Mingjun Gao1,2, Sofia Laila Wik1,3, Qinyao Yu1,4,5, Fanyu Xue1,6, Sze Chai Chan1, Shui Hang Chow1, Yusuff Adebayo Adebisi7, Claire Chenwen Zhong1, Don Eliseo Lucero-Prisno III8, Martin C. S. Wong1,9, Junjie Huang1,9
1The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China;
2Adam Smith Business School, College of Social Science, University of Glasgow, Glasgow, UK;
3Karolinska Institute, Solna, Sweden;
4Jinan University-University of Birmingham Joint Institute, Jinan University, Guangzhou, China;
5School of Mathematics, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, UK;
6Faculty of Health Sciences, University of Ottawa, Ottawa, Canada;
7Nuffield Department of Population Health, University of Oxford, Oxford, UK;
8Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK;
9Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
Correspondence to: Dr. Junjie Huang, PhD. The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Public Health, Prince of Wales Hospital, 5/F, School of Public Health Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR, China. Email: junjie_huang@link.cuhk.edu.hk.
Background: Breast cancer poses a significant threat to women’s health and places a burden on healthcare systems worldwide. However, low- and middle-income countries (LMICs) often have insufficient breast cancer prevention, treatment, and understanding of risk factors. This study aims to investigate the disease burden, risk factors, and temporal trends of breast cancer specifically in LMICs.
Methods: From 1990 to 2019, this study extracted incidence, prevalence, disability-adjusted life years (DALYs) and breast cancer risk factors from the Global Burden of Disease (GBD) databases for 204 countries or territories. Temporal trends were examined using joinpoint regression analysis.
Results: Among the income groups, the lower middle-income category had the highest DALYs value, with 1,787 years per 100,000 people. In the map analysis, 91% of African and Middle Eastern countries had age-standardized DALYs rates higher than the crude rate. LMICs countries collectively accounted for 74% of the global burden of DALYs lost due to breast cancer in 2019. Between 1990 and 2019, the prevalence of behavior-related risk factors for breast cancer increased by 47% in upper-middle income countries and 19% in low-income countries. However, it remained relatively consistent in lower-middle income countries. In lower-middle income countries, the risk associated with metabolic syndromes was higher compared to the risk associated with behavioral factors alone. For the recent past decade, breast cancer incidences increased significantly in lower-middle income countries [average annual percentage change (AAPC): 1.69, 95% confidence interval (CI): 1.51–1.87, P<0.001], upper-middle income countries (AAPC: 1.32, 95% CI: 1.12–1.48, P<0.001), and low-income countries (AAPC: 1.62, 95% CI: 1.57–1.68, P<0.001).
Conclusions: Breast cancer affects women globally, particularly in LMICs. This research shows how breast cancer in LMICs is aggravated by low resources and healthcare infrastructure. To successfully reduce breast cancer in these contexts, future studies must emphasize healthcare resource allocation.
Keywords: Breast cancer; low- and middle-income countries (LMICs); disease burden; risk factors; temporal trends
