Recent changes in breast cancer incidence and mortality in Estonia: Transition to the west

Abstract

Background The aim of this study was to examine breast cancer (BC) incidence and mortality trends in Estonia during recent decades and to compare the pattern of these trends with other selected European countries and regions. We attempt to explain the findings in relation to changes in Estonian society and healthcare system. Methods BC incidence (1985-2012) and mortality (1985-2013) data for Estonia were obtained from the Estonian Cancer Registry and Statistics Estonia. Data for selected European countries were obtained from the EUREG database. Joinpoint regression was used to analyze age-standardized rates in Estonia by age. For international comparison of incidence and mortality rates, we used scatterplot with 95% confidence ellipses and the mortality to incidence ratio. Results The overall BC incidence continues to increase in Estonia, while mortality has been in decline since 2000. Both incidence and mortality trends varied considerably across age groups. Among women aged 60 years and older, BC incidence increased at a rate of nearly 3% per year. Significant decrease in mortality was seen only among women aged 50-59 years. Comparison of scatterplots between countries and regions revealed two clusters in Europe separated along the incidence axis. The correlation between incidence and mortality in Estonia changed its direction in the mid-1990s. Conclusion In recent years, the dynamics of BC burden in Estonia has transitioned towards the high incidence-low mortality type model, which is characteristic to Western, Northern and Southern Europe. Although overall BC incidence is much lower in Estonia than in more affluent European countries, mortality from BC is still relatively high, particularly among elderly women.

The impact of sociodemographic factors on the utilization of radiation therapy in breast cancer patients in Estonia: a register-based study

“…In multivariate analysis, RT utilization was the highest among women aged 50–59 and the difference from older and younger age groups was borderline significant. It has been reported previously that mortality from BC among patients aged 50–59 in Estonia has significantly declined since 2000, while it did not decrease among women aged ≥ 60 over the same time period [ 2 ]. Whereas these trends are consistent with screening activities, as women aged 50–59 have been the target age group for organized mammography screening since 2004 [ 20 ], the impact of RT in combination with other therapies can be considered as well.…”

“…Breast cancer (BC) is a major health burden among women worldwide as well as in Estonia. Although overall BC incidence has increased in Estonia [ 1 ], mortality from BC has decreased steadily since 2000 [ 2 ]. However, there’s still a survival gap between Estonia and more developed countries [ 3 ], despite rapid increase observed since 1990s, particularly for locally/regionally spread cancers [ 4 ].…”

Heterogeneity of Tumors in Breast Cancer: Implications and Prospects for Prognosis and Therapeutics

“…Nowadays, however, this belief is only a myth as around 45% of the cases and 55% of deaths due to breast cancer occur in low- and middle-income countries, according to recent estimates [ 11 , 26 ]. Adoption of “western lifestyle” is largely implied in increasing the incidence and burden of breast cancer in low- and middle-income countries [ 11 , 27 ].…”

Incidence-Based Breast Cancer Mortality Trends in Estonia Before and After the Introduction of Organized Mammography Screening: A Register-Based Study

“…Previous studies of BC trends in Estonia have indicated that in parallel with continuous incidence increase, mortality started to slowly decrease in the second half of the 1990s. 15 This was accompanied by an increase in relative survival. 16 , 17 Declining mortality together with consistent survival increases in Europe have been contributed to increasing proportions of women being diagnosed at an earlier stage, enabling more effective treatment.…”