Epidemiology of breast cancer and their development factors
- Authors: Knyazeva V.A.1
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Affiliations:
- ФГБОУ ВО "ВГМУ им. Н.Н. Бурденко" Минздрава России
- Issue: Vol 9 (2020): Материалы XVI Международной Бурденковской научной конференции 23-25 апреля 2020 года
- Pages: 43-45
- Section: Влияние факторов внешней среды на здоровье человека
- URL: https://www.new.vestnik-surgery.com/index.php/2415-7805/article/view/5958
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Abstract
Relevance. One of the main health problems at the present stage is cancer incidence. According to the world health organization, current trends will lead to an increase in global cancer rates by 60% by 2040. Moreover, the jump in the number of new cases of diseases (by about 81%) will occur in developing countries, where the survival rates of cancer patients are at a fairly low level correlating with low income. In the structure of causes of death in the Russian Federation, Oncology ranks second. The leading cancer pathology among women both in the world and in Russia is breast cancer (BC). In 2018, the incidence of breast cancer in the Russian Federation reached 89.79 per 100 thousand us, and in the Voronezh region-93.53 per 100 thousand us. Similar indicators in 2009 were 71.22 and 68.04 per 100 thousand us. in Russia and the Voronezh region, respectively, which can not but attract attention to this nosology.
Goal. Identification of epidemiological characteristics of breast cancer in the Voronezh region and the city of Voronezh and determination of current methods of prevention.
Methods. The method of retrospective analytical research was used.
Results. In the structure of mortality from malignant neoplasms in women, breast cancer is the leader – 16.2%, and the average age of women who died is 66.1 according to 2018 data. It was possible to reduce the mortality rate from malignant neoplasms of this localization in comparison with 2009 (the absolute loss rate was -17.23 per 100 thousand people), but the distribution of indicators by age groups of the female population remained the same.
Conclusion. The incidence of breast cancer remains at a high level; in the Voronezh region, this indicator is higher than in the Russian Federation. However, it is worth noting that by 2018, it was possible to reduce the mortality rate among breast cancer patients.
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RELEVANCE
Cancer is the second most common cause of death in the world. In 2018, there were about 18 million new cancer cases and 9.6 million deaths worldwide. Of the 15.2 million premature deaths from noncommunicable diseases worldwide in 2016, 4.5 million (29.8%) were caused by malignancies. Mortality rates from non-communicable diseases, and in particular from cancer, are declining in most higher-income countries, but there is no progress in low-income countries, which creates problems in achieving this goal [1].
After analyzing the situation in the Russian Federation, the cancer incidence rate for 2018 in women was 430.32 per 100 thousand people. If we compare these data with similar indicators in 2009, the average annual growth rate is 2.27%.
The leading cancer pathology among women both in the world and in Russia is breast cancer (BC). It is known that Oncology has a multifactorial nature, which is based on the inheritance of predisposition and the action of environmental factors. The greatest impact on the development of breast cancer is caused by mutations in the BRCA1 and BRCA2 genes, the presence of a family history of cases of this disease, early menarche, late labor, hormone therapy, benign breast neoplasia, and alcohol consumption. In the works of foreign colleagues, it is indicated that the level of breast cancer incidence in women of late age (65-69 years) correlates with external factors, namely the nature of nutrition: the use of a large amount of sugar and fat leads to changes in cellular metabolism, increased prostaglandin synthesis, and activation of lipid peroxidation. In turn, oxidative stress initiates the progression of cancer.
Hormone-dependent tumors are certainly associated with aspects of childbirth. As a rule, the risk of developing breast cancer is higher in women who do not give birth, women with a late first pregnancy and a history of abortions before it. For women of early age (40-44 years), the probability of breast cancer is associated with genetic characteristics and blood of group II (AA or AO) [2].
The study of the intestinal microbiota, which directly depends on the nature of human nutrition and has an impact on the life expectancy of cancer patients, has become an actual direction in the study of the development of carcinogenesis and its factors. Breast tumors have been considered most extensively for their potential relationship with the intestinal microflora. It is assumed that Pro-inflammatory metabolites of the microbiota act as Pro-tumor agents. Also, clinical studies have established the existence of estrogen-dependent associations of the microbiome with breast cancer, but a precise understanding of the relationship between hormonal metabolism and intestinal microflora has yet to be established [3].
PURPOSE
The main purpose of this work was to study various epidemiological indicators of cancer incidence in the Russian Federation and the Voronezh region, in particular, the incidence of breast cancer in women, as well as to study the factors contributing to the development of pathology.
METHODS
Study design:
A retrospective descriptive and analytical study with elements of statistical analysis.
Compliance criteria:
The study included female individuals who have an established diagnosis of "breast cancer".
Terms and conditions:
The work was carried out on the basis of the center for hygiene and epidemiology in the Voronezh region. The General conclusions of the study could be influenced by factors such as the population's access to medical care and, consequently, the registration of cases, the accuracy and results of histological studies of patients ' biopsies.
Duration of the study:
Data on cancer incidence over a 10-year period (from 2009 to 2018) in the Voronezh region were subject to retrospective analysis, with a thorough analysis of indicators that can give an accurate assessment of the oncoepidemiological situation in the country and the Voronezh region in particular.
Description of medical intervention:
There was no direct medical intervention.
Main outcome of the study:
The study of the incidence of malignant neoplasms in the Russian population showed that the minimum indicators were recorded at the beginning of the study, that is, in 2009: women – 353.86 per 100 thousand of us. The maximum indicator for the analyzed period is noted in 2018 – 430.32 per 100 thousand us. In the structure of cancer incidence in women for many years in a row, breast cancer has been leading and its share is 20.9% according to data for 2018. Moreover, the indicator of the incidence of breast cancer in the Voronezh region in 2018 was 93.53 per 100 thousand. us., which is higher than the same indicator in Russia – 89.79 per 100 thousand us.
Additional study outcomes:
The highest relative mortality rate of women is recorded in the age range from 85 years and older – 99.9 per 100 thousand people, while the largest proportion of deaths from breast cancer in the structure is made by women aged 45-49 years – 23%.
Analysis in subgroups:
The absolute number of women who were diagnosed with breast cancer in the Voronezh region for the period from 2009 to 2018 was 10086.
Methods for registering outcomes:
To register the results of the work, we used pivot tables and various types of charts built in Microsoft Office Excel 2013.
Statistical analysis:
The sample size was not pre-calculated.
The method of statistical observation was used, which included organized collection and further processing of information with the calculation of intensive and extensive indicators. The results were processed using Microsoft Office Excel 2013.
RESULTS
Object of research:
The object of the study was data from the state statistical reporting form No. 7 "Information on malignant neoplasms", Rosstat data on the gender and age distribution of deaths from malignant neoplasms, provided by the Moscow research cancer Institute named after P. A. Herzen and the Russian Center for information technology and epidemiological research in the field of Oncology in the form of the book "Malignant neoplasms in Russia" for the period from 2009 to 2018.
Main results of the research:
According to the International Agency for research on cancer, more than 9.5 million cases of cancer were fatal in 2018. Of these, 627,000 deaths are due to breast cancer. Every year, cancer rates due to changing environmental factors are constantly growing. In Russia, as in the rest of the world, cancer pathology is the second leading cause of death, second only to cardiovascular diseases. Since 1999, the incidence of breast neoplasms in the Russian Federation has increased by 1.5 times, and in the Voronezh region over the past 10 years, this indicator has increased by 1.4 times. It is worth noting that the incidence of malignant neoplasms in the urban population in 2018 was 76.8%, while in rural areas this figure was more than 3 times lower (23.2%). This can be evidence of both the low level of detection of cancer pathology outside of large cities, and the relationship between the exposure of the population of large cities to urban factors and health status.
Over the past 10 years, the average age of women who are diagnosed with cancer for the first time has increased from 63.4 to 64.2 years. This may be interpreted as a consequence of an increase in the proportion of older persons in the country's population and their life expectancy. If we understand the essence of pathology, we can assume that this is due to the gradual accumulation of molecular damage, which, reaching a critical point, cause the development of neoplastic processes. Continuing the consideration of the age aspect in Oncology, it was found that cases of breast cancer begin to be registered at the age of 15-19 years, and the peak incidence of women with breast neoplasms occurs at the age of 65-69 years. The relative mortality rate from breast cancer in women reaches the highest value in the age range "85+" (in 2009 – 117.23 per 100 thousand us, in 2018 – 99.91 per 100 thousand us). However, the highest proportion of deaths from this pathology was registered in women aged 45-49 years in both 2009 and 2018.
Additional findings of the study:
The progressive decline in the number of cases of infectious diseases and the associated increase in life expectancy, along with changes in reproductive behaviors and lifestyle factors, are prerequisites for an increase in the burden of breast cancer in low-and middle-income countries, including the socio-economic burden. As part of the study, Russia calculated the cost of breast cancer patients: direct medical expenses amounted to about 24 billion rubles. for the year, excluding the cost of paying pensions to women with disabilities and temporary disability benefits.
Adverse event:
There were no adverse events.
DISCUSSION
Summary of the main research result:
Based on the data obtained as a result of a retrospective study, we can conclude that there is a progressive increase in the incidence of cancer, in particular, breast cancer, which has long occupied a leading position in the structure of female cancer pathology. Also, it is worth noting that this indicator registered in the Voronezh region is higher than the one in the Russian Federation. But at the same time, by 2018, it was possible to achieve a reduction in the death rate from this pathology.
Discussion of the main research result:
The dynamics of the incidence of malignant neoplasms in Russia is characterized by a clear upward trend: the average annual growth rate is 2.27%. In the structure of the incidence of malignant neoplasms in women, breast cancer is in the first place and its share is 20.9%. This frequency of the disease is explained by a variety of factors that lead to neoplastic processes in the hormone-dependent glandular tissue. These include changes in women's attitudes to childbearing, unwillingness to procreate, late pregnancies, and refusal to breastfeed. A big problem and a prerequisite for the emergence of breast cancer is the obesity of girls, which leads to premature puberty and early menarche.
Research restriction:
The data of the objects that were analyzed may depend on the population's access to medical care, the qualifications of medical personnel, as well as the capabilities and equipment of clinical and diagnostic laboratories.
CONCLUSION
The incidence of malignant neoplasms remains a major unresolved health problem. In 2018, the incidence of breast cancer in the Russian Federation reached 89.79 per 100 thousand us, and in the Voronezh region-93.53 per 100 thousand us. The state approves many Federal targeted programs aimed at combating breast cancer, which are based on early detection and registration of women with malignant neoplasms, informing about the significance of the problem, the possibility and availability of diagnostics. However, the illiteracy of the population, the lack of qualified personnel in remote regions of our country, and the insufficient equipment of mammography rooms do not allow us to reduce the level of mortality and morbidity to the indicators that we strive for. In the future, it is planned to conduct an in-depth study of the oncoepidemiology of breast cancer among women living in the Voronezh region, on the basis of oncological institutions and attach the results of this work to new research.
About the authors
Victoria A. Knyazeva
ФГБОУ ВО "ВГМУ им. Н.Н. Бурденко" Минздрава России
Author for correspondence.
Email: vic.knz@mail.ru
ORCID iD: 0000-0003-0247-5491
SPIN-code: 7705-3001
Student of the medical-preventive faculty
Russian Federation, Voronezh, Studencheskaya street, 10.References
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