Breast Cancer

, Volume 26, Issue 4, pp 428–445 | Cite as

Breast cancer incidence, mortality and mortality-to-incidence ratio (MIR) are associated with human development, 1990–2016: evidence from Global Burden of Disease Study 2016

  • Rajesh SharmaEmail author
Original Article



To examine breast cancer burden in females using incidence, mortality and mortality-to-incidence ratio (MIR) and its association with human development.


We employ the data of breast cancer in females from the Global Burden of Disease 2016 study for the period 1990 to 2016 for 102 countries. Human development is measured using the human development index (HDI). 5-year survival rate of breast cancer is proxied using the mortality-to-incidence ratio (MIR).


Globally, breast cancer has claimed 535341 female lives and 1.7 million incident cases had surfaced in 2016. High incidence rates were observed in very high HDI countries led by the Netherlands (117.2/100,000), whereas the mortality rate was high in low/medium HDI countries led by Afghanistan (35.4/100,000). Breast cancer incidence has more than doubled in 60/102 countries, whereas deaths have doubled in 43/102 countries. Globally, breast cancer MIR decreased from 0.41 to 0.32 over 1990–2016 and displayed negative gradient with HDI (r = − 0.87), indicating a low 5-year survival in less developed countries.


Heterogeneity in breast cancer burden, as per human development, and increasing breast cancer incidence and low survival rates, indicated by MIR, call for broader human development, improving breast cancer awareness, and cost-effective screening and treatment in less developed countries.


Breast cancer Incidence Mortality Mortality-to-incidence ratio (MIR) 


Compliance with ethical standards

Conflict of interest

The authors of the paper declare no conflict of interest.


  1. 1.
    GBD 2016 Cause of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2016;390(10100):1151–210.Google Scholar
  2. 2.
    Global Burden of Disease Cancer Collaborators. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990–2016. a systematic analysis for the Global Burden of Disease Study. JAMA Oncol. 2018. Scholar
  3. 3.
    Sankaranarayanan R, Swaminathan R, Brenner H, Chen K, Chia KS, Chen JG, et al. Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol. 2010;11(2):165–73.CrossRefGoogle Scholar
  4. 4.
    Vostakolaei F, Karim-Kos HE, Janssen-Heijnen ML, Visser O, Verbeek AL, Kiemeney LA. The validity of the mortality to incidence ratio as a proxy for site-specific cancer survival. Eur J Public Health. 2010;21(5):573–7.CrossRefGoogle Scholar
  5. 5.
    Chen SL, Wang SC, Ho CJ, Kao YL, Hsieh TY, Chen WJ, et al. Prostate cancer mortality-to-incidence ratios are associated with cancer care disparities in 35 countries. Sci Rep. 2017;7:40003.CrossRefGoogle Scholar
  6. 6.
    Wang SC, Sung WW, Kao YL, Hsieh TY, Chen WJ, Chen SL, et al. The gender difference and mortality-to-incidence ratio relate to health care disparities in bladder cancer: National estimates from 33 countries. Sci Rep. 2017;7(1):4360.CrossRefGoogle Scholar
  7. 7.
    Tsai MC, Wang CC, Lee HL, Peng CM, Yang TW, Chen HY, et al. Health disparities are associated with gastric cancer mortality-to-incidence ratios in 57 countries. World J Gastroenterol. 2017;23(44):7881.CrossRefGoogle Scholar
  8. 8.
    Wang CC, Tsai MC, Peng CM, Lee HL, Chen HY, Yang TW, et al. Favorable liver cancer mortality-to-incidence ratios of countries with high health expenditure. Eur J Gastroenterol Hepatol. 2017;29(12):1397–401.Google Scholar
  9. 9.
    Sunkara V, Hebert JR. The colorectal cancer mortality-to-incidence ratio as an indicator of global cancer screening and care. Cancer. 2015;121(10):1563–9.CrossRefGoogle Scholar
  10. 10.
    Ginsburg O, Bray F, Coleman MP, Vanderpuye V, Eniu A, Kotha SR, et al. The global burden of women’s cancers: a grand challenge in global health. Lancet. 2017;389(10071):847–60.CrossRefGoogle Scholar
  11. 11.
    Foreman KJ, Lozano R, Lopez AD, Murray CJ. Modeling causes of death: an integrated approach using CODEm. Popul Health Metr. 2012;10(1):1.CrossRefGoogle Scholar
  12. 12.
    Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2016. (GBD 2016). 2017. Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME). Accessed 5 July 2018.
  13. 13.
    United Nations Development Program (UNDP). Human Development Database. 2018. Accessed 30 June 2018 and 1 July 2018.
  14. 14.
    Porter P. “Westernizing” women’s risks? Breast cancer in lower-income countries. N Engl J Med. 2008;358(3):213–6.CrossRefGoogle Scholar
  15. 15.
    Arnold M, Pandeya N, Byrnes G, Renehan AG, Stevens GA, Ezzati M, et al. Global burden of cancer attributable to high body-mass index in 2012: a population-based study. Lancet Oncol. 2015;16(1):36–46.CrossRefGoogle Scholar
  16. 16.
    Park SK, Kim Y, Kang D, et al. Risk factors and control strategies for the rapidly rising rate of breast cancer in Korea. J Breast Cancer. 2011;14:79–87.CrossRefGoogle Scholar
  17. 17.
    Hortobagyi GN, de la Garza Salazar J, Pritchard K, Amadori D, Haidinger R, Hudis CA, et al. The global breast cancer burden: variations in epidemiology and survival. Clin Breast Cancer. 2005;6(5):391–401.CrossRefGoogle Scholar
  18. 18.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56(2):106–30.CrossRefGoogle Scholar
  19. 19.
    WHO Guide for effective programmes; cancer control: knowledge into action; module 3: early detection (free full text). 2018. Accessed 6 Aug 2018.
  20. 20.
    Jørgensen KJ, Zahl PH, Gøtzsche PC. Overdiagnosis in organised mammography screening in Denmark. A comparative study. BMC Womens Health. 2009;9(1):36.CrossRefGoogle Scholar
  21. 21.
    Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2009. Scholar
  22. 22.
    Jørgensen KJ, Zahl PH, Gøtzsche PC. Breast cancer mortality in organised mammography screening in Denmark: comparative study. BMJ. 2010;340:c1241.CrossRefGoogle Scholar
  23. 23.
    Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med. 2012;367(21):1998–2005.CrossRefGoogle Scholar
  24. 24.
    Kalager M, Adami HO, Bretthauer M, Tamimi RM. Overdiagnosis of invasive breast cancer due to mammography screening: results from the Norwegian screening program. Ann Intern Med. 2012;156(7):491–9.CrossRefGoogle Scholar
  25. 25.
    Corbex M, Burton R, Sancho-Garnier H. Breast cancer early detection methods for low and middle-income countries, a review of the evidence. Breast. 2012;21(4):428–34.CrossRefGoogle Scholar
  26. 26.
    Sankaranarayanan R, Ramadas K, Thara S, Muwonge R, Prabhakar J, Augustine P, Venugopal M, Anju G, Mathew BS. Clinical breast examination: preliminary results from a cluster randomized controlled trial in India. J Natl Cancer Inst. 2011;103(19):1476–80.CrossRefGoogle Scholar
  27. 27.
    Luthar UK. Clinical downstaging of cancer of the uterine cervix e an interim strategy for developing countries. In: Proceedings of the UICC congress. 1994.Google Scholar
  28. 28.
    Devi BCR, Tang TS, Corbex M. Reducing by half the percentage of late-stage presentation for breast and cervix cancer over 4 years: a pilot study of clinical downstaging in Sarawak, Malaysia. Ann Onc. 2007;18(7):1172–6.CrossRefGoogle Scholar
  29. 29.
    World Bank Database. 2018. WDI data. Accessed 25 July 2018.
  30. 30.
    Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services. Lancet Glob Health. 2018;6(2):e152–68.CrossRefGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2019

Authors and Affiliations

  1. 1.University School of Management and EntrepreneurshipDelhi Technological UniversityDelhiIndia

Personalised recommendations