 countries, most of which were high-HDI countries. Among the population aged ≥40 years, there were 26 and 11 countries showing significantly increased trends in incidence and mortality, respectively. Ecological analysis showed that countries with higher prevalence rates of high cholesterol and higher health expenditures were more likely to have higher FBC incidence, and countries with higher rates of obesity and poorer universal health coverage were more likely to have higher FBC mortality.

Conclusions: Despite decreased or stabilized FBC incidence and mortality rates were observed in some countries with high HDI over the past decades, disease burden became even severer in developing countries, especially for the population aged ≥40 years. Effective targeted preventive programs are strongly encouraged to reduce the FBC disease burden worldwide.

Figure 1

Correlation between age-standardized breast cancer incidence (A) and mortality rates (B) and HDI (Data source: GLOBOCAN 2020). ASIR: Age-standardized incidence rate; ASMR: Age-standardized mortality rate; HDI: Human development index.

Figure 2

The AAPC of the incidence and mortality of breast cancer in female, all ages. (A) AAPC for countries in Africa, Asia, Oceania, North America, South America; (B) AAPC for countries in Northern, Southern, Western, Eastern, and Central Europe. ^∗P < 0.05; AAPC: Annual percentage change.

Figure 3

The AAPC of the incidence and mortality of breast cancer in females aged younger than 40 years. (A) AAPC for countries in Africa, Asia, Oceania, North America, South America; (B) AAPC for countries in Northern, Southern, Western, Eastern, and Central Europe. ^∗P < 0.05; AAPC: Annual percentage change.

Figure 4

The AAPC of the incidence and mortality of breast cancer in females aged 40 years or older. (A) AAPC for countries in Africa, Asia, Oceania, North America, South America; (B) AAPC for countries in Northern, Southern, Western, Eastern, and Central Europe. ^∗P < 0.05; AAPC: Annual percentage change.

Figure 5

Time-lag analyses of changes in risk factors on breast cancer incidence and mortality. BC: breast cancer; UHC: universal health coverage. ^∗P < 0.05.