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Epidemiology of breast cancer in the Czech Republic

Dušek L.¹, Abrahámová J.², Májek O.¹, Daneš J.³, Mužík J.^1
1 Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
² Thomayer Hospital Prague, Czech Republic
³ 1st Faculty of Medicine at Charles University in Prague, Czech Republic

ARTICLE CONTENTS

• Breast cancer incidence and prevalence rates in women
• Breast cancer mortality rates in women
• Age of breast cancer patients
• Diagnosis of breast cancer – tumour morphology and clinical stage of disease
• Breast cancer in young women
• Breast cancer in men

In the long term, cancer has been a serious health issue in the Czech Republic, particularly with respect to the ever growing number of newly diagnosed patients each year. Cancer epidemiology helps us understand this issue better, making it possible for us to assess the population burden, to point out high-risk groups in the population, to assess the effectiveness of diagnosis and treatment, and to predict the numbers of cancer patients, which is essential for planning health care costs in the future. However, the availability of comprehensive population-based data is an essential prerequisite for cancer epidemiology to be applied effectively. Thanks to the Czech National Cancer Registry (CNCR), which has been maintained and updated in a standardized manner since 1976, such data is available for the Czech Republic, covering the entire period from 1976 to 2009 (as on December 2012). CNCR contains records on all diagnosed cancers in the Czech population; this article deals with breast cancer, which is the most commonly diagnosed cancer in females.

Breast cancer incidence and prevalence rates in women

Breast cancer is the most common cancer (see Note) in Czech women, accounting for 24.3% of all newly diagnosed malignancies in the female population in 2005–2009 (see Figure 1). The incidence trend in the entire monitored period has continuously increased (see Figure 2) – apart from the last few years when it has stabilised and even decreased. A total of 5,975 women were diagnosed with breast cancer in 2009, representing 105.4 breast cancer patients per 100,000 women. In terms of prevalence, 61,407 women were alive in the Czech Republic in 2009 who have had a diagnosis of breast cancer, representing 1,147.9 patients per 100,000 women (see Table 1).

Note: excluding non-melanoma skin cancer

Figure 1: Incidence for all cancers combined in females in the Czech Republic, 2005–2009.	Figure 2: Trends in breast cancer (C50) incidence and mortality rates in females in the Czech Republic since 1977.

Table 1: Incidence and prevalence rates of breast cancer in females in the Czech Republic.

Data source: CNCR, IHIS (*)

High incidence of breast cancer is typical for economically developed countries, particularly for those of Northern and Western Europe and of North America. Czech breast incidence rates per 100,000 women rank 25th globally and 16th among European countries (see Figure 3).

Figure 3: International comparison of breast cancer (C50) incidence rates in females.	Figure 4: Stages of breast cancer (C50) in females in the Czech Republic at the time of diagnosis.

Breast cancer mortality rates in women

Breast cancer not only presents the major cancer incidence burden of the female population – it is also the most common cause of cancer death in women. 1,902 Czech women died of breast cancer in 2009, representing 36 deaths per 100,000 women. Despite the ever growing incidence of breast cancer, mortality has been stable in the long term (see Figure 2), which unequivocally demonstrates an improvement in treatment success, particularly thanks to a higher proportion of tumours detected at early clinical stages (see Figure 4).

Age of breast cancer patients

Breast cancer risk is strongly related to age, with incidence rates rising considerably after the age of 40. In the period between 2005 and 2009, around 50% of cases were diagnosed in the 54-73 age group, with the median age of 63 years (see Figure 5).

Figure 5: Age structure of breast cancer (C50) patients, 2005–2009.	Figure 6: Main morphological types of breast cancer (C50) in females as recorded in CNCR (*), 2005–2009.

Diagnosis of breast cancer – tumour morphology and clinical stage of disease

Basic characteristics of a newly diagnosed tumour involve its morphological type, biological behaviour (malignant or benign), exact location (topography) and stage of the disease. According to data from 2005–2009, ductal carcinoma is the most common type of breast cancer in women (78.9% of cases), followed by lobular carcinoma (12.8% of cases) (see Figure 6).

Clinical stage of any malignant neoplasm is one of the crucial characteristics needed to estimate the prognosis and to choose the right treatment strategy. The clinical stage is determined according to exactly specified rules which are stipulated in the so-called TNM classification of malignant tumours. According to pre-defined types of examination, the tumour is described with three parameters: T – size of the primary tumour, N – degree of spread to regional lymph nodes, N – presence of metastases in distant organs (beyond regional lymph nodes). These parameters are then employed to establish the clinical stage of the disease. Stages 1 and 2 are referred to as “early”, with a good prognosis and high treatment success; advanced stages 3 and 4, however, represent a high-risk group with a significantly poorer prognosis. The trend in the proportion of early stages among newly diagnosed breast cancers in Czech women has been rising over the entire monitored period. This trend has stabilised between 2007–2009 with 37–38% of cases in stage 1 and 32–33% of cases in stage 2 (see Figure 4). The introduction of modern diagnostic methods (such as mammography) have significantly contributed to the high proportion of early-detected clinical stages, combined with the nationwide use of those methods within the Czech National Breast Screening Programme (this website provides more detailed information about the programme).

Breast cancer in young women

Although the majority of breast cancer cases occcurs in middle-aged and elderly women, it can also affect young women. The incidence is extremely low in women under 20 (only 16 cases have been recorded over the entire monitored period since 1977), but it grows slowly after the age of 20. Between 2005 and 2009, breast cancer incidence in women aged 20–34 was 106 cases per year, representing 1.7% of all newly diagnosed cases of breast cancer (see Table 2).

Table 2: Newly diagnosed cases of breast cancer (C50) in younger females in the Czech Republic, 2005–2009.

Data source: CNCR (*)

Breast cancer in men

Although the vast majority of breast cancer cases occur in women, this disease can also affect men. Breast cancer in men, however, only occurs rarely, with an incidence of around 38 newly diagnosed cases per year, corresponding to 0.7 cases per 100,000 men (see Table 3).

Table 3: Epidemiological description of breast cancer (C50) in males in the Czech Republic.

Data source: CNCR (*)

Last updated on 11 December 2012

List of abbreviations (*)

CNCR = Czech National Cancer Registry
IHIS = Institute of Health Information and Statistics of the Czech Republic