Temporal Trends and Future Prediction of Breast Cancer Incidence Across Age Groups in Trivandrum, South India.

BACKGROUND: Increasing breast cancer (BC) incidence rates have been reported from India; causal factors for this increased incidence are not understood and diagnosis is mostly in advanced stages. Trivandrum exhibits the highest BC incidence rates in India. This study aimed to estimate trends in incidence by age from 2005- 2014, to predict rates through 2020 and to assess the stage at diagnosis of BC in Trivandrum. MATERIALS AND METHODS: BC cases were obtained from the Population Based Cancer Registry, Trivandrum. Distribution of stage at diagnosis and incidence rates of BC [Age-specific (ASpR), crude (CR) and age-standardized (ASR)] are described and employed with a joinpoint regression model to estimate average annual percent changes (AAPC) and a Bayesian model to estimate predictive rates. RESULTS: BC accounts for 31% (2681/8737) of all female cancers in Trivandrum. Thirty-five percent (944/2681) are <50 years of age and only 9% present with stage I disease. Average age increased from 53 to 56.4 years (p=0.0001), CR (per 105 women) increased from 39 (ASR: 35.2) to 55.4 (ASR: 43.4), AAPC for CR was 5.0 (p=0.001) and ASR was 3.1 (p=0.001). Rates increased from 50 years. Predicted ASpR is 174 in 50-59 years, 231 in > 60 years and overall CR is 80 (ASR: 57) for 2019- 20. CONCLUSIONS: BC, mostly diagnosed in advanced stages, is rising rapidly in South India with large increases likely in the future; particularly among post-menopausal women. This increase might be due to aging and/or changes in lifestyle factors. Reasons for the increased incidence and late stage diagnosis need to be studied.

Overall survival from breast cancer in Kerala, India, in relation to menstrual, reproductive, and clinical factors.

BACKGROUND: Breast cancer accounts for one-fourth of cancer cases seen in female patients in Kerala, India. Results of a retrospective analysis of breast cancer in Kerala are presented in this article. METHODS: Case records of 449 patients with breast carcinoma treated during 1983-1984 were reviewed. Survival analysis was done by the Kaplan-Meier product limit method. The survival curves were compared by the log-rank test. A forward stepwise procedure with the Cox proportional hazards regression analysis was performed to identify factors influencing survival. RESULTS: The overall 5-year survival rate was 40%. The 5-year survival rates were 85% for patients with T1, 63% for T2, 32% for T3, and 21% for T4 lesions. Those with N0 disease had a 68% 5-year survival rate. The survival rates were 90% for patients with Stage I, 65% for Stage II, 33% for Stage III, and 6% for Stage IV disease. On multivariate analysis, the following factors were found to significantly influence survival: response to treatment (P < 0.001), stage (P < 0.01), and regional nodal involvement (P < 0.05). CONCLUSIONS: Two-thirds of patients with advanced-stage disease on presentation seem to account for the poor overall survival. Early detection of breast cancer by breast self-examination and physician breast examination should be encouraged in developing countries to improve treatment results in breast cancer.