Elsevier

Cancer Epidemiology

Volume 55, August 2018, Pages 73-80
Cancer Epidemiology

Breast and cervical cancer incidence and mortality trends in Russia 1980–2013

https://doi.org/10.1016/j.canep.2018.05.008Get rights and content

Highlights

  • The paper presents an assessment of recent breast and cervical cancer trends in Russia.

  • While breast cancer incidence rates in Russia are increasing, mortality rates are in decline.

  • Cervical cancer rates as well as risks among more recent generations are uniformly on the rise.

  • Cervical cancer has surpassed breast cancer in terms of years of life lost per one death.

  • The cervical cancer pattern emphasizes an overwhelming need for cancer control activities.

Abstract

Background

Breast and cervical cancer are among the leading causes of preventable cancer deaths in women in Russia. The aim of this study is to analyze changes in breast and cervical cancer incidence and mortality trends using data from the Russian State Cancer Registry.

Methods

The age-standardized rates of cervical cancer incidence (1993–2013) and mortality (1980–2013) were analyzed using piecewise linear regression. Age-period-cohort models were used to estimate the temporal effects and provide future predictions.

Results

Breast and cervical cancer incidence rates uniformly increased over two decades from 33.0 to 47.0 per 100,000 and from 10.6 to 14.2 per 100,000, respectively. Breast cancer mortality rates however declined from 17.6 to 15.7 in 2013, while cervical cancer mortality increased steadily from 5.6 to 6.7. Breakpoints in the risk occurred in cohorts born 1937–1953, indicating a recent generational decrease in breast cancer mortality, but a concomitant increase in cervical cancer. Cervical cancer has already surpassed breast cancer in terms of years of life lost (YLL) (23.4 per death vs 18.5 in 2009–2013), while future projections suggest that the annual YLL could reach 1.2 million for cervical cancer and (decline to) 1.8 million for breast cancer by the year 2030.

Conclusion

The temporal patterns of breast cancer incidence and mortality in Russia are in line with other countries in Europe, although cervical cancer rates and the risk of occurrence in recent generations is rapidly increasing; these trends underscore the need to place immediate priority in national cervical vaccination and screening programs.

Introduction

Breast cancer is the most common cancer type of women globally while cervical cancer is among most common cancer types in less developed regions [1]. Both breast and cervical cancer are among the leading causes of preventable cancer deaths in women in Russia [2]. Despite their high frequency, systematic large-scale efforts aimed at primary and secondary prevention to control breast and cervical tumours, while available [[3], [4], [5]], are not systematically implemented in the country [6].

A thorough quantification of the healthcare problem and its eligibility is the first of the WHO criteria for screening described by Wilson and Jungner [7]. Cost-effectiveness of interventions also depends on the cancer scale and profile, an assessment of trends, and projections evaluating possible impacts in the presence and absence of cancer control programmes [8,9]. Assessing cancer patterns and trends is essential for setting the health care priorities, identifying targets for intervention as well as guiding further research. Appropriate quantification requires valid, consistent and comparable data over time to reflect real trends and interpretation of the underlying changes [10].

Epidemiological data from Russia has not been extensively reported for several reasons: the language barrier, still limited formal education in epidemiology, scarce resources for cancer epidemiologic research and a lack of formal quality evaluation of registry data [11,12]. This is unfortunate given the vast proportion of the European population that Russia constitutes and the long history of the population-based cancer registration system in the country, established in the USSR in 1953 [12]. All medical facilities are obliged to notify the regional population-based cancer registries of all newly-diagnosed cancer cases and any new hospitalization of patients with cancer. The State Cancer Registry (SCR) based at the Herzen Research Institute of Oncology in Moscow aggregates the data from the regional registries and produces an annual report with crude data that is freely available [13]. Several changes in lifestyle, behavioral and reproductive factors in the last few decades in Russia, together with socioeconomic changes, likely influence the changing cancer profiles now observed [14].

The analysis of cancer trends and their changes in Russia are thus essential to understand the impact of cancer on the health care system in Russia. The aim of this study is to describe breast and cervical cancer incidence and mortality trends in Russia, quantifying changes using several indicators of the cancer burden including years of life lost (YLL), and a prediction of the future burden circa 2030, via an extrapolation of recent trends and demographic changes, as a baseline for cancer control action.

Section snippets

Incidence, mortality, and population data

This study followed the data analysis protocol developed for the Russian cancer registries (details are described in Supplementary Material 1). Female breast and cervical cancer incidence (1993–2013) and mortality (1993–2013) data were acquired from the SCR based at the P. Herzen Moscow Oncological Research Center in Moscow. Obligatory cancer registration covers the entire population of the Russian Federation (143.5 million people in 2013) since 1953, but the SCR was officially established only

Incidence and mortality: overall patterns and trends

During the study period 1993–2013, an average 47,700 cases of breast cancer were registered in Russia annually, with 18,830 deaths from the disease for the period 1980–2013. Correspondingly, an average of 12,990 cervical cancer cases were registered in Russia in the period 1993–2013, with 7430 cervical cancer deaths (corrected estimates) registered in 1980–2013 (number of cases and deaths for 4 and 5-year periods are presented in Table 1). A constant increase in incidence rates for breast

Discussion

This study is the first broad assessment of cancer incidence and mortality patterns and trends from the State Cancer Registry of Russia. The results revealed substantial and somewhat contrasting changes in trends of breast and cervical cancer in Russian women during the past decades. For cervical cancer, an alarming increase in incidence and mortality rates is clearly observed, while the pattern for breast cancer was not dissimilar to many European countries, with an increasing incidence trend

Conflict ofinterest statement

The authors have no relevant affiliations or financial involvement with any organisation or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Source of funding

This work was funded by Faculty of Social Sciences of University of Tampere grants for participants of International Doctoral Programme in Epidemiology. This source of funding and support had no involvement in the study design, data collection, analysis or interpretation, or the writing of the report

Author contributions

Anton Barchuk: study design, literature search and review, data identification and extraction, data analysis, data interpretation, writing, reviewing and revising the manuscript, final approval of the version to be submitted.

Anssi Auvinen: study design, data interpretation, reviewing manuscript, writing, reviewing and revising the manuscript, final approval of the version to be submitted.

Ahti Anttila: study design, data interpretation, reviewing manuscript, final approval of the version to be

Acknowledgements

Acknowledgments to Olga Gretsova, Galina Petrova, Mikhail Prostov, prof. Valery Starinsky and prof. Andrey Kaprin from the State Cancer Registry research group, P. Herzen Moscow Oncological Research Center, branch of National Medical Research Radiological Center.

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