Global patterns of breast cancer incidence and

mortality: A population-based cancer registry data

analysis from 2000 to 2020
Authors: Shaoyuan Lei, Rongshou Zheng, Siwei Zhang, Shaoming
Wang, Ru Che, Kexin Sun, Hongmei Zeng
Publication Year: 2021

Data Sources
1. GLOBOCAN Cancer Today Database (2020) Provided data on the burden of
breast cancer across 185 countries or territories, including cancer incidence, mortality, and
prevalence for 36 cancer types. Hosted by the International Agency for Research on Cancer
(IARC).
2. Cancer Incidence in Five Continents Time Trends (CI5plus) Database: Utilized
continuous annual incidence data from 108 high-quality population-based cancer registries
across various nations or subnational regions to analyze temporal trends in breast cancer
rates.
3. IARC Cancer Mortality Database (for South Korea, USA, United Kingdom,
and Australia): Extracted selected cancer mortality statistics by country from the World
Health Organization (WHO) database. China’s mortality rate data was derived from the
National Central Cancer Registry.
4. Human Development Index (HDI): Used to measure the development level of
countries. HDI considers factors like life expectancy, education, and gross national income.
It’s calculated as the geometric mean of three indices: health, education, and income. The
formula used was HDI = (IHealth × IEducation × IIncome )1/3 .
5. ICD-10 Data Code C50 By clearly defining and separating concerns, Extracted from
the overall cancer database to estimate breast cancer incidence and mortality rates specifi-
cally.

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Association between HDI and burden of breast cancer
1. Breast Cancer Rates Based on HDI Levels: Very high HDI countries accounted
for 45.0% of breast cancer cases and 33.8% of breast cancer deaths. Medium and low HDI
countries combined accounted for only 18.4% of breast cancer cases but 30.1% of breast
cancer deaths.
2. Incidence and Mortality Rates: Age-standardized incidence rates were more than
twice as high in very high/high HDI countries compared to medium/low HDI countries.Age-
standardized mortality rates in low HDI countries were 1.5 times higher than in very high
HDI countries.
3. Age-Specific Rates: Both incidence and mortality rates increased with age, reaching
their highest point at age 70.
4. Association with HDI Levels: There’s a correlation between breast cancer rates
and HDI levels.Age-standardized incidence rates of breast cancer increased with higher HDI
levels (R2 = 0.47, P < 0.001).Age-standardized mortality rates of breast cancer decreased
with higher HDI levels (R2 = 0.25, P = 0.014).

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Trends in breast cancer incidence and mortality
1. Breast Cancer Incidence Trends (2000-2012): South Korea, China, and the United
Kingdom experienced increased age-standardized incidence rates (AAPC 6.1%, 2.1%, and
0.5% respectively), while the USA showed a decreased trend (-0.9%).Age-specific incidence
rates saw notable increases in different age groups: South Korea’s highest increase was in
the 70-79 age group (AAPC 8.4%), China and the UK showed significant rates in the 60-69
age group (3.8% and 1.7% respectively), and the USA experienced the largest decrease in
the 50-59 age group (-1.8%).

2. Breast Cancer Mortality Trends (2000-2015): China and South Korea saw slight
increases in age-standardized mortality rates (AAPC 1.0% and 1.8% respectively), while the
USA, Australia, and the United Kingdom experienced decreases (AAPC -1.9%, -2.0%, and
-2.5% respectively). Age-specific mortality rates showed distinct patterns: China and South
Korea had the greatest increases in age groups 80 and 60-69 respectively, while the USA,
Australia, and the United Kingdom showed the most significant decreases in age groups ¡40.

In summary, during the specified periods, various countries experienced divergent trends
in both breast cancer incidence and mortality rates. South Korea, China, and the United
Kingdom witnessed increased incidence rates, while the USA showed a decrease. Similarly,
mortality rates varied with increases in China and South Korea, and decreases in the USA,
Australia, and the United Kingdom. Age-specific rates also displayed distinct patterns across
these countries.

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Conclusions
The global burden of breast cancer is rising fast and varies greatly across countries. The inci-
dence and mortality of breast cancer increased rapidly in developing countries, especially in
China, but decreased in the USA. Increased health awareness, effective prevention strategies,
and improved access to medical treatment are extremely important to curb the snowballing
burden of breast cancer.