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Open Access Research article

Competing risks to breast cancer mortality in Catalonia

Ester Vilaprinyo1*, Rosa Gispert2, Montserrat Martínez-Alonso3, Misericòrdia Carles4, Roger Pla5, Josep-Alfons Espinàs6 and Montserrat Rué3

Author Affiliations

1 Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Hospitalet de Llobregat Catalonia, Spain

2 Servei d'Informació i Estudis, Departament de Salut, Generalitat de Catalunya, Catalonia, Spain

3 Institut de Recerca Biomèdica de Lleida (IRBLLEIDA)-Universitat de Lleida, Catalonia, Spain

4 Facultat de Ciències Econòmiques i Empresarials, Universitat Rovira i Virgili, Catalonia, Spain

5 Institut Català de la Salut a Terres de l'Ebre, Tortosa, Catalonia, Spain

6 Pla Director d'Oncologia, Departament de Salut, Generalitat de Catalunya, Catalonia, Spain

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BMC Cancer 2008, 8:331  doi:10.1186/1471-2407-8-331

Published: 12 November 2008

Abstract

Background

Breast cancer mortality has experienced important changes over the last century. Breast cancer occurs in the presence of other competing risks which can influence breast cancer incidence and mortality trends. The aim of the present work is: 1) to assess the impact of breast cancer deaths among mortality from all causes in Catalonia (Spain), by age and birth cohort and 2) to estimate the risk of death from other causes than breast cancer, one of the inputs needed to model breast cancer mortality reduction due to screening or therapeutic interventions.

Methods

The multi-decrement life table methodology was used. First, all-cause mortality probabilities were obtained by age and cohort. Then mortality probability for breast cancer was subtracted from the all-cause mortality probabilities to obtain cohort life tables for causes other than breast cancer. These life tables, on one hand, provide an estimate of the risk of dying from competing risks, and on the other hand, permit to assess the impact of breast cancer deaths on all-cause mortality using the ratio of the probability of death for causes other than breast cancer by the all-cause probability of death.

Results

There was an increasing impact of breast cancer on mortality in the first part of the 20th century, with a peak for cohorts born in 1945–54 in the 40–49 age groups (for which approximately 24% of mortality was due to breast cancer). Even though for cohorts born after 1955 there was only information for women under 50, it is also important to note that the impact of breast cancer on all-cause mortality decreased for those cohorts.

Conclusion

We have quantified the effect of removing breast cancer mortality in different age groups and birth cohorts. Our results are consistent with US findings. We also have obtained an estimate of the risk of dying from competing-causes mortality, which will be used in the assessment of the effect of mammography screening on breast cancer mortality in Catalonia.