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

  • Mathew, Aleyamma (Divisions of Cancer Epidemiology & Bio-statistics, Regional Cancer Centre) ;
  • George, Preethi Sara (Divisions of Cancer Epidemiology & Bio-statistics, Regional Cancer Centre) ;
  • Arjunan, Asha (Divisions of Radiation Oncology, Regional Cancer Centre) ;
  • Augustine, Paul (Divisions of Surgical Oncology, Regional Cancer Centre) ;
  • Kalavathy, MC (Divisions of Cancer Epidemiology & Bio-statistics, Regional Cancer Centre) ;
  • Padmakumari, G (Divisions of Cancer Epidemiology & Bio-statistics, Regional Cancer Centre) ;
  • Mathew, Beela Sarah (Divisions of Radiation Oncology, Regional Cancer Centre)
  • Published : 2016.06.01


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 $10^5$ 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.


  1. Althuis MD, Fergenbaum JH, Garcia-Closas M, et al (2004). Etiology of hormone receptor-defined breast cancer: a systematic review of the literature. Cancer Epidemiol Biomarkers Prev, 13, 1558-68.
  2. Amadou A, Ferrari P, Muwonge R, et al (2013). Overweight, obesity and risk of premenopausal breast cancer according to ethnicity: a systematic review and dose-response metaanalysis. Obes Rev, 14, 665-78. https://doi.org/10.1111/obr.12028
  3. Anders CK, Johnson R, Litton J, et al (2009). Breast cancer before age 40 years. Semin Oncol, 36, 237-49. https://doi.org/10.1053/j.seminoncol.2009.03.001
  4. Anderson WF, Chu KC, Chang S, Sherman ME (2004). Comparison of age-specific incidence rate patterns for different histopathologic types of breast carcinoma. Cancer Epidemiol Biomarkers Prev, 13, 1128-35.
  5. Assi HA, Khoury KE, Dbouk H, et al (2013). Epidemiology and prognosis of breast cancer in young women. J Thorac Dis, 1, 2-8.
  6. Bauer KR, Brown M, Cress RD, et al (2007). Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype. Cancer, 109, 1721-8. https://doi.org/10.1002/cncr.22618
  7. Bertucci F, Birnbaum D (2008). Reasons for breast cancer heterogeneity. J Biol, 7, 6. https://doi.org/10.1186/jbiol67
  8. Brenton JD, Carey LA, Ahmed AA, Caldas C (2005). Molecular classification and molecular forecasting of breast cancer: ready for clinical application? J Clin Oncol, 23, 7350-60. https://doi.org/10.1200/JCO.2005.03.3845
  9. Dey S, Boffetta P, Mathews A, et al (2009). Risk factors according to estrogen receptor status of breast cancer patients in Trivandrum, South India. Int J Cancer, 125, 1663-70. https://doi.org/10.1002/ijc.24460
  10. Dhillon PK, Yeole BB, Dikshit R, et al (2011). Trends in breast, ovarian and cervical cancer incidence in Mumbai, India over a 30-year period, 1976-2005: an age-period-cohort analysis. Br J Cancer, 105, 723-30. https://doi.org/10.1038/bjc.2011.301
  11. Dikshit RP, Yeole BB, Nagrani R, et al (2012). Increase in breast cancer incidence among older women in Mumbai: 30-year trends and predictions to 2025. Cancer Epidemiol, 36, 215-20. https://doi.org/10.1016/j.canep.2012.03.009
  12. Dolle JM, Daling JR, White E, et al (2009). Risk factors for triple-negative breast cancer in women under the age of 45 years. Cancer Epidemiol Biomarkers Prev, 18, 1157-66. https://doi.org/10.1158/1055-9965.EPI-08-1005
  13. Ferlay J, Soerjomataram I, Ervik M, et al (2013). GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France.
  14. Gajalakshmi V, Mathew A, Brennan P, et al (2009). Breast feeding and breast cancer risk in India: a multicenter casecontrol study. Int J Cancer, 125, 662-5. https://doi.org/10.1002/ijc.24429
  15. Ghiasvand R, Adami HO, Harirchi I, et al (2014). Higher incidence of premenopausal breast cancer in less developed countries; myth or truth? Ghiasvand et al. BMC Cancer, 14, 343. https://doi.org/10.1186/1471-2407-14-343
  16. Hemminki K, Försti A, Sundquist J, Mousavi S (2011). Preventable breast cancer is postmenopausal. Breast Cancer Res Treat, 125, 163-167. https://doi.org/10.1007/s10549-010-0926-8
  17. Huang CS, Lin CH, Lu YS, Shen CY (2010). Unique features of breast cancer in Asian women-Breast cancer in Taiwan as an example. J Steroid Biochemistry Molecular Biol, 118, 300-3. https://doi.org/10.1016/j.jsbmb.2009.12.017
  18. Ilic M, Vlajinac H, Marinkovic J, Vasiljevic S (2013). Joinpoint regression analysis of female breast cancer mortality in Serbia 1991-2010. Women Health, 53, 439-50. https://doi.org/10.1080/03630242.2013.806388
  19. Jemal A, Center MM, DeSantis C, Ward EM (2010). Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev, 19, 1893-907. https://doi.org/10.1158/1055-9965.EPI-10-0437
  20. Jia M, Zheng R, Zhang S, et al (2015). Female breast cancer incidence and mortality in 2011, China. J Thorac Dis, 7, 1221-6.
  21. Keramatinia A, Mousavi-Jarrahi S, Hiteh M, Mosavi-Jarrahi A (2014). Trends in incidence of breast cancer among women under 40 in Asia, Asian Pac J Cancer Prev, 15, 1387-90. https://doi.org/10.7314/APJCP.2014.15.3.1387
  22. Kim HJ, Fay MP, Feuer EJ, Midthune DN (2000). Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 19, 335-51. https://doi.org/10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z
  23. Leung GM, Thach TQ, Lam TH, et al (2002). Trends in breast cancer incidence in Hong Kong between 1973 and 1999: an age-period-cohort analysis. Br J Cancer, 87, 982-8. https://doi.org/10.1038/sj.bjc.6600583
  24. Li C, Yu C, Wang P (2015). An age-period-cohort analysis of female breast cancer mortality from 1990-2009 in China. Int J Equity Health, 14, 76. https://doi.org/10.1186/s12939-015-0211-x
  25. Lima CA, Rangel MR, Macedo-Lima M, da Silva AM (2012). Time trends in breast cancer incidence and mortality in a mid-sized northeastern Brazilian city. BMC Public Health, 12, 883. https://doi.org/10.1186/1471-2458-12-883
  26. Mathew A, Gajalakshmi V, Rajan B, et al (2008). Pattern of anthropometric factors among urban and rural women in south India and the risk of breast cancer: a multicentric case-control study. Br J Cancer, 99, 207-213. https://doi.org/10.1038/sj.bjc.6604423
  27. Mathew A, Gajalakshmi V, Rajan B, et al (2009). Physical activity level among urban and rural women in south India and the risk of breast cancer: a case-control study. Eur J Cancer Prev, 18, 368-76. https://doi.org/10.1097/CEJ.0b013e32832e1c46
  28. Mathew A, Rajan B, Pandey M (2004). Do younger women with non-metastatic and non-inflammatory breast carcinoma have poor prognosis? World J Surg Oncol, 2, 2. https://doi.org/10.1186/1477-7819-2-2
  29. Merlo DF, Ceppi M, Filiberti R, et al (2012). Breast cancer incidence trends in European women aged 20-39 years at diagnosis. Breast Cancer Res Treat, 134, 363-70. https://doi.org/10.1007/s10549-012-2031-7
  30. Murthy N S, Chaudhry K, Nadayil D, et al (2009). Changing trends in incidence of breast cancer: Indian scenario. Ind J Cancer, 46, 73-4. https://doi.org/10.4103/0019-509X.48603
  31. NCRP (National Cancer Registry Programme) (2016). Three year report of the population based cancer registries 2012-2014: Report of 27 PBCRs: Indian Council Medical Research, Bangalore, India.
  32. Porter P (2008). "Westernizing" women's risks? Breast cancer in lower-income countries. New England J Med, 358, 213-6. https://doi.org/10.1056/NEJMp0708307
  33. Rose DP, Vona-Davis L (2010). Interaction between menopausal status and obesity in affecting breast cancer risk. Maturitas, 66, 33-8. https://doi.org/10.1016/j.maturitas.2010.01.019
  34. Rossouw JE, Anderson GL, Prentice RL, et al (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA, 288, 321-33. https://doi.org/10.1001/jama.288.3.321
  35. Sloan FA, Gelband H, editors (2007). Cancer control opportunities in low- and middle-income countries. Washington, DC, USA: Institute of Medicine of the National Academies.
  36. Sprague BL, Trentham-Dietz A, Burnside ES (2010). Socioeconomic disparities in the decline in invasive breast cancer incidence. Breast Cancer Res Treat, 122, 873-878. https://doi.org/10.1007/s10549-010-0737-y
  37. Takiar R, Shobana B (2009). Cancer incidence rates and the problem of denominators-a new approach in Indian cancer registries. Asian Pac J Cancer Prev, 10, 123-6.
  38. Takiar R, Srivastav A (2008). Time trend in breast and cervix cancer of women in India (1990-2003). Asian Pac J Cancer Prev, 9, 777-80.
  39. Unger-Saldana K (2014). Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol, 10, 465-77.
  40. Yeole BB, Kurkure AB (2003). An epidemiological assessment of increasing incidence and trends in breast cancer in Mumbai and other sites in India, during the last two decades. Asian Pac J Cancer Prev, 4, 51-6.