Time Trend Partitioning of Breast Cancer Prevalence and Mortality

Igor Akushevich, Duke University
Arseniy Yashkin, Duke University
Julia Kravchenko, Duke University
Bryce Durgin, Duke University
Rachel Greenup, Duke Medical Center
Shelley Hwang, Duke University
Kenneth C. Land , Duke University
Anatoliy I. Yashin, Duke University

The time trend of female breast cancer (FBC) prevalence and mortality is the result of three competing processes: changes in the incidence rate, stage-specific survival, and ascertainment at early stages. Our new partitioning approach allows for the evaluation of the relative contributions of each of these components. Applying this approach to SEER data, we found that from 1993 the increase in prevalence was due to increased incidence (explains approximately 50% of total trend), improved survival (30-35%) and increased ascertainment at early stages (15-20%). The increase in FBC mortality up to 2002 was primarily due to the effect of increased incidence. After 2002 the trend goes to zero and changes sign (i.e., mortality decreases) due to the increased impact of survival. Partitioning approaches provide quantitative information on factors contributing to disease trends, a clear interpretation of the obtained results, and form the basis for both predictive inference and formal forecasting models.

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 Presented in Session 5. Health & Mortality 1