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,
ar
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
Eastern Africa
Western Africa
Southern Africa
South-Central Asia
South America
Melanesia
Middle Africa
Central America
Caribbean
Less developed regions
Polynesia
South-Eastern Asia
World
Central and Eastern Europe
Eastern Asia
Micronesia
More developed regions
Northern Europe
Southern Europe
Western Europe
Northern Africa
Northern America
Australia/New Zealand
Western Asia
Cervical cancer
Mortality Incidence
Figure 2: Incidence of, and mortality from, breast and cervical cancers by World region, 2008
Data extracted from GLOBOCAN (4) International Agency for Research on Cancer. GLOBOCAN 2008. Cancer incidence, mortality and prevalence worldwide in 2008.
Available from: http://globocan.iarc.fr/