Background. This study was undertaken to evaluate trends in breast cancer incidence in Egypt from 1999 to 2008 and to make projections for breast cancer occurrence for the years 2009–2015. Patients and Methods. We utilized joinpoint regression and average annual percent change (AAPC) measures with 95% confidence intervals (CI) to describe the trends in breast cancer incidence rates from the Gharbiah Cancer Registry by age and stage at diagnosis and to estimate expected breast cancer caseloads for 2009–2015. Results. From 1999 to 2008, the AAPC in breast cancer incidence rates in Gharbiah significantly increased among women 50 years and older and among localized tumors (AAPC %, 95% CI, 3.1% to 8.0%). Our results predict a significant increase in breast cancer caseloads from 2009 to 2015 among women aged 30–39 (AAPC %, 95% CI, 0.9% to 1.1%) and among women aged 40–49 years (AAPC %, 95% CI, 1.0% to 2.6%). Conclusion. These results have important implications for allocating limited resources, managing treatment needs, and exploring the consequences of prior interventions and/or changing risk factors in Egypt and other developing countries at the same stages of demographic and health transitions. 1. Introduction Breast cancer rates are increasing in developing countries, including Egypt, and are largely attributed to aging of the population, delay in time of first pregnancy, decrease in number of children and in breastfeeding, and a move toward high-calorie Western diets [1–4]. Although breast cancer incidence rates in Egypt are substantially lower than the rates in the United States and other developed countries [5–7], breast cancer is the most common cancer among women in Egypt [8]. Furthermore, the current demographic trends favor the likelihood that breast cancer will become an even greater public health concern in Egypt in the future. Trends in the stage at diagnosis of breast cancer in the Gharbiah registry have not been reported, and this information is critical for evaluation of downstaging efforts. Detailed information on trends of breast cancer by stage of diagnosis may promote the reduction of disparities in the presentation of disease by focusing limited resources on the susceptible populations and can aid in our overall understanding of the etiology of breast cancer in a setting that differs in regard to its risk factor profile as compared to many developed countries. The specific aim of this study was to examine trends in breast cancer incidence by age, stage, and hormone receptor status in the Gharbiah registry from 1999 to 2008. Further, we
References
[1]
L. S. Freedman, B. K. Edwards, L. A. G. Ries, and J. L. Young, Eds., Cancer Incidence in Four Member Countries (Cyprus, Egypt, Israel, and Jordan) of the Middle East Cancer Consortium (MECC) Compared with US SEER, NIH Publication No. 06-5873, National Cancer Institute, Bethesda, Md, USA, 2006.
[2]
P. L. Porter, “Global trends in breast cancer incidence and mortality,” Salud Pública de México, vol. 51, supplement 2, pp. s141–146, 2009.
[3]
P. Porter, “‘Westernizing’ women's risks? Breast cancer in lower-income countries,” The New England Journal of Medicine, vol. 358, no. 3, pp. 213–216, 2008.
[4]
A. Jemal, M. M. Center, C. DeSantis, and E. M. Ward, “Global patterns of cancer incidence and mortality rates and trends,” Cancer Epidemiology Biomarkers and Prevention, vol. 19, no. 8, pp. 1893–1907, 2010.
[5]
R. Gad, Breast Cancer, chapter 8, Middle Eastern Cancer Consortium, http://seer.cancer.gov/publications/mecc/mecc_breast.pdf.
[6]
American Cancer Society, Global Cancer Facts & Figures, American Cancer Society, Atlanta, Ga, USA, 2nd edition, 2011.
[7]
L. N. Shulman, W. Willett, A. Sievers, and F. M. Knaul, “Breast cancer in developing countries: opportunities for improved survival,” Journal of Oncology, vol. 2010, Article ID 595167, 6 pages, 2010.
[8]
S. Omar, H. Khaled, R. Gaafar, A. R. Zekry, S. Eissa, and O. El-Khatib, “Breast cancer in Egypt: a review of disease presentation and detection strategies,” Eastern Mediterranean Health Journal, vol. 9, no. 3, pp. 448–463, 2003.
[9]
World Health Organization, ICD-10: International Statistical Classification of Diseases and Related Health Problems, 10th edition, 2008.
[10]
J. L. Young Jr., S. D. Roffers, L. A. G. Ries, A. G. Fritz, and A. A. Hurlbut, Eds., SEER Summary Staging Manual-2000: Codes and Codinginstructions, National Cancer Institute, Bethesda, Md, USA, 2001.
[11]
L. X. Clegg, B. F. Hankey, R. Tiwari, E. J. Feuer, and B. K. Edwards, “Estimating average annual per cent change in trend analysis,” Statistics in Medicine, vol. 28, no. 29, pp. 3670–3682, 2009.
[12]
CAPMAS Census Reports, 1996 and 2006.
[13]
Joinpoint Regression Program, Version 4.0.4—May 2013, Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute.
[14]
“Egypt Demographic and Health Survey,” 2008.
[15]
A.M. Austin, A.G. Hill, and W. W. Fawzi, “Maternal obesity trends in Egypt 1995–2005,” Maternal & Child Nutrition, vol. 9, no. 2, pp. 167–179, 2013.
[16]
A. Khorshid, N. Ibrahim, O. Galal, and G. Harrison, “Development of food consumption monitoring system in Egypt,” Advances in Agricultural Research in Egypt, vol. 1, no. 3, pp. 163–217, 1998.
[17]
W. H. Herman, M. A. Ali, R. E. Aubert et al., “Diabetes mellitus in Egypt: risk factors and prevalence,” Diabetic Medicine, vol. 12, no. 12, pp. 1126–1131, 1995.
[18]
O. M. Galal, “The nutrition transition in Egypt: obesity, undernutrition and the food consumption context,” Public Health Nutrition, vol. 5, no. 1, pp. 141–148, 2002.
[19]
“Central Intelligence Agency World Factbook,” October 2010, https://www.cia.gov/library/publications/the-world-factbook/fields/2228.html.
[20]
S. B. Desai, M. T. Moonim, A. K. Gill, R. S. Punia, K. N. Naresh, and R. F. Chinoy, “Hormone receptor status of breast cancer in India: a study of 798 tumours,” Breast, vol. 9, no. 5, pp. 267–270, 2000.
[21]
W. Y. Chen and G. A. Colditz, “Risk factors and hormone-receptor status: epidemiology, risk-prediction models and treatment implications for breast cancer,” Nature Reviews Clinical Oncology, vol. 4, no. 7, pp. 415–423, 2007.
[22]
K. R. Hess, L. Pusztai, A. U. Buzdar, and G. N. Hortobagyi, “Estrogen receptors and distinct patterns of breast cancer relapse,” Breast Cancer Research and Treatment, vol. 78, no. 1, pp. 105–118, 2003.
[23]
S. Dey, A. S. Soliman, A. Hablas et al., “Urban-rural differences in breast cancer incidence by hormone receptor status across 6 years in Egypt,” Breast Cancer Research and Treatment, vol. 120, no. 1, pp. 149–160, 2010.
[24]
C. I. Li, J. R. Daling, and K. E. Malone, “Incidence of invasive breast cancer by hormone receptor status from 1992 to 1998,” Journal of Clinical Oncology, vol. 21, no. 1, pp. 28–34, 2003.
[25]
W.-Y. Huang, B. Newman, R. C. Millikan, M. J. Schell, B. S. Hulka, and P. G. Moorman, “Hormone-related factors and risk of breast cancer in relation to estrogen receptor and progesterone receptor status,” American Journal of Epidemiology, vol. 151, no. 7, pp. 703–714, 2000.
[26]
M. D. Althuis, J. H. Fergenbaum, M. Garcia-Closas, L. A. Brinton, M. P. Madigan, and M. E. Sherman, “Etiology of hormone receptor-defined breast cancer: a systematic review of the literature,” Cancer Epidemiology Biomarkers and Prevention, vol. 13, no. 10, pp. 1558–1568, 2004.
[27]
J. Manjer, J. Malina, G. Berglund, L. Bondeson, J. P. Game, and L. Janzon, “Smoking associated with hormone receptor negative breast cancer,” International Journal of Cancer, vol. 91, pp. 580–554, 2001.
[28]
V. W. Setiawan, K. R. Monroe, L. R. Wilkens, L. N. Kolonel, M. C. Pike, and B. E. Henderson, “Breast cancer risk factors defined by estrogen and progesterone receptor status,” American Journal of Epidemiology, vol. 169, no. 10, pp. 1251–1259, 2009.
[29]
N. Howlander, A. M. Noone, M. Yu, and K. A. Cronin, “Use of imputed population-based cancer registry data as a method of accounting for missing information: application to estrogen receptor status for breast cancer,” American Journal of Epidemiology, vol. 176, no. 4, pp. 347–356, 2012.
