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Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database

BMJ 2010; 341 doi: (Published 11 August 2010) Cite this as: BMJ 2010;341:c3620

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  1. Philippe Autier, group head and research director12,
  2. Mathieu Boniol, biostatistician and senior researcher12,
  3. Carlo LaVecchia, professor3,
  4. Lars Vatten, professor4,
  5. Anna Gavin, director of Northern Ireland Cancer Registry5,
  6. Clarisse Héry, researcher1,
  7. Mary Heanue, senior researcher1
  1. 1International Agency for Research on Cancer, Lyon, France
  2. 2International Prevention Research Institute (iPRI), Lyon, France
  3. 3Mario Negri Institute and School of Medicine of the University of Milan, Milan, Italy
  4. 4Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
  5. 5Northern Ireland Cancer Registry, Queen’s University, Belfast, Northern Ireland
  1. Correspondence to: P Autier, International Prevention Research Institute (iPRI), 95 Cours Lafayette, 69006 Lyon, France philippe.autier{at}
  • Accepted 21 May 2010


Objective To examine changes in temporal trends in breast cancer mortality in women living in 30 European countries.

Design Retrospective trend analysis.

Data source WHO mortality database on causes of deaths

Subjects reviewed Female deaths from breast cancer from 1989 to 2006

Main outcome measures Changes in breast cancer mortality for all women and by age group (<50, 50-69, and ≥70 years) calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in all age mortality began to change.

Results From 1989 to 2006, there was a median reduction in breast cancer mortality of 19%, ranging from a 45% reduction in Iceland to a 17% increase in Romania. Breast cancer mortality decreased by ≥20% in 15 countries, and the reduction tended to be greater in countries with higher mortality in 1987-9. England and Wales, Northern Ireland, and Scotland had the second, third, and fourth largest decreases of 35%, 29%, and 30%, respectively. In France, Finland, and Sweden, mortality decreased by 11%, 12%, and 16%, respectively. In central European countries mortality did not decline or even increased during the period. Downward mortality trends usually started between 1988 and 1996, and the persistent reduction from 1999 to 2006 indicates that these trends may continue. The median changes in the age groups were −37% (range −76% to −14%) in women aged <50, −21% (−40% to 14%) in 50-69 year olds, and −2% (−42% to 80%) in ≥70 year olds.

Conclusions Changes in breast cancer mortality after 1988 varied widely between European countries, and the UK is among the countries with the largest reductions. Women aged <50 years showed the greatest reductions in mortality, also in countries where screening at that age is uncommon. The increasing mortality in some central European countries reflects avoidable mortality.


  • Contributors: Study concept and design: PA. Data collection: PA, MH, MB. Data analysis: PA, CH, MB. Data interpretation: all authors. Writing of manuscript: PA, CLV, AG, LV. Editing of final version and approval for submission: all authors. PA is the guarantor of the study.

  • Funding: Institutions in which authors work had no influence in the conduct of the research or in the writing of the paper. The work of the Northern Ireland Cancer Registry is funded by the Public Health Agency for Northern Ireland

  • Competing interests: All authors have completed the Unified Competing Interest form and declare no financial or non-financial interests that may be relevant to the submitted work.

  • Ethical approval: Not required.

  • Data sharing: The WHO mortality database is available at

  • Accepted 21 May 2010

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