Elsevier

The Breast

Volume 36, December 2017, Pages 89-95
The Breast

Original article
Trends and predictions to 2020 in breast cancer mortality in Europe

https://doi.org/10.1016/j.breast.2017.06.003Get rights and content

Highlights

  • EU breast cancer mortality rates declined by 15% between 2002 and 2012.

  • We predict a further 10% decline in breast cancer mortality to 2020.

  • The falls were largest in the young.

  • Trends were less favourable in central and eastern than in western Europe.

  • The key determinant of the falls is management; early diagnosis contributed, too.

Abstract

Objectives

We analyzed trends in mortality from breast cancer in women in 36 European countries and the European Union (EU) over the period 1970–2014, and predicted numbers of deaths and rates to 2020.

Materials and methods

We derived breast cancer death certification data and population figures from the World Health Organization and Eurostat databases. We obtained 2020 estimates using a joinpoint regression model.

Results

Overall, EU breast cancer mortality rates (world standard) declined from 17.9/100,000 in 2002 to 15.2 in 2012. The predicted 2020 rate is 13.4/100,000. The falls were largest in young women (20–49 years, −22% between 2002 and 2012). Within the EU, declines were larger in the United Kingdom (UK) and other northern and western European countries than in most central and eastern Europe. The UK has the second lowest predicted breast cancer mortality rate in 2020 (after Spain), starting from the highest one in 1970. Breast cancer mortality is predicted to rise in Poland, where the predicted 2020 rate is 15.3/100,000. We estimated that about 32,500 breast cancer deaths will be avoided in 2020 in the EU as compared to the peak rate of 1989, and a total of 475,000 breast cancer deaths over the period 1990–2020.

Conclusion

The overall favourable breast cancer mortality trends are mainly due to a succession of improvements in the management and treatment of breast cancer, though early diagnosis and screening played a role, too. Improving breast cancer management in central and eastern Europe is a priority.

Introduction

After long term rises, breast cancer mortality has been declining in most of Europe since the mid or late 1980's [1]. The declines were earlier and larger in northern Europe, where breast cancer rates were originally highest [2], [3]. This led to a levelling of breast cancer mortality across Europe, although substantial differences were still evident; among major countries overall mortality rates were between 21/100,000 women in Denmark and 12.8 in Spain around 2007 [4], [5]. The favourable trend in breast cancer mortality over the last few decades is essentially due to advancement in diagnosis and treatment which have steadily accumulated over this period, though incidence has declined in recent generations as well [6], [7].

To provide an updated and comprehensive picture of recent trends and patterns in breast cancer mortality across Europe, we considered the most recent mortality data (up to 2014 in most countries) and provided predictions to 2020 [8] for select larger European countries and the whole European Union (EU).

Section snippets

Materials and methods

We retrieved official death certification data for breast cancer from the World Health Organization (WHO) database [9], from 1970 to 2014 (or the most recent available year), for European countries.

In some countries, data were missing for one or more calendar years. We did not extrapolate missing data, except for the calculation of the EU rates, where we used the nearest available data, for the few missing data in single countries. We considered the EU as defined on May 2017, i.e. including 28

Results

Table 1 gives the age-standardized mortality rates from breast cancer at all ages and at ages 20–49, 50–69 and 70–79 years for 36 European countries and the EU as a whole around 2002 (2000–2004 quinquiennium), 2007 (2005–2009 quinquiennium) and 2012 (single year), with the percent changes between 2012 and 2002.

Overall EU breast cancer mortality rates declined from 17.9 in 2002 to 15.2 per 100,000 in 2012 (−15.3%). All major EU countries showed favourable trends, and the percent changes ranged

Discussion

The present analysis confirms and extends the continuing favourable trends in breast cancer mortality registered across Europe over the last three decades [4], [18]. In some countries, such as the UK and other northern European countries, which had the highest rates in the past [2], the decline has reached 50%. The UK is predicted to have the second lowest cancer mortality rate in 2020. The falls were smaller, and inconsistent, in eastern Europe, which, for unclear reasons, had the lowest rates

Funding

This work was supported by the Italian Association for Cancer Research (AIRC, project N. 18440); MIUR (Ministero dell'Istruzione, dell'Università e della Ricerca), with a SIR (Scientific Independence of Young Researchers) 2014 grant (project N. RBSI1465UH).

Conflicts of interest

None.

Ethical approval

The approval of the journal on ethical consent and the standards of animal care is not required.

Acknowledgments

The authors acknowledge Dr Iman Elsayed for her assistance to data analysis.

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