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Medline ® Abstract for Reference 4

of 'Prognostic and predictive factors in early, nonmetastatic breast cancer'

Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis.
Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R, Lopez AD, Murray CJ, Naghavi M
Lancet. 2011 Oct;378(9801):1461-84. Epub 2011 Sep 14.
BACKGROUND: Breast and cervical cancer are important causes of mortality in women aged≥15 years. We undertook annual age-specific assessments of breast and cervical cancer in 187 countries.
METHODS: We systematically collected cancer registry data on mortality and incidence, vital registration, and verbal autopsy data for the period 1980-2010. We modelled the mortality-to-incidence (MI) ratio using a hierarchical model. Vital registration and verbal autopsy were supplemented with incidence multiplied by the MI ratio to yield a comprehensive database of mortality rates. We used Gaussian process regression to develop estimates of mortality with uncertainty by age, sex, country, and year. We used out-of-sample predictive validity to select the final model. Estimates of incidence with uncertainty were also generated with mortality and MI ratios.
FINDINGS: Global breast cancer incidence increased from 641,000 (95% uncertainty intervals 610,000-750,000) cases in 1980 to 1,643,000 (1,421,000-1,782,000) cases in 2010, an annual rate of increase of 3·1%. Global cervical cancer incidenceincreased from 378,000 (256,000-489,000) cases per year in 1980 to 454,000 (318,000-620,000) cases per year in 2010-a 0·6% annual rate of increase. Breast cancer killed 425,000 (359,000-453,000) women in 2010, of whom 68,000 (62,000-74,000) were aged 15-49 years in developing countries. Cervical cancer death rates have been decreasing but the disease still killed 200,000 (139,000-276,000) women in 2010, of whom 46,000 (33,000-64,000) were aged 15-49 years in developing countries. We recorded pronounced variation in the trend in breast cancer mortality across regions and countries.
INTERPRETATION: More policy attention is needed to strengthen established health-system responses to reduce breast and cervical cancer, especially in developing countries.
FUNDING: Susan G Komen for the Cure and the Bill&Melinda Gates Foundation.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.