Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database.
Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database.
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DOI：
10.1136/bmj.c3620
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发表时间：
2010-08-11
期刊：
影响因子：
--
通讯作者：
Heanue M
中科院分区：
文献类型：
--
作者：
Autier P;Boniol M;La Vecchia C;Vatten L;Gavin A;Héry C;Heanue M
目的研究30个欧洲国家妇女乳腺癌死亡率的时间变化趋势。设计回顾性趋势分析。数据来源世卫组织死亡原因死亡率数据库研究对象回顾了1989年至2006年女性乳腺癌死亡主要结果测量所有女性和按年龄组（<50岁、50-69岁和≥70岁）乳腺癌死亡率的变化，这些变化是通过对数转换和年龄调整死亡率的线性回归计算的。联合点分析用于确定所有年龄段死亡率趋势开始变化的年份。从1989年到2006年，乳腺癌死亡率中位数降低了19%，冰岛降低了45%，罗马尼亚增加了17%。1987- 1989年，15个国家的乳腺癌死亡率下降了20%以上，死亡率较高的国家下降幅度更大。英格兰、威尔士、北爱尔兰和苏格兰的降幅分别为35%、29%和30%，位居第二、第三和第四。在法国、芬兰和瑞典，死亡率分别下降了11%、12%和16%。在此期间，中欧国家的死亡率没有下降，甚至没有上升。死亡率下降的趋势通常始于1988年至1996年，1999年至2006年的持续下降表明这种趋势可能会继续下去。50岁以下女性的中位变化为- 37%（范围为- 76%至- 14%），50-69岁女性为- 21%(- 40%至14%)，≥70岁女性为- 2%（- 42%至80%）。结论：1988年后欧洲各国乳腺癌死亡率的变化差异很大，英国是下降幅度最大的国家之一。50岁以下妇女的死亡率下降幅度最大，在该年龄不常见筛查的国家也是如此。一些中欧国家的死亡率上升反映了可避免的死亡率。
Objective To examine changes in temporal trends in breast cancer mortality in women living in 30 European countries. Design Retrospective trend analysis. Data source WHO mortality database on causes of deaths Subjects reviewed Female deaths from breast cancer from 1989 to 2006 Main outcome measures Changes in breast cancer mortality for all women and by age group (<50, 50-69, and ≥70 years) calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in all age mortality began to change. Results From 1989 to 2006, there was a median reduction in breast cancer mortality of 19%, ranging from a 45% reduction in Iceland to a 17% increase in Romania. Breast cancer mortality decreased by ≥20% in 15 countries, and the reduction tended to be greater in countries with higher mortality in 1987-9. England and Wales, Northern Ireland, and Scotland had the second, third, and fourth largest decreases of 35%, 29%, and 30%, respectively. In France, Finland, and Sweden, mortality decreased by 11%, 12%, and 16%, respectively. In central European countries mortality did not decline or even increased during the period. Downward mortality trends usually started between 1988 and 1996, and the persistent reduction from 1999 to 2006 indicates that these trends may continue. The median changes in the age groups were −37% (range −76% to −14%) in women aged <50, −21% (−40% to 14%) in 50-69 year olds, and −2% (−42% to 80%) in ≥70 year olds. Conclusions Changes in breast cancer mortality after 1988 varied widely between European countries, and the UK is among the countries with the largest reductions. Women aged <50 years showed the greatest reductions in mortality, also in countries where screening at that age is uncommon. The increasing mortality in some central European countries reflects avoidable mortality.
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