Cancer Control 2014

CANCER MANAGEMENT

CANCER CONTROL 2014 53

continue to be even more so as coverage of the HPV vaccine

progresses, a disease that kills women living in poverty. The

burden of breast cancer, by contrast, falls on women at all

levels of income, yet the probability of death is greater if the

woman is poor.20 As is evident from Figure 2, while the

incidence of breast cancer is several times higher in countries

of high income, mortality rates are similar indicating that

fatality is much higher in low- and middle-income countries.

Further, and particularly due to the relatively young age

distributions of populations, a large group of young women

face these cancers in low- and middle-income countries.

Although the incidence of breast cancer typically increases

with age, as a fraction of all women within this age group, it is

twice as common in women under age 50 - often the primary

custodians and caregivers of families including young

children - in low- and middle-income countries as it is in highincome countries.5,28

A recent study comparing four Latin

American countries to the United States and Canada found

similar results.29 This generates a particular set of challenges

related to maternal health and reproduction.

Data and methods

We use data from several sources - global cross-sectional

data, historical data from a sub-set of countries and subnational data from Mexico

- to demonstrate the cancer

transition for women by comparing mortality rates for

cervical and breast cancer.

The global cross-sectional data are age-adjusted (to the

world standard population) rates for the year 2008 extracted

from GLOBOCAN (http://globocan.iarc.fr/). Historical

trend data for specific countries are age-adjusted (to the

world population) rates extracted from CI5plus

(http://ci5.iarc.fr/ci5plus/ci5plus.htm).

The analysis for Mexico uses official mortality data

published by the Ministry of Health. We use the sub-national

series that spans 1979 to 2010 at the state level.30 The statelevel

data aggregates over a wide range of municipalities,

including both larger urban centres where access to health

and other services tends to be better and levels of poverty

less severe, and smaller, poorer municipalities with much

less access.

These data are aggregated according to the index of

deprivation (marginalization) developed and maintained by

the National Population Council.

31 Mexico's five-category

deprivation index differentiates the 32 states (federal

entities) and municipalities according to the proportion of

the population with low levels of education, residence in

inadequate dwellings (without drainage, electricity or water,

or characterized by overcrowding or earth flooring), low

household monetary income and rural residence. The index,

0 20 40 60 80 100

Western Europe

Australia/New Zealand

Northern Europe

Northern America

Southern Europe

More developed Regions

Polynesia

Micronesia

Central and Eastern Europe

South America

Caribbean

World

Southern Africa

Northern Africa

Western Asia

Western Africa

South-Eastern Asia

Less developed regions

Central America

Eastern Asia

South-Central Asia

Melanesia

Middle Africa

Eastern Africa

Breast cancer Mortality Incidence

0 10 20 30 40