Abstract:

Objective To analyze the incidence and mortality trends of female breast cancer in China from 1990 to 2019 and the impact of age-period-cohort （APC） on it. Methods The incidence and mortality of breast cancer of Chinese women aged 20-95 years from 1990 to 2019 were collected from the Global Burden of Disease （GBD） in 2019. Joinpoint software was used to estimate the average annual percentage change rate （AAPC） of age standardized incidence and mortality， and analyze the changing trend of disease burden of breast cancer in Chinese women from 1990 to 2019. The R language based APC model developed by the National Cancer Institute of the United States was used to analyze the impact of age， period and cohort on their changes. Results From 1990 to 2019， the age standardized incidence of female breast cancer in China showed an upward trend， from 17.07/100 000 in 1990 to 35.61/100 000 in 2019， with an average annual increase of 2.59% （95%CI： 2.45%-2.73%， P<0.001）， which was higher than the global level （AAPC=0.47%， 95%CI： 0.31%-0.63%， P<0.001）. The standardized mortality showed a slight downward trend， from 9.16/100 000 in 1990 to 9.01/100 000 in 2019， with a decrease of 0.05% （95%CI： -0.20%-0.09%， P=0.479）， but there was not a statistically significant difference. APC model results showed that the incidence and mortality of female breast cancer increased with age. With the passage of time， the incidence from 1990 to 2019 showed an upward trend， and the incidence risk rose to 1.49 in the 2015-2019 period （95%CI： 1.42-1.57， P<0.001）. The mortality showed a downward trend， and the death risk was the highest in the 1990-1994 period （RR=0.79， 95%CI： 0.74-0.83， P<0.001）. Cohort effect results showed that the later the women were born， the higher the risk of morbidity. The women born in the cohort from 1995 to 1999 had the highest risk （RR=3.12， 95%CI： 1.82-5.33， P<0.001）. The risk of death showed a unimodal distribution， showing a trend of first increasing and then decreasing， the later the women were born， the lower the risk of death. The birth cohort from 1950 to 1954 had the highest risk of death （RR=1.04， 95%CI： 0.98-1.09， P<0.001）， and then showed a downward trend， falling to 0.48 （95%CI： 0.19-1.24， P<0.001） in the birth cohort from 1995 to 1999. Conclusion From 1990 to 2019， the incidence of breast cancer in Chinese women shows an upward trend， which is significantly higher than the global increase， and the mortality tends to stabilize. APC model analysis finds that the incidence and mortality increase with age， and the period and cohort effects show that the incidence risk of breast cancer in Chinese women gradually increases with the passage of the period and cohort. The period effect of mortality shows a downward trend， and the cohort effect of mortality shows a unimodal distribution， showing a trend of first increasing and then decreasing.

Key words: Breast neoplasms, Mortality, Incidence, China