Gonçalo Forjaz de Lacerda1, Scott P Kelly2, Joana Bastos3, Clara Castro4, Alexandra Mayer5, Angela B Mariotto6, William F Anderson2. 1. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA; Azores Region Cancer Registry, Azores Oncological Centre, Portugal. Electronic address: goncalo.forjaz@nih.gov. 2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA. 3. Centre Region Cancer Registry, Portuguese Institute of Oncology, Coimbra, Portugal. 4. Northern Region Cancer Registry, Portuguese Institute of Oncology, Porto, Portugal. 5. Southern Region Cancer Registry, Portuguese Institute of Oncology, Lisbon, Portugal. 6. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
Abstract
BACKGROUND: Female breast cancer incidence rates have been increasing in Portugal for years. We, therefore, conducted the first nationwide breast cancer study to assess regional differences. METHODS: Cases were obtained from population-based cancer registries covering the country's Mainland (South, North, Centre), as well as the two Autonomous Regions (Azores and Madeira), for the time-period 1998 through 2011. Analyses were restricted to ages 30-84 years and stratified by region. We used the age-period-cohort (APC) framework to complement standard descriptive techniques and to forecast future trends. Estimable APC parameters included net drift, longitudinal age-specific incidence rate curves, and fitted age-specific incidence rate ratios. RESULTS: There were 71 545 breast cancer cases diagnosed in Portugal at ages 30-84 years from 1998 to 2011. The South presented the highest age-standardized rate (155.8/100 000), while the North presented the fastest rate of increase (3.6%/year). Age-specific statistical interactions were observed between regions. Younger women in the North revealed a decreased risk of developing breast cancer compared to women from the same age group in the South and Centre, while that risk was reversed in older women (p < 0.05). We estimate that from 2014 onwards, the North might rank first among all regions. CONCLUSION: The variant patterns observed could be due to a combination of different screening practices and/or exposure to risk factors across regions. Disease heterogeneity among younger and older women may also explain part of the differences in age-specific rates. These results justify continued monitoring of breast cancer incidence by region.
BACKGROUND:Female breast cancer incidence rates have been increasing in Portugal for years. We, therefore, conducted the first nationwide breast cancer study to assess regional differences. METHODS: Cases were obtained from population-based cancer registries covering the country's Mainland (South, North, Centre), as well as the two Autonomous Regions (Azores and Madeira), for the time-period 1998 through 2011. Analyses were restricted to ages 30-84 years and stratified by region. We used the age-period-cohort (APC) framework to complement standard descriptive techniques and to forecast future trends. Estimable APC parameters included net drift, longitudinal age-specific incidence rate curves, and fitted age-specific incidence rate ratios. RESULTS: There were 71 545 breast cancer cases diagnosed in Portugal at ages 30-84 years from 1998 to 2011. The South presented the highest age-standardized rate (155.8/100 000), while the North presented the fastest rate of increase (3.6%/year). Age-specific statistical interactions were observed between regions. Younger women in the North revealed a decreased risk of developing breast cancer compared to women from the same age group in the South and Centre, while that risk was reversed in older women (p < 0.05). We estimate that from 2014 onwards, the North might rank first among all regions. CONCLUSION: The variant patterns observed could be due to a combination of different screening practices and/or exposure to risk factors across regions. Disease heterogeneity among younger and older women may also explain part of the differences in age-specific rates. These results justify continued monitoring of breast cancer incidence by region.
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