Trends of Breast Cancer Incidence in Iran During 2004-2008: A Bayesian Space-time Model

  • Jafari-Koshki, Tohid (Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences) ;
  • Schmid, Volker Johann (Bioimaging Group, Department of Statistics, Ludwig Maximimilians) ;
  • Mahaki, Behzad (Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences)
  • Published : 2014.02.28


Background: Breast cancer is the most frequently diagnosed cancer in women and estimating its relative risks and trends of incidence at the area-level is helpful for health policy makers. However, traditional methods of estimation which do not take spatial heterogeneity into account suffer from drawbacks and their results may be misleading, as the estimated maps of incidence vary dramatically in neighboring areas. Spatial methods have been proposed to overcome drawbacks of traditional methods by including spatial sources of variation in the model to produce smoother maps. Materials and Methods: In this study we analyzed the breast cancer data in Iran during 2004-2008. We used a method proposed to cover spatial and temporal effects simultaneously and their interactions to study trends of breast cancer incidence in Iran. Results: The results agree with previous studies but provide new information about two main issues regarding the trend of breast cancer in provinces of Iran. First, this model discovered provinces with high relative risks of breast cancer during the 5 years of the study. Second, new information was provided with respect to overall trend trends o. East-Azerbaijan, Golestan, North-Khorasan, and Khorasan-Razavi had the highest increases in rates of breast cancer incidence whilst Tehran, Isfahan, and Yazd had the highest incidence rates during 2004-2008. Conclusions: Using spatial methods can provide more accurate and detailed information about the incidence or prevalence of a disease. These models can specify provinces with different health priorities in terms of needs for therapy and drugs or demands for efficient education, screening, and preventive policy into action.


  1. Noroozi A, Jomand T, Tahmasebi R (2011). Determinants of breast self-examination performance among Iranian women: an application of the health belief model. J Canc Educ, 26, 365-74.
  2. Sadjadi A, Hislop TG, Bajdik C, et al (2009). Comparison of breast cancer survival in two populations: Ardabil, Iran and British Columbia, Canada. BMC Cancer, 9, 381.
  3. Sadjadi A, Malekzadeh R, Derakhshan MH, et al (2003). Cancer occurence in ardabil: results of a population-based cancer regisry from Iran. Int J Cancer, 107, 113-8.
  4. Sadjadi A, Nouraie M, Ghorbani A, et al (2009). Epidemiology of breast cancer in the Islamic Republic of Iran: first results from a population-based cancer registry. East Medit Health J, 15, 1426-31.
  5. Semnani S, Roshandel G, Keshtkar A, et al (2008). Annual Report of Golestan Population-based Cancer Registry; Number 3, 2006.
  6. Somi MH, Farhang S, Mirinezhad SK, et al (2008). Cancer in east azerbaijan, Iran: results of a population-based cancer registry. Asian Pac J Cancer Prev, 9, 327-30.
  7. Taghavi A, Fazeli Z, Vahedi M, et al (2012). Increased trend of breast cancer mortality in Iran. Asian Pac J Cancer Prev, 13, 367-70.
  8. Taheri NS, Bakhshandeh Nosrat S, Aarabi M, et al (2012). Epidemiological pattern of breast cancer in Iranian women: is there an ethnic disparity? Asian Pac J Cancer Prev, 13, 4517-20.
  9. Waller LA, Carlin BP, Xia H, et al (1997). Hierarchical spatiotemporal mapping of disease rates. J Amer Stat Assoc, 92, 607-17.
  10. Lunn D, Spiegelhalter D, Thomas A, et al (2009). The BUGS project: evolution, critique, and future directions. Stat Med, 28, 3049-67.
  11. Lamyian M, Hydarnia A, Ahmadi F, et al (2007). Barriers to and factors faciliating breast cancer screening among Iranian women: a qualitative study. East Medit Health J, 13, 1160-9.
  12. Lawson AB, Biggeri A, Boehning D, et al (2000). Disease mapping models: an empirical evaluation. Stat Med, 19, 2217-41.<2217::AID-SIM565>3.0.CO;2-E
  13. Lawson AB, Browne WJ, Vidal Rodeiro CL (2003). Disease Mapping with WinBUGS and MLwiN. John Wiley & Sons Ltd.
  14. MacNab YC, Dean CB (2002). Spatio-temporal modelling of rates for the construction of disease maps. Stat Med, 21, 347-58.
  15. Mahaki B, Mehrabi Y, Kavousi A, et al (2011). Multivariate disease mapping of seven prevalent cancers in Iran using a shared component model. Asian Pac J Cancer Prev, 12, 2353-8.
  16. Maiti T (1998). Hierarchical Bayes estimation of mortality rates for disease mapping. J Stat Plan Inf, 69, 339-48.
  17. Montazeri A, Vahdaninia M, Harirchi I, et al (2008). Breast cancer in Iran: need for greater women awareness of warning signs and effective screening methods. Asia Pac Fam Med, 7, 6.
  18. Mousavi SM, Gouya MM, Ramazani R, et al (2009). Cancer incidence and mortality in Iran. Ann Oncol, 20, 556-63.
  19. Mousavi SM, Mohagheghi MA, Mousavi Jerrahi A, et al. (2008). Outcome of breast cancer in iran: a study of Tehran cancer registry data. Asian Pac J Cancer Prev, 9, 275-8.
  20. Mousavi SM, Montazeri A, Mohagheghi MA, et al (2007). Breast cancer in Iran: an epidemiological review. Breast J, 13, 383-91.
  21. Clayton D and Kaldor J (1987). Empirical Bayes estimates of age-standardized relative risk for use in disease mapping. Biomet, 43, 671-81.
  22. Besag J (1974). Spatial interaction and the statistical analysis of lattice systems. J Royal Stat Soci. Series B (Methodological), 36, 192-236.
  23. Besag J, York J, Mollie A (1991). Bayesian image restoration, with two applications in spatial statistics. Ann Inst Statist Math, 43, 1-59.
  24. Bohning D, Dietz E, Schlattmann P (2000). Space-time mixture modelling of public health data. Stat Med, 19, 2333-44.<2333::AID-SIM573>3.0.CO;2-Q
  25. Ferlay J, Shin H-R, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917.
  26. Fouladi N, Pourfarzi F, Amani F, et al (2012). Breast Cancer in Ardabil province in the North-West of Iran: an epidemiological study. Asian Pac J Cancer Prev, 13, 1543-5.
  27. Gilks WR, Richardson S, Spiegelhalter DJ (1996). Markov Chain Monte Carlo in Practice. Chapman & Hall.
  28. Harirchi I, Karbakhsh M, Kashefi A, et al. (2004). Breast cancer in iran: results of a multi-center study. Asian Pac J Cancer Prev, 5, 24-7.
  29. Jemal A, Bray F, Center MM, et al (2011). Global Cancer Statistics. CA Cancer J Clin, 61, 69-90.
  30. Kavousi A, Meshkani MR, Mohammadzadeh M (2009). Spatial analysis of relative risk of lip cancer in Iran: a Bayesian approach. Environmet, 20, 347-59.
  31. Knorr-Held L (2000). Bayesian modelling of inseparable Spacetime variation in disease risk. Stat Med, 19, 2555-67.<2555::AID-SIM587>3.0.CO;2-#
  32. Knorr-Held L, Besag J (1998). Modelling risk from a disease in time and space. Stat Med, 17, 2045-60.<2045::AID-SIM943>3.0.CO;2-P
  33. Asmarian NS, Ruzitalab A, Kavousi A, et al (2013). Area-toarea poisson kriging analysis of mapping of county-level esophageal cancer incidence rates in Iran. Asian Pac J Cancer Prev, 14, 11-3.
  34. Babu GR, Samari G, Cohen SP, et al (2011). Breast cancer screening among females in Iran and recommendations for improved practice: a review. Asian Pac J Cancer Prev, 12, 1647-55.
  35. Bernardinelli L, Clayton D and Montomoli C (1995a). Bayesian estimates of disease maps: how important are priors? Stat Med, 14, 2411-31.
  36. Bernardinelli L, Clayton D, Pascutto C, et al (1995b). Bayeian analysis of space-time variation in disease risk. Stat Med, 14, 2433-43.
  37. Bernardinelli L, Pascutto C, Best NG, et al (1997). Disease mapping with errors in covariates. Stat Med, 16, 741-52.<741::AID-SIM501>3.0.CO;2-1

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