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. 2023 Sep 1;21(1):299.
doi: 10.1186/s12916-023-03004-4.

Estimating disparities in breast cancer screening programs towards mortality, case fatality, and DALYs across BRICS-plus

Sumaira Mubarik  1   2 , Saima Shakil Malik  3 , Zhang Yanran  1   4 , Eelko Hak  2 , Nawsherwan  5 , Fang Wang  6 , Chuanhua Yu  7
Affiliations

Estimating disparities in breast cancer screening programs towards mortality, case fatality, and DALYs across BRICS-plus

Sumaira Mubarik et al. BMC Med. .

Abstract

Background: Numerous studies over the past four decades have revealed that breast cancer screening (BCS) significantly reduces breast cancer (BC) mortality. However, in BRICS-plus countries, the association between BCS and BC case fatality and disability are unknown. This study examines the association of different BCS approaches with age-standardized mortality, case-fatality, and disability-adjusted life years (DALYs) rates, as well as with other biological and sociodemographic risk variables, across BRICS-plus from a national and economic perspective.

Methods: In this ecological study applying mixed-effect multilevel regression models, a country-specific dataset was analyzed by combining data from the Global Burden of Disease study 2019 on female age-standardized BC mortality, incidence, and DALYs rates with information on national/regional BCS availability (against no such program or only a pilot program) and BCS type (only self-breast examination (SBE) and/or clinical breast examination (CBE) [SBE/CBE] versus SBE/CBE with mammographic screening availability [MM and/or SBE/CBE] versus SBE/CBE/mammographic with digital mammography and/or ultrasound (US) [DMM/US and/or previous tests] in BRICS-plus countries.

Results: Compared to self/clinical breast examinations (SBE/CBE) across BRICS-plus, more complex BCS program availability was the most significant predictor of decreased mortality [MM and/or SBE/CBE: - 2.64, p < 0.001; DMM/US and/or previous tests: - 1.40, p < 0.001]. In the BRICS-plus, CVD presence, high BMI, second-hand smoke, and active smoking all contributed to an increase in BC mortality and DALY rate. High-income and middle-income regions in BRICS-plus had significantly lower age-standardized BC mortality, case-fatality, and DALYs rates than low-income regions when nationwide BC screening programs were implemented.

Conclusions: The availability of mammography (digital or traditional) and BCS is associated with breast cancer burden in BRICS-plus countries, with regional variations. In light of high-quality evidence from previous causal studies, these findings further support the preventive role of mammography screening for BCS at the national level. Intervening on BCS related risk factors may further reduce the disease burden associated with BC.

Keywords: BRICS-plus; Breast cancer screening; CVD; Case fatality; Disability; Mortality.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Age-standardized mortality rate (ASMR) 1990–2019 by type of screening test among BRICS-plus countries. CBE, clinical breast examination; DMM, digital mammography; DMM/US, digital mammography and/or ultrasound; MM, mammography; SBE, self-breast examination; SBE/CBE tests, self-breast examination and/or clinical breast examination; US, ultrasound
Fig. 2
Fig. 2
Age-standardized incidence rate (ASIR) 1990–2019 by type of screening test among BRICS-plus countries. CBE, clinical breast examination; DMM, digital mammography; DMM/US, digital mammography and/or ultrasound; MM, mammography; SBE, self-breast examination; SBE/CBE tests, self-breast examination and/or clinical breast examination; US, ultrasound
Fig. 3
Fig. 3
Case fatality percent (CFP) 1990–2019 by type of screening test among BRICS-plus countries. CFP indicate age-standardized mortality to incidence ratio and multiply by 100. CBE, clinical breast examination; DMM, digital mammography; DMM/US, digital mammography and/or ultrasound; MM, mammography; SBE, self-breast examination; SBE/CBE tests, self-breast examination and/or clinical breast examination; US, ultrasound
Fig. 4
Fig. 4
Age-standardized disability adjusted life years (ASDALYs) rate 1990–2019 by type of screening test among BRICS-plus countries. CBE, clinical breast examination; DMM, digital mammography; DMM/US, digital mammography and/or ultrasound; MM, mammography; SBE, self- breast examination; SBE/CBE tests, self-breast examination and/or clinical breast examination; US, ultrasound
Fig. 5
Fig. 5
Age-standardized A mortality rate, B incidence rate, C disability-adjusted life years (DALYs) in year 2019 by type of screening test and income level/group among BRICS-plus countries. CBE, clinical breast examination; DMM, digital mammography; DMM/US, digital mammography and/or ultrasound; MM, mammography; SBE, self-breast examination; SBE/CBE tests, self-breast examination and/or clinical breast examination; US, ultrasound
Fig. 6
Fig. 6
Relationship between breast cancer (BC) mortality, incidence, and case fatality (per 100,000 person-years) and countries’ sociodemographic index (SDI) by type of screening test among BRICS-plus, from 1990 to 2019. A For age-standardized mortality rate (ASMR). B For age-standardized incidence rate (ASIR). C For case fatality percent (CFP). CFP indicate age-standardized mortality to incidence ratio and multiply by 100. CBE, clinical breast examination; DMM, digital mammography; DMM/US, digital mammography and/or ultrasound; MM, mammography; SBE, self-breast examination; SBE/CBE tests, self-breast examination and/or clinical breast examination; US, ultrasound
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