Global, regional, national burden of breast cancer in 185 countries: evidence from GLOBOCAN 2018

Abstract

Purpose

This study aims to examine the burden of breast cancer in 185 countries in 2018.

Methods

The estimates of incidence, mortality, and prevalence of breast cancer were drawn from GLOBOCAN 2018. The overall burden of breast cancer was gauged using breast cancer burden index (BRCBI)—a novel index comprising age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), mortality-to-incidence ratio (MIR), prevalence-to-incidence ratio (PIR), and prevalence-to-mortality ratio (PMR). The socioeconomic status of countries was measured using human development index (HDI)

Results

Globally, breast cancer was responsible for an estimated 626,679 deaths at age-standardized rate of 13/100,000; there were 2.1 million cases diagnosed in 2018 at age-standardized rate of 46.3/100,000. The ASIR varied 22-fold from 5/100,000 (Bhutan) to 113.2/100,000 (Belgium). The ASMR varied 13-fold from 2.7/100,000 (Bhutan) to 36.9/100,000 (Fiji). The HDI exhibited a positive gradient with ASIR (r = 0.73), PIR (r = 0.98), and PMR (r = 0.85); with MIR, however, it exhibited a negative association (r = − 0.83). The BRCBI spanned from 0.70 in Somalia to 78.92 in South Korea and exhibited a positive association with HDI (r = 0.76). An additional 46,823 female lives in 2018 and a cumulative total of 333,304 lives could have been saved over 2013–2018, had countries performed as per their HDI.

Conclusions

The substantial burden of breast cancer in developing and low-resource economies calls for a holistic approach to cancer management and control that includes oncologic infrastructure to provide cost-effective screening, diagnostic, therapeutic, and palliative services, greater breast cancer awareness, and mitigation of risk factors.

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Notes

  1. 1.

    Choosing minimum values as 1st percentile also helped in not assigning 0 value to BRCBI.

  2. 2.

    An alternate index using arithmetic mean was generated; it has a pairwise correlation of r = 0.9230 with BRCBI (Supplementary Table S3).

  3. 3.

    Number of deaths that could be prevented in 2018 was calculated as per the following.

    $$({\text{Extra}}\; {\text{Deaths}})_{2018} = ({\text{Incidence}})_{2018}({\text{Observed}}\; {\text{MIR}}-{\text{Expected}}\; {\text{MIR}})$$
  4. 4.

    Number of lives saved as per PMR was calculated as per the following.

    $$\left( {{\text{Extra}}\; {\text{Deaths}}} \right)_{2013{-}18} = \left( {{\text{Observed}} \;{\text{Deaths}}} \right)_{2018} \left( {{\text{Observed}}\; {\text{PMR }}- {\text{Expected}}\; {\text{PMR}}} \right)$$

References

  1. 1.

    Global Burden of Disease Cancer Collaboration (2019) 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 to 2017: a systematic analysis for the global burden of disease study. JAMA Oncol 5(12):1749–1768. https://doi.org/10.1001/jamaoncol.2019.2996

    Article  PubMed Central  Google Scholar 

  2. 2.

    Allemani C, Matsuda T, Di Carlo V et al (2018) Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 391(10125):1023–1075

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Sharma R (2019) 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. Breast Cancer 26(4):428–445

    PubMed  Article  PubMed Central  Google Scholar 

  4. 4.

    Pérez-Solis MA, Maya-Nuñez G, Casas-González P et al (2016) Effects of the lifestyle habits in breast cancer transcriptional regulation. Cancer Cell Int 16(1):7

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  5. 5.

    Yung RL, Ligibel JA (2016) Obesity and breast cancer: risk, outcomes, and future considerations. Clin Adv Hematol Oncol 14(10):790–797

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Bradbury AR, Olopade OI (2007) Genetic susceptibility to breast cancer. Rev Endocr Metab Disord 8(3):255–267

    PubMed  Article  PubMed Central  Google Scholar 

  7. 7.

    Kim H, Choi DH (2013) Distribution of BRCA1 and BRCA2 mutations in Asian patients with breast cancer. J Breast Cancer 16(4):357–365

    PubMed  PubMed Central  Article  Google Scholar 

  8. 8.

    Skol AD, Sasaki MM, Onel K (2016) The genetics of breast cancer risk in the post-genome era: thoughts on study design to move past BRCA and towards clinical relevance. Breast Cancer Res 18(1):99

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  9. 9.

    Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424

    PubMed  PubMed Central  Article  Google Scholar 

  10. 10.

    Ferlay J, Colombet M, Soerjomataram I et al (2019) Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 144(8):1941–1953

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  11. 11.

    UNDP. Human Development Statistical Update 2018. (United nations Development Programme,2016) http://hdr.undp.org/sites/default/files/2018_human_development_statistical_update.pdf. Accessed 24 June2019

  12. 12.

    Vostakolaei F, Karim-Kos HE, Janssen-Heijnen ML et al (2010) The validity of the mortality to incidence ratio as a proxy for site-specific cancer survival. Eur J Public Health 21(5):573–577

    Article  Google Scholar 

  13. 13.

    Choi E, Lee S, Nhung BC et al (2017) Cancer mortality-to-incidence ratio as an indicator of cancer management outcomes in Organization for Economic Cooperation and Development countries. Epidemiol Health 39:e2017006

    PubMed  PubMed Central  Article  Google Scholar 

  14. 14.

    Sharma R (2019) The burden of prostate cancer is associated with human development index: evidence from 87 countries, 1990–2016. EPMA J 10(2):137–152

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Ferlay J, Ervik M, Lam F et al Global Cancer Observatory. Lyon, France: International Agency for Research on Cancer. https://gco.iarc.fr/. Accessed Dec 2019 - Jan 2020

  16. 16.

    Human Development Database. http://hdr.undp.org/en/data#. Accessed Dec 2019

  17. 17.

    Brinton LA, Figueroa JD, Awuah B et al (2014) Breast cancer in Sub-Saharan Africa: opportunities for prevention. Breast Cancer Res Treat 144(3):467–478

    PubMed  PubMed Central  Article  Google Scholar 

  18. 18.

    Sharma R (2020) Breast cancer burden in Africa: evidence from GLOBOCAN 2018. J Public Health. https://doi.org/10.1093/pubmed/fdaa099

    Article  Google Scholar 

  19. 19.

    DeSantis CE, Ma J, Goding Sauer A et al (2017) Breast cancer statistics, racial disparity in mortality by state. CA Cancer J Clin 67(6):439–448

    PubMed  Article  PubMed Central  Google Scholar 

  20. 20.

    Gabriel CA, Domchek SM (2010) Breast cancer in young women. Breast Cancer Res 12(5):212

    PubMed  PubMed Central  Article  Google Scholar 

  21. 21.

    Corbex M, Bouzbid S, Boffetta P (2014) Features of breast cancer in developing countries, examples from North-Africa. Eur J Cancer 50(10):1808–1818

    PubMed  Article  PubMed Central  Google Scholar 

  22. 22.

    Youlden DR, Cramb SM, Yip CH, Baade PD (2014) Incidence and mortality of female breast cancer in the Asia-Pacific region. Cancer Boil Med 11(2):101

    Google Scholar 

  23. 23.

    Youlden DR, Cramb SM, Dunn NA et al (2012) The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality. Cancer Epidemiol 36(3):237–248

    PubMed  Article  PubMed Central  Google Scholar 

  24. 24.

    Shapiro S (1997) Periodic screening for breast cancer: the HIP randomized controlled trial. JNCI Monogr 1997(22):27–30

    Article  Google Scholar 

  25. 25.

    Tabár L, Yen AM, Wu WY et al (2015) Insights from the breast cancer screening trials: how screening affects the natural history of breast cancer and implications for evaluating service screening programs. Breast J 21(1):13–20

    PubMed  Article  PubMed Central  Google Scholar 

  26. 26.

    Bleyer A, Welch HG (2012) Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med 367(21):1998–2005

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  27. 27.

    Marmot MG, Altman DG, Cameron DA et al (2013) The benefits and harms of breast cancer screening: an independent review. Br J Cancer 108(11):2205–2240

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    Harford JB (2011) Breast-cancer early detection in low-income and middle-income countries: do what you can versus one size fits all. Lancet Oncol 12(3):306–312

    PubMed  Article  PubMed Central  Google Scholar 

  29. 29.

    Black E, Richmond R (2019) Improving early detection of breast cancer in sub-Saharan Africa: why mammography may not be the way forward. Glob Health 15(1):3

    Article  Google Scholar 

  30. 30.

    dos-Santos-Silva I, de Stavola BL, Junior NL, Nogueira MC, Aquino EM, Bustamante-Teixeira MT, Silva GA (2019) Ethnoracial and social trends in breast cancer staging at diagnosis in Brazil, 2001–14: a case only analysis. Lancet Glob Health 7(6):e784–e797

    PubMed  PubMed Central  Article  Google Scholar 

  31. 31.

    Mittra I, Mishra GA, Singh S et al (2010) A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening. Int J Cancer 126(4):976–984

    CAS  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Sankaranarayanan R, Ramadas K, Thara S et al (2011) Clinical breast examination: Preliminary results from a cluster randomized controlled trial in India. J Natl Cancer Inst 103(19):1476–1480

    PubMed  Article  PubMed Central  Google Scholar 

  33. 33.

    Abuidris DO, Elsheikh A, Ali M et al (2013) Breast-cancer screening with trained volunteers in a rural area of Sudan: a pilot study. Lancet Oncol 14(4):363–370

    PubMed  Article  PubMed Central  Google Scholar 

  34. 34.

    Song QK, Wang XL, Zhou XN et al (2015) Breast cancer challenges and screening in China: Lessons from current registry data and population screening studies. Oncologist 20(7):773–779

    PubMed  PubMed Central  Article  Google Scholar 

  35. 35.

    Sankaranarayanan R, Swaminathan R, Brenner H et al (2010) Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol 11(2):165–173

    PubMed  Article  PubMed Central  Google Scholar 

  36. 36.

    Jedy-Agba E, McCormack V, Adebamowo C et al (2016) Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health 4(12):e923–e935

    PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Abdulrahman GO, Rahman GA (2012) Epidemiology of breast cancer in Europe and Africa. J Cancer Epidemiol 2012:915610

    PubMed  Article  PubMed Central  Google Scholar 

  38. 38.

    Sariego J (2009) Patterns of breast cancer presentation in the United States: does geography matter? Am Surg 75(7):545–550

    PubMed  Article  PubMed Central  Google Scholar 

  39. 39.

    Akuoko CP, Armah E, Sarpong T, Quansah DY, Amankwaa I, Boateng D (2017) Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa. PLoS ONE 12(2):e0171024

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  40. 40.

    Tetteh DA, Faulkner SL (2016) Sociocultural factors and breast cancer in sub-Saharan Africa: implications for diagnosis and management. Women’s Health 12(1):147–156

    CAS  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Yip CH (2019) Downstaging is more important than screening for asymptomatic breast cancer. Lancet Glob Health 7(6):e690–e691

    PubMed  Article  PubMed Central  Google Scholar 

  42. 42.

    McCormack V, McKenzie F, Foerster M, Zietsman A, Galukande M, Adisa C, Anele A, Parham G, Pinder LF, Cubasch H, Joffe M (2020) Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study. Lancet Glob Health 8(9):e1203–e1212

    PubMed  PubMed Central  Article  Google Scholar 

  43. 43.

    Devi BC, Tang TS, Corbex M (2007) 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. Malays Ann Oncol 18(7):1172–1176

    CAS  Article  Google Scholar 

  44. 44.

    Foerster M, Anderson BO, McKenzie F, Galukande M, Anele A, Adisa C, Zietsman A, Schuz J, dos Santos SI, McCormack V (2019) Inequities in breast cancer treatment in sub-Saharan Africa: findings from a prospective multi-country observational study. Breast Cancer Res 21(1):93

    PubMed  PubMed Central  Article  Google Scholar 

  45. 45.

    Clegg-Lamptey J, Dakubo J, Attobra YN (2009) Why do breast cancer patients report late or abscond during treatment in ghana? A pilot study. Ghana Med J 43(3):127–131

    CAS  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Sullivan R, Alatise OI, Anderson BO (2015) Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 16(11):1193–1224

    PubMed  Article  PubMed Central  Google Scholar 

  47. 47.

    Porter P (2008) ‘Westernising’ women’s risks? Breast cancer in lower income countries. N Engl J Med 358(3):213–216

    CAS  PubMed  Article  PubMed Central  Google Scholar 

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Correspondence to Rajesh Sharma.

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Sharma, R. Global, regional, national burden of breast cancer in 185 countries: evidence from GLOBOCAN 2018. Breast Cancer Res Treat (2021). https://doi.org/10.1007/s10549-020-06083-6

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Keywords

  • Breast cancer
  • Incidence
  • Mortality
  • Mortality-to-incidence ratio
  • Prevalence-to-mortality ratio
  • Breast cancer burden index
  • GLOBOCAN