Characteristics of the national health system, stage of breast cancer at diagnosis and mortality from breast cancer: a population-based analysis



In some countries, age-standardized breast cancer death rates have declined by 2-4% per year since the 1990s, but others have yet to achieve this result. In this study, we sought to characterize the associations between characteristics of the national health system and the age-standardized death rate from breast cancer, and the degree of reduction in breast cancer correlated with national reductions in breast cancer. age-standardized death rate.


In this population-based study, national estimates of the age-standardized death rate for women aged 69 and under obtained from GLOBOCAN 2020 were correlated with a large panel of standardized data from the national health system. as reported in the WHO 2020 Cancer Country Profiles. These health systems characteristics include health expenditure, universal health coverage service coverage index (UHC index), dedicated funding for health programs. early detection, breast cancer early detection guidelines, referral systems, cancer control plans, number of dedicated public and private cancer centers per 10,000 cancer patients, and pathology services . We tested the differences between continuous variables using the Kruskal-Wallis nonparametric test and for categorical variables using the Pearson χ2 test. Single and multiple linear regression analyzes were fitted to identify associations between health system characteristics and age-standardized breast cancer death rates. Data on TNM stage at diagnosis were obtained from national or subnational cancer registries, supplemented by a review of the PubMed literature from 2010 to 2020. Trends in mortality from 1950 to 2016 were assessed at using the WHO cancer mortality database. The significance level was set at a p-value of 0.05 or less.


148 countries had comprehensive health system data. The following variables were significantly higher in high-income countries than in low-income countries in the unadjusted analyzes: health expenditure (p = 0.0002), UHC index (p year for at least 3 consecutive years since 1990 had at least 60% of patients with invasive breast cancer presenting as stage I or II disease. Some countries have achieved this reduction without most women having access to population-based mammography screening.


Countries with low breast cancer death rates are characterized by increased levels of coverage of essential health services and a higher number of public cancer centers. Among countries that achieve lasting reductions in mortality, the majority of breast cancers are diagnosed at an early stage, which reinforces the value of early clinical diagnosis programs in improving breast cancer outcomes.




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