Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.
Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
Med Decis Making. 2018 Apr;38(1_suppl):24S-31S. doi: 10.1177/0272989X17717981.
Breast cancer simulation models must take changing mortality rates into account to evaluate the potential impact of cancer control interventions. We estimated mortality rates due to breast cancer and all other causes combined to determine their impact on overall mortality by year, age, and birth cohort.
Based on mortality rates from publicly available datasets, an age-period-cohort model was used to estimate the proportion of deaths due to breast cancer for US women aged 0 to 119 years, with birth years 1900 to 2000. Breast cancer mortality was calculated as all-cause mortality multiplied by the proportion of deaths due to breast cancer; other-cause mortality was the difference between all-cause and breast cancer mortality.
Breast cancer and other-cause mortality rates were higher for older ages and birth cohorts. The percent of deaths due to breast cancer increased across birth cohorts from 1900 to 1940 then decreased. Among 50-year-old women, in the 1920 birth cohort, 52 (9.9%) of 100,000 deaths (95% CI, 9.8% to 10.1%) were attributed to breast cancer whereas 476 of 100,000 were due to other causes; in the 1960 birth cohort, 22 (8.5%) of 100,000 deaths (95% CI, 8.3% to 8.7%) were attributed to breast cancer with 242 of 100,000 deaths due to other causes. The percentage of all deaths due to breast cancer was highest (4.1% to 12.9%) for women in their 40s and 50s for all birth cohorts.
This study offers evidence that advances in breast cancer screening and treatment have reduced breast cancer mortality for women across the age spectrum, and provides estimates of age-, year- and birth cohort-specific competing mortality rates for simulation models. Other-cause mortality estimates are important in these models because most women die from causes other than breast cancer.
乳腺癌模拟模型必须考虑不断变化的死亡率，以评估癌症控制干预措施的潜在影响。我们估计了乳腺癌和所有其他原因导致的死亡率，以确定其对逐年、按年龄和出生队列的总死亡率的影响。
基于公开数据集中的死亡率数据，使用年龄-时期-队列模型估计了美国 0 至 119 岁女性乳腺癌死亡的比例，出生年份为 1900 年至 2000 年。乳腺癌死亡率计算为全因死亡率乘以乳腺癌死亡率比例；其他原因死亡率为全因死亡率与乳腺癌死亡率之差。
乳腺癌和其他原因死亡率随年龄和出生队列的增加而升高。乳腺癌死亡率比例在 1900 年至 1940 年的出生队列中逐渐增加，然后下降。在 50 岁的女性中，在 1920 年出生队列中，每 100,000 例死亡中有 52 例（99%置信区间为 9.8%至 10.1%）归因于乳腺癌，而每 100,000 例死亡中有 476 例归因于其他原因；在 1960 年出生队列中，每 100,000 例死亡中有 22 例（95%置信区间为 8.3%至 8.7%）归因于乳腺癌，而每 100,000 例死亡中有 242 例归因于其他原因。所有出生队列中，40 多岁和 50 多岁的女性死于乳腺癌的比例最高（4.1%至 12.9%）。
本研究为乳腺癌筛查和治疗的进步降低了各年龄段女性乳腺癌死亡率提供了证据，并为模拟模型提供了年龄、年份和出生队列特定的竞争死亡率估计。在这些模型中，其他原因死亡率的估计很重要，因为大多数女性死于乳腺癌以外的原因。
