Comparison of Bayesian Spatial Ecological Regression Models for Investigating the Incidence of Breast Cancer in Iran, 2005- 2008

  • Khoshkar, Ahmad Haddad (Department of Biostatistics, School of Public Health, Isfahan University of Medical Sciences) ;
  • Koshki, Tohid Jafari (Department of Biostatistics, School of Public Health, Isfahan University of Medical Sciences) ;
  • Mahaki, Behzad (Department of Biostatistics, School of Public Health, Isfahan University of Medical Sciences)
  • Published : 2015.09.02


Background: Breast cancer is the most prevalent kind of cancer among women in Iran. Regarding the importance of cancer prevention and considerable variation of breast cancer incidence in different parts of the country, it is necessary to recognize regions with high incidence of breast cancer and evaluate the role of potential risk factors by use of advanced statistical models. The present study focussed on incidence of breast cancer in Iran at the province level and also explored the impact of some prominent covariates using Bayesian models. Materials and Methods: All patients diagnosed with breast cancer in Iran from 2005 to 2008 were included in the study. Smoking, fruit and vegetable intake, physical activity, obesity and the Human Development Index (HDI), measured at the province level, were considered as potential modulating factors. Gamma-Poisson, log normal and BYM models were used to estimate the relative risk of breast cancer in this ecological investigation with and without adjustment for the covariates. Results: The unadjusted BYM model had the best fit among applied models. Without adjustment, Isfahan, Yazd, and Tehran had the highest incidences and Sistan- Baluchestan and Chaharmahal-Bakhtiari had the lowest. With the adjusted model, Khorasan-Razavi, Lorestan and Hamedan had the highest and Ardebil and Kohgiluyeh-Boyerahmad the lowest incidences. A significantly direct association was found between breast cancer incidence and HDI. Conclusions: BYM model has better fit, because it contains parameters that allow including effects from neighbors. Since HDI is a significant variable, it is also recommended that HDI should be considered in future investigations. This study showed that Yazd, Isfahan and Tehran provinces feature the highest crude incidences of breast cancer.


  1. Abbastabar H, SoleimaniDodran M, HamidiFard P, et al (2013). The relationship between breast cancer and the most common non-contagious disease risk factors: an ecologic study. J Health Syst Res, 8, 369-74.
  2. Akbari M, Abachizadeh K, Khayamzadeh M, et al (2008). Iran cancer report. cancer research center shahidbeheshti university of medical sciences Tehran, Qom: Darolfekr.
  3. Arkani M, Safaii A, Karimi K, et al (2012). Association of the insulin gene polymorphism and colorectal cancer. Koomesh J, 13, 172-6.
  4. Asmarian NS, Kavousi A, Salehi M, Mahaki B (2013). Comparison of point poisson kriging and empirical bayesian methods in mapping of gastrointestinal cancer incidence rate in Iran. J Health Syst Res, 9, 277-85.
  5. Bakhtiari A, Hajian K, Faramarzi M (2004). Examine the relationship between demographic, social and lifestyle in women with breast cancer. Babol Univers J Med Sci, 9, 55-62.
  6. Barrios C, Werutsky G, Martinez-Mesa J (2013). Abstract P1- 09-06: breast cancer in the pan-American region: inequities in incidence and mortality rates according to the human development index. Cancer Research, 73.
  7. Bray F, Jemal A, Grey N, Ferlay J, Forman D (2012). Global cancer transitions according to the human development index (2008-2030): a population-based study. Lancet Oncol J, 13,790-801.
  8. Clayton D, Kaldor J (1987). Empirical Bayes estimates of age-standardized relative risks for use in disease mapping. Biometrics J, 43, 671-81.
  9. Fehm T, Ruckhaberle E, Lammert E, Zeeb M (2013). Introduction to breast cancer. Principles Metabolism Health Diseases J, 379-84.
  10. HolakoueeNaeeni K, Ardalan A, Mahmoudi M, MotovallianA,Yahia Poor Y (2006). Study on risk factors for breast cancer in Mazandaran in 1383. Public Health Inst Health Res J, 4, 27-36.
  11. Jafari-Koshki T, Schmid VJ, Mahaki B (2014). Trends of breast cancer incidence in Iran during 2004-2008: A Bayesian space-time model. Asian Pac J Cancer Prev, 15, 1557-61.
  12. Kahn HS, Tatham LM, Patel AV, Thun MJ, Heath Jr CW (1998). Increased cancer mortality following a history of nonmelanoma skin cancer. Jama J, 280, 910-2.
  13. Kerenyi NA, Pandula E, Feuer G (1990). Why the incidence of cancer is increasing: the role of 'light pollution'. Medical Hypotheses J, 33, 75-8.
  14. Kruk J (2007). Association of lifestyle and other risk factors with breast cancer according to menopausal status: a case-control study in the Region of Western Pomerania (Poland). Asian Pac J Cancer Prev, 8, 513-24.
  15. Kruk J (2014). Lifestyle components and primary breast cancer prevention. Asian Pac J Cancer Prev, 15, 10543-5.
  16. Lawson A, Biggeri A, Bohning D, et al (1999). Disease mapping and risk assessment for public health: John Wiley & Sons.
  17. Lawson AB, Browne WJ, Rodeiro CLV (2003). Disease mapping with WinBUGS andMLwiN: John Wiley & Sons;
  18. 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.
  19. Mahaki B, Mehrabi Y, Kavousi A, Mohammadian M, Khodakarim S (2013). Applying gamma-poisson, lognormal, and BYM Models in comparing relative risk of suicide among provinces of Ilam, Iran. J Health Syst Res, 9, 86-95.
  20. RahmatiYamchi M, Zarghami N, RahbaniNoubar M, Najafipour R, Mobsser M (2013). Correlation between telomerase gene expression and different stages of breast cancer and obesity. 2, 35-43.
  21. Saki A, Hajianzadeh E, Tehranian N (2011). Evaluation of breast cancer risk factors using analysis of tree models. OfoghDanesh J, 17, 60-7
  22. Shahar S, Salleh RM, Ghazali AR, Koon PB, Mohamud W (2010). Roles of adiposity, lifetime physical activity and serum adiponectin in occurrence of breast cancer among Malaysian women in Klang Valley. Asian Pac J Cancer Prev, 11, 61-6.
  23. Sharif Zadeh G, Hosseni M, Kermani T, Atai M, Akhbari H (2011). Factors associated with breast cancer-a case-control study. Birjand Univers J Medical Sci, 18, 191-9.
  24. Snowdon DA, PHILLIPS RL, Choi W (1984). Diet, obesity, and risk of fatal prostate cancer. Am J epidemiol, 120, 244-50.
  25. Tehrani M, MohseniS (2013). Case finding and clinical study of obese patients. Iranian J Diabetes Metabolism, 12, 393-8.
  26. VahedianShahroodi M, Poorhaji F, Ismaili H, Poorhaji F (2013). The role of physical activity in the prevention of breast cancer. proceedings of the eighth student conference of medical universities in East.1.
  27. Yost K, Perkins C, Cohen R, Morris C, Wright W (2001). Socioeconomic status and breast cancer incidence in California for different race/ethnic groups. Cancer Causes Control J, 12, 703-11.