Trends in incidence, mortality and survival in women with breast cancer from 1985 to 2012 in Granada, Spain: a population-based study

Background: The incidence of breast cancer has increased since the 1970s. Despite favorable trends in prognosis, the role of changes in clinical practice and the introduction of screening remain controversial. We examined breast cancer trends to shed light on their determinants. Methods: Data were obtained for 8502 new cases of breast cancer in women between 1985 and 2012 from a population-based cancer registry in Granada (southern Spain), and for 2470 breast cancer deaths registered by the Andalusian Institute of Statistics. Joinpoint regression analyses of incidence and mortality rates were obtained. Observed and net survival rates were calculated for 1, 3 and 5 years. The results are reported here for overall survival and survival stratified by age group and tumor stage. Results: Overall, age-adjusted (European Standard Population) incidence rates increased from 48.0 cases x 100,000 women in 1985-1989 to 83.4 in 2008-2012, with an annual percentage change (APC) of 2.5% (95%Cl, 2.1-2.9) for 1985-2012. The greatest increase was in women younger than 40 years (APC 3.5, 95%Cl, 2.4-4.8). For 2000-2012 the incidence trend increased only for stage I tumors (APC 3.8, 95%Cl, 1.9-5.8). Overall age-adjusted breast cancer mortality decreased (APC - 1, 95%Cl, - 1.4 - - 0.5), as did mortality in the 50-69 year age group (APC - 1.3, 95%Cl, - 2.2 - - 0.4). Age-standardized net survival increased from 67.5% at 5 years in 1985-1989 to 83.7% in 2010-2012. All age groups younger than 70 years showed a similar evolution. Five-year net survival rates were 96.6% for patients with tumors diagnosed in stage I, 88.2% for stage II, 62.5% for stage III and 233% for stage IV. Conclusions: Breast cancer incidence is increasing - a reflection of the evolution of risk factors and increasing diagnostic pressure. After screening was introduced, the incidence of stage I tumors increased, with no decrease in the incidence of more advanced stages. Reductions were seen for overall mortality and mortality in the 50-69 year age group, but no changes were found after screening implementation. Survival trends have evolved favorably except for the 70-84 year age group and for metastatic tumors.