Stage, biological profile and trends in the incidence and mortality of breast cancer in Uruguay
Analysis by age groups
DOI:
https://doi.org/10.29193/RMU.40.1.3Keywords:
BREAST NEOPLASMS, NEOPLASM STAGING, INCIDENCE, MORTALITY, URUGUAYAbstract
Introduction: Breast cancer is the most common malignant tumor and the leading cause of cancer death in women in Uruguay and worldwide. Epidemiological evidence suggests that breast cancer in different age groups behaves as distinct pathologies. The objective of this work is to characterize breast cancer in Uruguay for different age groups.
Method: Temporal trends in the incidence of breast cancer in women in Uruguay are analyzed for the period 2002-2019, along with mortality trends for this cause from 1990 to 2020. For the five-year period 2015-2019, the distribution of stages at diagnosis and biological profiles (Luminal, Triple-negative, and Her2 positive) is also analyzed. Three age segments are analyzed: women aged 20 to 44 years, 45 to 69 years, and 70 years and older.
Results: The incidence rates for all age groups remained stable during the period 2002-2019, while mortality showed a decreasing trend in the period 1990-2020. In women under 45, there is an increase in incidence, with mortality decreasing until 2010, followed by a stabilization of rates; in women aged 45 to 69, incidence remains stable and mortality decreases; in those over 70, incidence decreases while mortality remains stable. More than 70% of cases are diagnosed at stages I and II. Luminal tumors (hormone receptor positive, Her2 negative) are the most frequent subtype for all age groups. The proportion of tumors with these characteristics increases with age, while the proportion of Her2 positive and triple-negative tumors decreases.
Conclusions: In Uruguayan women, breast cancer presents differential characteristics for the three age groups analyzed.
References
Ferlay J, Colombet M, Soerjomataram I, Parkin D, Piñeros M, Znaor A, et al. Cancer statistics for the year 2020: an overview. Int J Cancer 2021. doi: 10.1002/ijc.33588.
Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71(3):209-49. doi: 10.3322/caac.21660.
Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, et al, eds. Cancer Today 8powered by GLOBOCAN 2018). Lyon: International Agency for Research on Cancer, 2018. Disponible en: https://gco.iarc.fr/today/home. (Consulta: 27 julio 2019).
Lei S, Zheng R, Zhang S, Wang S, Chen R, Sun K, et al. Global patterns of breast cancer incidence and mortality: A population-based cancer registry data analysis from 2000 to 2020. Cancer Commun (Lond) 2021; 41(11):1183-94. doi: 10.1002/cac2.12207.
Xu S, Liu Y, Zhang T, Zheng J, Lin W, Cai J, et al. The Global, Regional, and National Burden and Trends of Breast Cancer From 1990 to 2019: Results From the Global Burden of Disease Study 2019. Front Oncol 2021; 11:689562. doi: 10.3389/fonc.2021.689562.
Clayton D, Schifflers E. Models for temporal variation in cancer rates. I: age-period and age-cohort models. Stat Med 1987; 6(4):449-67. doi: 10.1002/sim.4780060405.
Clemmesen J. Carcinoma of the breast; results from statistical research. Br J Radiol 1948; 21(252):583-90. doi: 10.1259/0007-1285-21-252-583.
Manton K, Stallard E. A two-disease model of female breast cancer: mortality in 1969 among white females in the United States. J Natl Cancer Inst 1980; 64(1):9-16.
Barrios E, Vassallo J, Alonso R, Garau M, Musetti C. III Atlas de incidencia de cáncer en el Uruguay 2002-2006. Montevideo: CHLCC, 2010.
Barrios E, Garau M, Alonso R, Musetti C. IV Atlas de incidencia de cáncer en el Uruguay 2007-2011. Montevideo: CHLCC, 2014.
Barrios, E.; Garau, M.; Alonso, R.; Musetti, C. V Atlas de Incidencia del Cáncer en el Uruguay. Periodo 2012-2016 . Montevideo: CHLCC, 2020. Disponible en: https://www.comisioncancer.org.uy/Ocultas/V-Atlas-de-Incidencia-del-Cancer-en-el-Uruguay-Periodo-2012-2016-uc250. (Consulta: 31 marzo 2023).
12. Comisión Honoraria de Lucha Contra el Cáncer. Incidencia y Mortalidad 2015-2019. Distribución por rango etario. Montevideo: CHLCC, 2019. Disponible en: https://www.comisioncancer.org.uy/Ocultas/Incidencia-y-Mortalidad-2015-2019-Distribucion-por-rango-etario--uc280. (Consulta: 31 marzo 2023).
Garau M, Musetti C, Alonso R, Barrios E. Trends in cancer incidence in Uruguay: 2002 -2015. Colomb Med (Cali) 2019; 50(4):224-38. doi: 10.25100/cm.v50i4.4212.
Ley N° 17242. Ley de prevención de cánceres genito mamarios. Licencia especial para realización de Papanicolau y/o radiografía mamaria. Montevideo, 28 de junio de 2000. Montevideo: IMPO, 2000. Disponible en: http://www.impo.com.uy/bases/leyes/17242-2000. (Consulta: 21 febrero 2019).
Decreto N° 219/006. Fijación de cuota mutual de Sociedades Médicas julio 2006. Montevideo, 17 de julio de 2006. Montevideo: IMPO, 2006.Disponible en: https://www.impo.com.uy/bases/decretos/219-2006. (Consulta: 10 mayo 2023).
Uruguay. Ministerio de Salud Pública. Ordenanza N° 402/006 Prevencion de cancer genitourinario. Montevideo: MSP, 2006. Disponible en: https://www.gub.uy/ministerio-salud-publica/institucional/normativa/ordenanza-n-402006-prevencion-cancer-genitourinario. (Consulta: 10 mayo 2023).
Uruguay. Ministerio de Salud Pública. Guía de práctica clínica de detección temprana del cáncer de mama: tamizaje y diagnóstico precoz. Montevideo: MSP, 2015. Disponible en: https://www.gub.uy/ministerio-salud-publica/sites/ministerio-salud-publica/files/documentos/publicaciones/Iniciativas%20sanitarias%20%28guia%20deteccion%20cancer%20mama%29.pdf. (Consulta: 10 mayo 2023).
Uruguay. Ministerio de Salud Pública. Ordenanza N° 842/015 Exoneracion de tasas moderadoras de mamografias en mujeres entre 50 y 69 años. Montevideo: MSP, 2015. Disponible en: https://www.gub.uy/ministerio-salud-publica/institucional/normativa/ordenanza-n-842015-exoneracion-tasas-moderadoras-mamografias-mujeres-entre. (Consulta: 10 mayo 2023).
International Agency for Research on Cancer. International rules for multiple primary cancers (ICD-O Thrid edition). 3 ed. Lyon: IARC, 2004. Disponible en: https://www.encr.eu/sites/default/files/pdf/MPrules_july2004.pdf. (Consulta: 1 julio 2019).
Fritz AG, editor. International classification of diseases for oncology: ICD-O. 3 ed. Geneva: WHO, 2013.
Segi M. Cancer Mortality for Selected Sites in 24 Countries (1950–57). Sendai: Department of Public Health, Tohoku University of Medicine, 1960.
Uruguay. Instituto Nacional de Estadística. Censos 1963-1996. Disponible en: https://www.ine.gub.uy/web/guest/censos-1963-1996. (Consulta: 16 diciembre 2021).
Uruguay. Instituto Nacional de Estadística. Censo 2004 Fase I. Montevideo: INE, 2005. Disponible en: http://www.ine.gub.uy/web/guest/censo-2004-fase-i. (Consulta: 8 noviembre 2016).
Uruguay. Instituto Nacional de Estadística. Censos 2011. Montevideo: INE, 2012. Disponible en: http://www.ine.gub.uy/censos-2011. (Consulta: 5 octubre 2016).
Kim H, Fay M, Feuer E, Midthune D. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000; 19(3):335-51. doi: 10.1002/(sici)1097-0258(20000215)19:3<335::aid-sim336>3.0.co;2-z.
National Cancer Institute. Statistical Research and Applications Branch. Joinpoint Regression Program, Ver 4.1.0. Bethesda, MD: national Cancer Institute, 2014.
von Elm E, Altman D, Egger M, Pocock S, Gøtzsche P, Vandenbroucke J. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61(4):344-9. doi: 10.1016/j.jclinepi.2007.11.008.
Brierley J, Gospodarowicz M, Wittekind C, eds. TNM classification of malignant tumours. 8 ed. Hoboken, NJ: Wiley, 2017.
Lakhani S, Van De Vijver M, Jacquemier J, Anderson T, Osin P, McGuffog L, et al. The pathology of familial breast cancer: predictive value of immunohistochemical markers estrogen receptor, progesterone receptor, HER-2, and p53 in patients with mutations in BRCA1 and BRCA2. J Clin Oncol 2002; 20(9):2310-8. doi: 10.1200/JCO.2002.09.023.
Acheampong T, Kehm R, Terry M, Argov E, Tehranifar P. Incidence trends of breast cancer molecular subtypes by age and race/ethnicity in the US From 2010 to 2016. JAMA Netw Open 2020; 3(8):e2013226. doi: 10.1001/jamanetworkopen.2020.13226.
Jemal A, Ward E, Thun M. Recent trends in breast cancer incidence rates by age and tumor characteristics among U.S. women. Breast Cancer Res 2007; 9(3):R28. doi: 10.1186/bcr1672.
Heer E, Harper A, Escandor N, Sung H, McCormack V, Fidler-Benaoudia M. Global burden and trends in premenopausal and postmenopausal breast cancer: a population-based study. Lancet Glob Health 2020; 8(8):e1027-37. doi: 10.1016/S2214-109X(20)30215-1.
Hassaine Y, Jacquet E, Seigneurin A, Delafosse P. Evolution of breast cancer incidence in young women in a French registry from 1990 to 2018: towards a change in screening strategy? Breast Cancer Res 2022; 24(1):87. doi: 10.1186/s13058-022-01581-5.
Heer E, Harper A, Sung H, Jemal A, Fidler-Benaoudia M. Emerging cancer incidence trends in Canada: The growing burden of young adult cancers. Cancer 2020; 126(20):4553-62. doi: 10.1002/cncr.33050.
Schoemaker M, Nichols H, Wright L, Brook M, Jones M, O’Brien K, et al. Association of body mass index and age with subsequent breast cancer risk in premenopausal women. JAMA Oncol 2018; 4(11):e181771. doi: 10.1001/jamaoncol.2018.1771.
Laudisio D, Muscogiuri G, Barrea L, Savastano S, Colao A. Obesity and breast cancer in premenopausal women: Current evidence and future perspectives. Eur J Obstet Gynecol Reprod Biol 2018; 230:217-21. doi: 10.1016/j.ejogrb.2018.03.050.
Scoccianti C, Key T, Anderson A, Armaroli P, Berrino F, Cecchini M, et al. European Code against Cancer 4th Edition: breastfeeding and cancer. Cancer Epidemiol 2015; 39(Suppl 1):S101-6. doi: 10.1016/j.canep.2014.12.007.
World Cancer Research Fund. American Institute for Cancer Research. Continuous Update Project. Diet, nutrition, physical activity and breast cancer. London: WCRF, 2018. Disponible en: https://www.wcrf.org/wp-content/uploads/2021/02/Breast-cancer-report.pdf. (Consulta: 10 mayo 2023).
Katalinic A, Eisemann N, Kraywinkel K, Noftz M, Hübner J. Breast cancer incidence and mortality before and after implementation of the German mammography screening program. Int J Cancer 2020; 147(3):709-18. doi: 10.1002/ijc.32767.
Bleyer A, Welch H. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med 2012; 367(21):1998-2005. doi: 10.1056/NEJMoa1206809.
Autier P, Boniol M, Middleton R, Doré J, Héry C, Zheng T, et al. Advanced breast cancer incidence following population-based mammographic screening. Ann Oncol 2011; 22(8):1726-35. doi: 10.1093/annonc/mdq633.
Rodriguez A. Contribution to the screening and early detection in breast cancer. J Glob Oncol 2018; 4(Suppl 2):130s.
Wojtyla C, Bertuccio P, Wojtyla A, La Vecchia C. European trends in breast cancer mortality, 1980-2017 and predictions to 2025. Eur J Cancer 2021; 152:4-17. doi: 10.1016/j.ejca.2021.04.026.
Berry D, Cronin K, Plevritis S, Fryback D, Clarke L, Zelen M, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005; 353(17):1784-92. doi: 10.1056/NEJMoa050518.
Hendrick R, Helvie M, Monticciolo D. Breast cancer mortality rates have stopped declining in U.S. women younger than 40 years. Radiology 2021; 299(1):143-9. doi: 10.1148/radiol.2021203476.
Narod S, Iqbal J, Miller A. Why have breast cancer mortality rates declined? J Cancer Policy 2015; 5:8-17.
Jatoi I, Miller A. Why is breast-cancer mortality declining? Lancet Oncol 2003; 4(4):251-4. doi: 10.1016/s1470-2045(03)01037-4.
Pintos J, Pérez-Galán A. Cáncer de mama: costo-efectividad de la determinación de receptores hormonales y tratamiento adyuvante con tamoxifeno en estadios I y II. Rev Méd Urug 2000; 16(2):114-22.
Garbino C. Tratamiento adyuvante sistémico del cáncer de mama: etapas I y II. Medwave 2003. doi: 10.5867/medwave.2003.08.3333.
Uruguay. Fondo Nacional de Recursos. Informe del tratamiento del cáncer de mama avanzado. Montevideo: FNR, 2022. Disponible en: https://www.fnr.gub.uy/wp-content/uploads/2022/05/informe_cancer_mama_2022.pdf. (Consulta: 30 marzo 2023).
Silva J, de Oliveira R, da Silva M, Carvalho M, Pedroso R, Pelloso S. Breast cancer mortality in young women in Brazil. Front Oncol 2021; 10:569933. doi: 10.3389/fonc.2020.569933.
Anders C, Fan C, Parker J, Carey L, Blackwell K, Klauber-DeMore N, et al. Breast carcinomas arising at a young age: unique biology or a surrogate for aggressive intrinsic subtypes? J Clin Oncol 2011; 29(1):e18-20. doi: 10.1200/JCO.2010.28.9199.
Azim HJr, Michiels S, Bedard P, Singhal S, Criscitiello C, Ignatiadis M, et al. Elucidating prognosis and biology of breast cancer arising in young women using gene expression profiling. Clin Cancer Res 2012; 18(5):1341-51. doi: 10.1158/1078-0432.CCR-11-2599.
Schopper D, de Wolf C. How effective are breast cancer screening programmes by mammography? Review of the current evidence. Eur J Cancer 2009; 45(11):1916-23. doi: 10.1016/j.ejca.2009.03.022.
Plevritis S, Munoz D, Kurian A, Stout N, Alagoz O, Near A, et al. Association of screening and treatment with breast cancer mortality by molecular subtype in US women, 2000-2012. JAMA 2018; 319(2):154-64. doi: 10.1001/jama.2017.19130.
Freedman R, Keating N, Lin N, Winer E, Vaz-Luis I, Lii J, et al. Breast cancer-specific survival by age: worse outcomes for the oldest patients. Cancer 2018; 124(10):2184-91. doi: 10.1002/cncr.31308.
de Glas N, Kiderlen M, Vandenbroucke J, de Craen A, Portielje J, van de Velde C, et al. Performing survival analyses in the presence of competing risks: a clinical example in older breast cancer patients. J Natl Cancer Inst 2015; 108(5):djv366. doi: 10.1093/jnci/djv366.
Albornoz H, Correa F, Saona G, Wald I, Bladizzoni M, Perna A. Evaluación del tratamiento adyuvante con Trastuzumab en el Cáncer de Mama operable. Montevideo: FNR, 2011. Disponible en: https://www.fnr.gub.uy/publicaciones/evaluacion-del-tratamiento-adyuvante-con-trastuzumab-en-el-cancer-de-mama-operable/. (Consulta: 30 marzo 2023).
Piñeiro N, Saona G, Correa F, Zubiaurre V, Delgado L. Informe de evaluación del tratamiento del cáncer de mama avanzado. Montevideo: FNR, 2022. Disponible en: www.fnr.gub.uy/wp-content/uploads/2022/05/informe_cancer_mama_2022.pdf. (Consulta: 30 marzo 2023).
