Secular Trends of Breast Cancer in China, South Korea, Japan and the United States: Application of the Age-Period-Cohort Analysis

To describe the temporal trends of breast cancer mortality in East Asia and to better understand the causes of these trends, we analyzed the independent effects of chronological age, time period and birth cohort on breast cancer mortality trends using age-period-cohort (APC) analysis. We chose three main countries in East Asia, namely China, South Korea, and Japan, which have reported death status to the WHO Mortality Database, and used the United States as a comparison population. Our study shows that in general, breast cancer mortality rates in females increased in all three East Asian countries throughout the study period. By APC analysis, we confirmed that there is, in fact, a difference in age-specific mortality rate patterns between the Eastern and the Western countries, which is presumably caused by the two-disease model. While the cause of the decrease from approximately the 1950s generation is still in question, we believe that increasing general awareness and improvements in the health-care system have made a significant contribution to it. Although the age and cohort effects are relatively strong, the period effect may be a more critical factor in the mortality trend, mainly reflecting the increase in exposures to carcinogens and behavioral risk factors.