Changes in breast cancer incidence may be attributed to implementation of all-national dispensarization: a population-based study from North-West Russia

Background

Breast cancer (BC) is the most common cancer pathology among women worldwide and leading cause of death in the developed and less developed countries. Consequently, there were two projects implemented in 2006 (National project “Health”) and in 2013 (Law of All-national dispensarization) focusing on improvement in health care delivery in Russia. The aim of study is to evaluate the effects of the projects on incidence and stage proportion in breast cancer.

Methods

In this retrospective population-based study, we analyzed data from the Arkhangelsk regional Cancer Registry over the period 2000-2014. The variables for the analysis included female gender only, date of birth, date of diagnosis, and stage according to the TNM 7 classification. Age-standardized rates per 100,000 person-years were calculated, using the direct method of standardization to the world population. The Joinpoint Regression Analysis program, version 4.2.0.2, was used to calculate trends of BC incidence and Stage proportions.

Results

Over the period of study, 5842 cases of breast cancer were recorded in the Arkhangelsk Regional Cancer Registry. The incidence of breast cancer has been increasing over the period from 35 to 48 cases per 100 000 between 2000 and 2014 with annual percentage change (APC) varying from 0.9% during a period 2000-2006 and 3.9% in 2007-2014. The proportion of Stage 1 varied from 9% to 21% between 2000 and 2014. In JoinPoint regression a significant growth of Stage 1 proportion was observed over the period 2011-2015 with APC 15.7%.

Conclusions

Over the past 15 years there has been a steady increase in breast cancer incidence in the Arkhangelsk region. Taking in account a significant growth of Stage 1 BC over the latter 4 years, this increase is at least partially explained by better earlier diagnosis after the implementation the All-national dispensarization in Russia. The National project “Health” is less possible responsible for the increased incidence.

Clinical trial identification

Legal entity responsible for the study

N/A

Funding

Northern State Medical University

Disclosure

All authors have declared no conflicts of interest.