Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/6811
Recent changes in breast cancer incidence in Spain, 1980-2004
Pollan-Santamaria, Marina ISCIII | Pastor-Barriuso, Roberto ISCIII | Ardanaz, Eva | Argüelles, Marcial | Martos, Carmen | Galcerán, Jaume | Sánchez-Pérez, María-José | Chirlaque, María-Dolores | Larrañaga, Nerea | Martínez-Cobo, Ruth | Tobalina, María-Cres | Vidal, Enric ISCIII | Marcos-Gragera, Rafael | Mateos, Antonio | Garau, Isabel | Rojas-Martín, María-Dolores | Jiménez, Rosario | Torrella-Ramos, Ana | Perucha, Josefina | Pérez-de-Rada, Maria-Eugenia | González, Susana | Rabanaque, María-José | Borràs, Joan | Navarro, Carmen | Hernández, Esther | Izquierdo, Angel | Lopez-Abente, Gonzalo ISCIII | Martínez, Carmen
J Natl Cancer Inst. 2009; 101(22): 1584–1591.
BACKGROUND: Since the 1980s, Spain experienced two decades of sharply increasing breast cancer incidence. Declines in breast cancer incidence have recently been reported in many developed countries. We examined whether a similar downturn might have taken place in Spain in recent years. METHODS: Cases of invasive female breast cancer were drawn from all population-based Spanish cancer registries that had at least 10 years of uninterrupted registration over the period 1980-2004. Overall and age-specific changes in incidence rates were evaluated using change-point Poisson models, which allow for accurate detection and estimation of trend changes. All statistical tests were two-sided. RESULTS: A total of 80,453 incident cases of invasive breast cancer were identified. Overall age- and registry-adjusted incidence rates rose by 2.9% (95% confidence interval [CI] = 2.7% to 3.1%) annually during the 1980s and 1990s; there was a statistically significant change in this trend in 2001 (95% CI = 1998 to 2004; P value for the existence of a change point <.001), after which incidence declined annually by 3.0% (95% CI = 1.8% to 4.1%). This trend differed by age group: There was a steady increase in incidence for women younger than 45 years, an abrupt downturn in 2001 for women aged 45-64 years, and a gradual leveling off in 1995 for women aged 65 years or older. Separate analyses for registries that had at least 15 years of uninterrupted registration detected a statistically significant interruption of the previous upward trend in breast cancer incidence in provinces that had aggressive breast cancer screening programs and high screening participation rates, including Navarra (change point = 1991, P < .001), Granada (change point = 2002, P = .003), Bizkaia (change point = 1998, P < .001), Gipuzkoa (change point = 1998, P = .001), and Araba (change point = 1997, P = .002). CONCLUSIONS: The recent downturn in breast cancer incidence among Spanish women older than 45 years is best explained by a period effect linked to screening saturation.
Adult | Age Factors | Age of Onset | Aged | Aged, 80 and over | Breast Neoplasms | Confidence Intervals | Female | Humans | Incidence | Mass Screening | Middle Aged | Registries | Spain | Time Factors
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