Population-based temporal trends and ethnic disparity in breast cancer mortality in South Africa (1999-2018): Joinpoint and age-period-cohort regression analyses

Gbenga Olorunfemi; Elena Libhaber; Oliver Chukwujekwu Ezechi; Eustasius Musenge

doi:10.3389/fonc.2023.1056609

Population-based temporal trends and ethnic disparity in breast cancer mortality in South Africa (1999-2018): Joinpoint and age-period-cohort regression analyses

Front Oncol. 2023 Feb 3:13:1056609. doi: 10.3389/fonc.2023.1056609. eCollection 2023.

Authors

Gbenga Olorunfemi¹, Elena Libhaber², Oliver Chukwujekwu Ezechi³, Eustasius Musenge¹

Affiliations

¹ Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
² Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
³ Division of Clinical Sciences, Nigerian Institute for Medical Research, Lagos, Nigeria.

Abstract

Globally, breast cancer is the leading cause of cancer deaths, accounting for 15.5% of female cancer deaths in 2020. Breast cancer is also the leading cause of female cancers in South Africa. The rapid epidemiological transition in South Africa may have an impact on the trends in breast cancer mortality in the country. We therefore evaluated the trends in the breast cancer mortality in SA over 20 years (1999-2020).

Methods: Joinpoint regression analyses of the trends in crude and age-standardized mortality rates (ASMR) of breast cancer among South African women were conducted from 1999 to 2018 using mortality data from Statistics South Africa. Age-period-cohort regression analysis was then conducted to evaluate the independent effect of age, period, and cohort on breast cancer mortality, and analysis was stratified by ethnicity.

Results: The mortality rate of breast cancer (from 9.82 to 13.27 per 100,000 women) increased at around 1.4% per annum (Average Annual Percent Change (AAPC): 1.4%, 95% CI:0.8-2.0, P-value< 0.001). Young women aged 30-49 years (1.1%-1.8%, P-value< 0.001) had increased breast cancer mortality. The risk of breast cancer mortality increased among successive birth cohorts from 1924 to 1928 but decreased among recent cohorts born from 1989 to 1993. In 2018, the breast cancer mortality rate among Blacks (9.49/100,000 women) was around half of the rates among the non-Blacks. (Coloreds: 18.11 per 100,000 women; Whites: 17.77/100,000 women; Indian/Asian: 13.24 per 100,000 women).

Conclusions: Contrary to the trends in high- and middle-income countries, breast cancer mortality increased in South Africa especially among young women. Breast cancer prevention programs should be intensified and should also target young women. The marked disparity in ethnic burden of breast cancer should be considered during planning and implementation of interventions.

Keywords: APC analysis; South Africa; age period cohort analysis; breast cancer mortality rate; ethnic disparity of cancer; female cancer trends; gynecological cancer trends; join point regression.

Grants and funding

This work was funded by GSK Africa Non-Communicable Disease Open Lab through the DELTAS Africa Sub-Saharan African Consortium for the Advanced Biostatistics (SSACAB) training program. The views expressed in this publication are those of the author(s) and not necessarily those of GSK (GSK grant number D1702270-01).