Nuffield Department of Population Health, University of Oxford, Oxford, UK.
The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK.
Int J Cancer. 2020 Oct 15;147(8):2131-2141. doi: 10.1002/ijc.33014. Epub 2020 Apr 30.
Breast cancer (BC) is the leading cause of cancer in sub-Saharan Africa (SSA) with rapidly increasing incidence rates reported in Uganda and Zimbabwe. However, the magnitude of these rising trends in premenopausal and postmenopausal women is unknown in most African countries. We used data from the African Cancer Registry Network on incident breast cancers in women from 11 population-based cancer registries in 10 countries representing each of the four SSA regions. We explored incidence changes among women before and after age 50 by calendar period and, where possible, generational effects in this unique sub-Saharan African cohort. Temporal trends revealed increasing incidence rates in all registries during the study period, except in Nairobi where rates stabilised during 2010 to 2014 after rapidly increasing from 2003 to 2010 (APC = 8.5 95%, CI: 3.0-14.2). The cumulative risk varied between and within regions, with the highest risks observed in Nairobi-Kenya, Mauritius and the Seychelles. There were similar or more rapidly increasing incidence rates in women aged 50+ compared to women <50 years in all registries except The Gambia. Birth cohort analyses revealed increases in the incidence rates in successive generations of women aged 45 and over in Harare-Zimbabwe and Kampala-Uganda. In conclusion, the incidence of BC is increasing rapidly in many parts of Africa; however, the magnitude of these changes differs. These results highlight the need for urgent actions across the cancer continuum from in-depth risk factor studies to provision of adequate therapy as well as the necessity of supporting the maintenance of good quality population-based cancer registration in Africa.
乳腺癌（BC）是撒哈拉以南非洲（SSA）地区的主要癌症原因，乌干达和津巴布韦报告的发病率迅速上升。然而，在大多数非洲国家，绝经前和绝经后妇女的这些上升趋势的幅度尚不清楚。我们使用了来自非洲癌症登记网络的数据，该数据涉及来自 10 个国家的 11 个基于人群的癌症登记处的 11 个国家的妇女中发生的乳腺癌。我们通过日历期探索了 50 岁之前和之后的妇女的发病率变化，并在这个独特的撒哈拉以南非洲队列中尽可能探索了代际影响。时间趋势显示，除了内罗毕，所有登记处的发病率在研究期间都在增加，在内罗毕，发病率在 2010 年至 2014 年期间稳定下来，因为 2003 年至 2010 年期间迅速增加（APC = 8.5 95%，CI：3.0-14.2）。风险在不同地区之间和内部有所不同，在内罗毕-肯尼亚、毛里求斯和塞舌尔观察到最高风险。除冈比亚外，所有登记处 50 岁以上的妇女的发病率与 50 岁以下的妇女相似或增长更快。出生队列分析显示，哈拉雷-津巴布韦和坎帕拉-乌干达的 45 岁及以上妇女的发病率呈递增趋势。总之，BC 的发病率在非洲许多地区迅速上升；然而，这些变化的幅度不同。这些结果强调了需要在癌症连续体中采取紧急行动，从深入的风险因素研究到提供足够的治疗，以及支持在非洲维持良好的基于人群的癌症登记的必要性。
