Breast Cancer in Iraq,Incidence Trends from 2000-2009

Background: Breast cancer is the most frequent malignancy of women worldwide. In Iraq, breast cancer ranksfirst among cancers diagnosed in women but no studies have been conducted on incidence trends. The presentstudy of breast cancer in the country during 2000-2009 was therefore performed. Materials and Methods: Theregistered data for breast cancer cases were collected from the Iraqi Cancer Registry/Ministry of Health. Thesignificance of incidence rate trends during 2000-2009 was tested using Poisson regression. Age-standardizedrates (ASR), and age-specific rates per 100,000 population were calculated. Results: A total of 23,792 incidentbreast cancer cases were registered among females aged ≥15 years, represented 33.8% of all cancers in femalesregistered during 2000-2009. It ranked first in all the years. The median age at diagnosis was 49 and the mean agewas 52 years. The incidence rate of all female breast cancer in Iraq (all ages) increased from 26.6 per 100,000 in2000 to 31.5 per 100,000 in 2009 (APC=1.14%, p<.0001). The incidence in age groups (40-49), (50-59) and (70+)increased in earlier years and has recently (2005-2009) become stable. The incidence in age group (60-69) didnot decline since 2003, while the incidence rates in the age group (15-39) started to decline in 2004. Conclusions:With the Iraqi Cancer Registry data during the period 2000-2009, the incidence of all female breast cancer inIraq (all ages) has risen. We found rapid increase in the age specific incidence rate among age group 60-69.However, breast cancer among Iraqi women still affects younger age groups than their counterparts in developedcountries. Further epidemiological research is needed to examine possible causes and prevention measures.     

Time Trend of Upper Gastrointestinal Cancer Incidence in China from 1990 to 2019 and Analysis Using an Age–Period–Cohort Model

The aim of this study was to investigate the upper gastrointestinal cancer incidence trend in China from 1990 to 2019 with Joinpoint software and to evaluate the age effect, cohort effect, and period effect using the age–period–cohort model, with the data obtained from the Global Burden of Disease, Injuries, and Risk Factors Study. The crude incidence rate (CR) of upper gastrointestinal cancer in China increased from 41.48/100,000 in 1990 to 62.64/100,000 in 2019, and the average annual percent change (AAPC) was 1.42 (p < 0.05). The age-standardized incidence rate (ASIR) decreased from 50.77/100,000 to 37.42/100,000, and the AAPC was −1.12 (p < 0.05). The net drift was −0.83 (p < 0.05), and the local drifts in the 35–79 age groups of males and all age groups of females were less than 0 (p < 0.05). The age effect showed that the upper gastrointestinal cancer onset risk gradually increased with age, the period effect was fundamentally manifested as a downward trend in onset risk after 2000, and the cohort effect indicated the decreased onset risk of the overall birth cohort after 1926. The ASIR of upper gastrointestinal cancer in China from 1990 to 2019 showed a downward trend, and the onset risk indicated the age, period, and cohort effects.     

Karachi Cancer Registry (KCR): Age-Standardized Incidence Rate by Age-Group and Gender in a Mega City of Pakistan

Objectives: To estimate the cancer incidence by age group and gender for the population of Karachi Division by analyzing the Karachi Cancer Registry data of 2017-19. Settings: The population of Karachi division is 16.1 million according to national census 2017. ‘Karachi Cancer Registry’ which is a part of ‘National Cancer Registry’ is collecting data from eight major hospitals in Karachi since 2017. For outcome measures, cancer counts and the age standardized incidence rates (ASIR) per 100,000 population were computed for age groups (0–14, 15–19 and ≥20 years), in both genders and all cancer site/type. Methods: The population denominators were based on the population of Karachi division estimated at 16.1 million in the population census, 2017. Counts and age-standardized incidence rates (ASIR) were calculated for each of the three age categories. Results: From Jan 2017 till Dec 2019 a total of 33,309 malignant cases were recorded in KCR database comprising 17,490 (52.5%) females and 15,819 (47.5%) males. ASIRs in age groups 0-14, 15-19 and ≥ 20 years, among female were 11.5, 2.4 and 223.6 and in males were 17.6, 3.2 and 216.7 respectively. The commonest diagnosis in children, adolescent and adults were (1) among females: children; bone (3.12),  leukemia (2.09) brain/CNS (1.26); in adolescents: bone (0.78), brain/CNS (0.27), connective and soft tissue (0.11), in adults: breast cancer (76.07), oral cancer (16.68) and ovary (10.89) respectively, and (2) among males: children; bone (4.56),  leukemia (2.79) and brain/CNS (1.88); in adolescent; bone (1.19), brain/CNS (0.31) and leukemia (0.21) and in adults: oral cancer (42.83), liver (16.10) and bone (13.37) respectively. Conclusion: Oral Cancer, a largely preventable cancer is the leading cancer in Karachi adult males while in female adults Breast Cancer is the leading cancer followed by Oral Cancer. In children and adolescents Bone, Leukemia and Brain/CNS malignancies are most common.     

Incidence of Childhood Leukemia in Iraq, 2000-2019

Background: Leukemia is a major concern for children worldwide. Around 30% of malignancies in children (ages 0–14) are caused by leukemia. Objective: This study aims to explore the time trends in the incidence of childhood leukemia (aged 0-14 years) in Iraq between 2000 and 2019. Methods: Poisson regression with a log link function was used to analyze the long-term trends of incidence related to childhood leukemia cancer based on published data from the Iraqi cancer registry between 2000 and 2019. Annual estimates of the population, by 5-year age groups and by gender obtained from the United Nations, population Division. Results: A total of 8,570 cases of leukemia children in Iraq between 2000 and 2019 were recorded, the boys to girl ratio were 1.32 to 1. The most diagnosed type of leukemia was Acute lymphoblastic leukemia, accounting for about 33.56%, followed by Leukemia Not specify (NOS) (17.3%) with a relatively equal proportion of stated instances between boys and girls in these subsets. The age-standardized incidence rates, aged 0-14 years, from 2000-2019 were 3.45/100,000 for both genders. The Joinpoint regression ASRs analysis of childhood leukemia from 2000-2019 among 0 –14 age group for both genders indicate that there was an overall significant increasing trend at 1.23% per year, while no one joinpoint was identified during the entire study period. Among boys, there was an overall insignificant increasing trend at 0.77% per year. Among girls, there was an overall significant increasing trend at 1.93% per year, while one joinpoint was identified during the entire study period.  Conclusions: The overall (both genders) incidence rate of childhood leukemia has been increasing significantly in Iraq. The test for trends was insignificant among boys, while it was significant among girls. The increasing trend of leukemia requires further epidemiological studies to describe incidence by geography in Iraq.     

Sociological Transition and Breast Cancer in the Arab World: the Experience of Lebanon

Background: Breast cancer is the leading cause of cancer death among females in Lebanon. This study aimed at analyzing its epidemiology in the country over time. Methods: Data were extracted from the Lebanese National Cancer Registry (NCR) for the years 2004 through 2010. Age-standardized and age-specific incidence rates for cancers per 100,000 population were calculated. Results: Breast cancer ranked first, accounting for an average of 37.6% of all new female cancer cases in Lebanon during the period of 2004-2010. Breast cancer was found to have been increasing faster than other hormone-related women’s cancers (i.e. of the ovaries and corpus uteri). The breast cancer age-standardized incidence rates (world population) (ASRw) increased steadily from 2004 (71.0) to 2010 (105.9), making the burden comparable to that in developed countries, reflecting the influence of sociological and reproductive patterns transitioning from regional norms to global trends. The age-specific incidence rates for breast cancer rose steeply from around age 35-39 years, to reach a first peak in the age group 45-49 years, and then dropped slightly between 50 and 64 years to rise again thereafter and reach a second peak in the 75+ age group. Five-year age-specific rates among Lebanese women between 35 and 49 years were among the highest observed worldwide in 2008. Conclusion: Breast cancer is continuously on the rise in Lebanon. The findings of this study support the national screening recommendation of starting breast cancer screening at the age of 40 years. It is mandatory to conduct an in-depth analysis of contributing factors and develop consequently a comprehensive National Breast Cancer Control strategy.     

1990—2019年江苏省男性前列腺癌疾病负担分析

目的 分析1990—2019年江苏省前列腺癌疾病负担的变化趋势。方法 采用2019年全球疾病负担研究中关于江苏省前列腺癌的发病率、死亡率、伤残调整寿命年(DALY)率、伤残损失寿命年(YLD)率以及过早死亡损失寿命年(YLL)率,分析1990—2019年江苏省前列腺癌疾病负担情况。利用Joinpoint软件计算前列腺癌标化发病率、标化死亡率、标化DALY率、标化YLD率和标化YLL率的年度变化百分比(Annual percentage change,APC)和平均年度变化百分比(Average annual percentage change,AAPC)。结果 1990—2019年江苏省前列腺癌标化发病率、标化YLD率均呈整体上升趋势(AAPC分别为2.10%、3.20%,P＜0.05),标化死亡率、标化DALY率和标化YLL率则呈现出下降的趋势(AAPC分别为-0.42%、-0.48%、-0.69%,P＜0.05)。1990年和2019年江苏省前列腺癌发病率和死亡率均随着年龄增长而上升,≥85岁组发病率和死亡率最高。1990年和2019年,≥85岁组前列腺癌DALY率、YLD率和YLL率均达到最高值。结论 1990—2019年,江苏省前列腺癌的整体疾病负担趋于下降,但发病水平持续上升,且前列腺癌导致的伤残负担持续升高,需加强前列腺癌的防治工作。     

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

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 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.     

2015年重庆市城乡女性乳腺癌发病及死亡现状分析

目的:了解重庆市女性乳腺癌发病与死亡现状,为开展乳腺癌防治提供建议.方法:收集整理2015年重庆市11个肿瘤登记点报告的乳腺癌(ICD-10编码为C50).采用SPSS 19.0统计分析发病率、死亡率、标化发病率、标化死亡率、构成比、顺位.不同地区间乳腺癌发病率与死亡率的比较采用χ2检验,年龄别发病率与死亡率趋势分析采用趋势χ2检验.结果:2015年11个肿瘤登记点女性乳腺癌粗发病率为31.48/10万,城市发病率(42.07/10万)高于农村(26.32/10万),差异有统计学意义(P=0.002),乳腺癌标化发病率为24.20/10万,在女性恶性肿瘤中顺位居第2位,占6.00%.女性乳腺癌粗死亡率为7.33/10万,城市(8.77/10万)与农村乳腺癌死亡率(6.62/10万)差异无统计学意义(P=0.099),乳腺癌标化死亡率为4.96/10万,在恶性肿瘤死亡顺位中居第6位,占2.10%.女性乳腺癌发病率25岁前低于5/10万,25岁后快速上升,50岁~年龄组达到高峰,随后下降.女性乳腺癌死亡率在40岁前低于5/10万,40岁后呈上升趋势,80岁~年龄组达到高峰.女性乳腺癌截缩发病率为56.01/10万,城市(67.91/10万)高于农村(50.55/10万),差异有统计学意义(P=0.001).截缩死亡率为10.75/10万,乳腺癌截缩死亡率城市(11.96/10万)与农村(10.42/10万)比较差异无统计学意义(P=0.136).发病累积危险度为2.27%,城市(3.07%)高于农村(1.93%),差异有统计学意义(P=0.039).死亡累积危险度为0.51%.结论:重庆市女性乳腺癌发病率与死亡率较高,应针对城乡女性乳腺癌发病死亡特点开展三级预防.     

European cancer mortality predictions for the year 2019 with focus on breast cancer

BackgroundTo overcome the lag with which cancer statistics become available, we predicted numbers of deaths and rates from all cancers and selected cancer sites for 2019 in the European Union (EU).Materials and methodsWe retrieved cancer death certifications and population data from the World Health Organization and Eurostat databases for 1970–2014. We obtained estimates for 2019 with a linear regression on number of deaths over the most recent trend period identified by a logarithmic Poisson joinpoint regression model. We calculated the number of avoided deaths over the period 1989–2019.ResultsWe estimated about 1 410 000 cancer deaths in the EU for 2019, corresponding to age-standardized rates of 130.9/100 000 men (−5.9% since 2014) and 82.9 women (−3.6%). Lung cancer trends in women are predicted to increase 4.4% between 2014 and 2019, reaching a rate of 14.8. The projected rate for breast cancer was 13.4. Favourable trends for major neoplasms are predicted to continue, except for pancreatic cancer. Trends in breast cancer mortality were favourable in all six countries considered, except Poland. The falls were largest in women 50–69 (−16.4%), i.e. the age group covered by screening, but also seen at age 20–49 (−13.8%), while more modest at age 70–79 (−6.1%). As compared to the peak rate in 1988, over 5 million cancer deaths have been avoided in the EU over the 1989–2019 period. Of these, 440 000 were breast cancer deaths.ConclusionBetween 2014 and 2019, cancer mortality will continue to fall in both sexes. Breast cancer rates will fall steadily, with about 35% decline in rates over the last three decades. This is likely due to reduced hormone replacement therapy use, improvements in screening, early diagnosis and treatment. Due to population ageing, however, the number of breast cancer deaths is not declining.     

Breast cancer incidence trends in deprived and affluent Scottish women

OBJECTIVE : Breast cancer is commoner in the affluent and breast cancer rates in many countries are rising; it remains unclear whether this incidence rise is consistent across the different socio-economic groups. The rising incidence of breast cancer may be related to changes in population risk factor profiles. This study aimed to determine breast cancer incidence trends in women of different socio-economic categories and whether these trends were related to breast cancer risk factor trends. DESIGN : Data on breast cancer incidence rates by deprivation quintile in Scotland 1991-2000 were analysed using linear regression. Data on first births at late maternal age, BMI trends (based on the Scottish Health Surveys) and breast screening uptake trends in the different categories were also analysed and their relation to breast cancer incidence trends explored. POPULATION AND SETTING : Breast cancer incidence data was based on all women in Scotland. BMI data was based on representative cross-sectional survey data from the Scottish Health Surveys-women in the 1995, 1998 and 2003 surveys were 16-64, 16-74 and aged 16 and over, respectively. First birth data was based on all women aged 35-39 in Scotland. Breast screening uptake data was studied in women of screening age, that is, aged 50-64. RESULTS : Breast cancer incidence rates in Scottish women are rising in parallel across all socio-economic categories and the incidence gap between deprived and affluent still remains. Since the late 1980s, numbers of first birth in Scottish women aged 35-39 have risen dramatically, especially in the affluent, but numbers were stable before this. The prevalence of obesity and mean BMI has increased over time in all socio-economic classes but BMI continues to be higher in the deprived. Uptake of screening invitations has increased in all socio-economic groups. CONCLUSIONS : Breast cancer is rising in women of all socio-economic status in Scotland and the deprived-affluent gap remains. Trends in late age at first pregnancy, prevalence of obesity and screening uptake do not fully explain the observed trends.     

Female Breast Cancer Mortality Rates in Turkey

The main objective of this study was to analyze the mortality trends of female breast cancer in Turkey betweenthe years 1987-2008. The rates per 100,000 age-standardized to the European standard population were assessedand time trends presented using joinpoint regression analysis. Average annual percent change (AAPC), anualpercent change (APC) and 95% confidence interval (CI) was calculated. Nearly 23,000 breast cancer deathsoccurred in Turkey during the period 1987-2008, with the average annual age-standardized mortality rate (ASR)being 11.9 per 100,000 women. In the last five years, significant increases were observed in all age groups, butthere was no significant change over the age of 65. In this period, the biggest significant increase was in the 45-54age group (AAPC=4.3, 95%CI=2.6 to 6.0).     

Assessment of the Risk of Breast Cancer Development Applying NCI Tool among Iraqi Women

Objective: As part of the bioinformatics studies, we utilized National Cancer Institute (NCI)’s Breast Cancer Risk Assessment Tool to estimate the five-year period and lifetime risk of breast cancer development among Iraqi risky women. Methods: Totally, 110 risky women aged 21-67 (mean=36±7.4) years were interviewed by a series of questions regarding the risk of breast cancer development. Moreover, 100 cases with mutation in the BRCA1 or BRCA2 genes were included. Results: Our results demonstrated that the patient’s estimated risk of breast cancer development during the next five years and lifetime (until the age 90 years) included 0.96% (p=0.211) and 9.97% (p=0.002), respectively being relatively low. Accordingly, the lifetime risk for the breast cancer development was significantly higher (10.38%) than that of 5-year. However, the age of patients was not significantly associated to the breast cancer development as there was no significant difference among various age groups. Conclusion: It was concluded that long-term or lifetime period plays as a significant risk factor for developing breast cancer among female patients who had had a screening episode in Iraq.     

2015年江苏省肝癌流行现状及2006—2015年变化趋势分析

[目的]分析江苏省2015年肝癌发病与死亡现状及2006—2015年变化趋势。[方法]收集整理江苏省经质量控制合格的的35个肿瘤登记处的2015年肿瘤登记资料,按性别、城乡和年龄组分层计算肝癌发病率和死亡率,并结合2015年江苏省相应分组的户籍人口资料,推算全省2015年肝癌的发病(死亡)数,以及全省肝癌的发病(死亡)率、年龄别发病(死亡)率、中国人口标化率(中标率)、世界人口标化率(世标率)、0~74岁累积发病(死亡)率及其在全部恶性肿瘤发病(死亡)中的构成和顺位等。汇总和整理全省各登记处2006—2015年肿瘤登记资料,应用Joinpoint软件,计算肝癌10年间的发病(死亡)中标率的平均年度变化百分比(AAPC)。中标率和世标率分别采用2000年中国人口普查标准人口构成和Segi’s世界标准人口年龄构成进行标化。[结果]江苏省2015年估计新发肝癌病例21 851例,约占全部恶性肿瘤发病构成的9.38%,位居恶性肿瘤发病顺位第4位。2015年江苏省肝癌发病率为28.68/10万,发病中标率为17.09/10万,发病世标率为16.78/10万,0~74岁累积发病率为1.94%。2015年江苏省估计肝癌死亡病例20 128例,约占全部恶性肿瘤死亡构成的12.95%,位居恶性肿瘤死亡顺位第4位。肝癌死亡率为26.42/10万,死亡中标率为15.52/10万,死亡世标率为15.24/10万,0~74岁累积死亡率为1.75%。2006—2015年江苏省肝癌发病中标率和死亡中标率均呈明显下降趋势,其AAPC分别为-5.30%(95%CI:-6.34%~-4.25%)和-5.72%(95%CI:-6.85%~-4.58%)。分城乡统计,无论男、女性,10年间城市地区的肝癌发病中标率和死亡中标率均无明显下降趋势;而农村地区呈显著下降趋势。[结论]江苏省肝癌的整体发病、死亡水平呈下降趋势,但仍是江苏居民中最常见的恶性肿瘤之一,相关防控工作仍需进一步加强。     

Breast cancer in New South Wales in 1972-1995: tumor size and the impact of mammographic screening.

To examine the use of mammographic screening in women in New South Wales (NSW), we measured uptake of initial mammograms and estimated the proportions of breast cancers that were screen detected. To see if mammographic screening has been associated with reductions in advanced breast cancers and mortality from breast cancer, we analyzed trends in age-specific and age-standardized breast cancer incidence and mortality from 1972 to 1995 and tumor size in 1986, 1989, 1992 and April to September 1995. Between 1984 and the end of 1995, an estimated 72% of NSW women in their 50s and 67% in their 60s had had at least 1 mammogram and, in 1995, an estimated 39% of invasive breast cancers in women in these age groups were detected by mammography. Before 1989, breast cancer incidence increased only slightly (+1.3% annually) but then, from 1990 to 1995, increased more rapidly (+3.1% annually). Between 1986 and 1995, rates of small cancers (< 1 cm) increased steeply by 2.7 times in women 40-49 years of age and 5.6 times in women 50-69 years of age. The incidence of large breast cancers (3+ cm), after little apparent change to 1992, fell by 17% in women 40-49 years of age and 20% in those 50-69 years of age to 1995. Breast cancer mortality increased slightly between 1972 and 1989 (+0.5% annually) but then fell (-2.3% annually) from 1990 to 1995. We concluded that breast cancer rates had been influenced in expected directions by the introduction of mammographic screening in women resident in NSW. We expect that recent falls in incidence of larger breast cancers and breast cancer mortality will become steeper as screening coverage increases in the second half of the 1990s.     

Breast cancer incidence and mortality in a Caribbean population: comparisons with African-Americans

We describe breast cancer incidence and mortality in the predominantly African-origin population of Barbados, which shares an ancestral origin with African-Americans. Age-standardized incidence rates were calculated from histologically confirmed breast cancer cases identified during a 45-month period (July 2002-March 2006). Mortality rates were estimated from death registrations over 10-years starting January 1995. There were 396 incident cases of breast cancer for an incidence rate of 78.1 (95% confidence interval (CI) 70.5-86.3), standardized to the US population. Breast cancer incidence in African-Americans between 2000 and 2004 was 143.7 (142.0-145.5) per 100,000. Incidence peaked at 226.6 (174.5-289.4) per 100,000 among Barbadian women aged 50-54 years, and declined thereafter, a pattern in marked contrast to trends in African-American women, whose rates continued to increase to a peak of 483.5 per 100,000 in those aged 75-79 years. Incidence rate ratios comparing Barbadian and African-American women showed no statistically significant differences among women aged>or=55 years (p相似文献   

International trends in cancer incidence in middle-aged and older adults in 44 countries

ObjectiveWe examine international incidence trends of lung, colorectal, prostate, and breast cancers, as well as all cancers combined excluding non-melanoma skin cancer (NMSC) in adults aged 50 and older, over a fifteen-year period using data from 113 high quality population-based cancer registries included in the Cancer in Five Continents (CI5) series and NORDCAN.Materials and methodsWe calculated annual incidence rates between 1998 and 2012 for ages 50–64, 65–74, and 75+, by sex and both sexes combined. We estimated average annual percentage change (AAPC) in rates using quasi-Poisson regression models.ResultsFrom 1998 to 2012, incidence trends for all cancers (excluding NMSC) have increased in most countries across all age groups, with the greatest increase observed in adults aged 75+ in Ecuador (AAPC = +3%). Colorectal cancer incidence rates increased in the majority of countries, across all age groups. Lung cancer rates among females have increased but decreased for males. Prostate cancer rates have sharply increased in men aged 50–64 with AAPC between 5% and 15% in 24 countries, while decreasing in the 75+ age group in 21 countries, by up to −7% in Bahrain. Female breast cancer rates have increased across all age groups in most countries, especially in the 65–74 age group and in Asia with AAPC increasing to 7% in the Republic of Korea.ConclusionsThese findings assist with anticipating changing patterns and needs internationally. Due to the specific needs of older patients, it is urgent that cancer systems adapt to address their growing number.     

Trends in cervical and breast cancer in Iceland. A statistical evaluation of trends in incidence and mortality for the period 1955-1989, their relation to screening and prediction to the year 2000

The time trends in incidence and mortality from cervical cancer and breast cancer in Iceland, from 1955 to 1989, were analyzed by fitting curvilinear regressions to the age-standardized rates. The effect of the screening was evaluated by comparing the curvature of the fitted regression lines and changes in screening activity. The incidence and mortality rates for both cancer types were predicted up to the year 2000. At the commencement of cervical cancer screening in 1964, both the incidence and mortality rates were on the increase. After 1970, both rates decreased significantly. Assuming that regular attendance at screening will be 85%, it is predicted that the incidence and mortality rates will level out at about 7.5 and 2 cases per 100,000 women per year, respectively, by the year 1995 and remain at that level. The incidence of breast cancer has increased steadily since 1955. A sharp rise has been observed since 1987, due to screening with mammography. The mortality rate has shown small but significant fluctuations with time. The incidence rate is predicted to increase at the same rate as before 1987 (i.e. at 1.1 cases per 100,000 women per year), but at a slightly higher level and is predicted to reach 84 cases per 100,000 women per year by the year 2000. Breast cancer mortality is predicted to decrease to about 17 cases per 100,000 women per year by 1995 and to remain at that level.