Topic Highlight
Copyright ©2014 Baishideng Publishing Group Inc.
World J Clin Oncol. Aug 10, 2014; 5(3): 465-477
Published online Aug 10, 2014. doi: 10.5306/wjco.v5.i3.465
Table 1 Countries with the highest breast cancer incidence and mortality rates[3]
CountryIncidence rateCountryMortality rate
1 Belgium111.91 Fiji28.4
2 Denmark1052 Bahamas26.3
3 France104.53 Nigeria25.9
4 The Netherlands994 Pakistan25.2
5 Bahamas98.95 New Caledonia24.4
6 Iceland96.36 Armenia24.2
7 United Kingdom957 Lebanon24.0
8 Barbados94.78 Trinidad and Tobago23.5
9 United States92.99 Ethiopia23.0
10 Ireland92.310 Uruguay22.7
11 French Polynesia92.211 Barbados22.1
12 Germany91.612 Serbia22.0
13 Italy91.313 Jordan21.8
14 Finland89.414 Syria21.5
15 Luxembourg89.115 Somalia20.6
16 New Caledonia87.616 Afghanistan20.6
17 Australia8617 Eritrea20.5
18 Malta85.918 French Polynesia20.4
19 New Zealand8519 Montenegro20.2
20 Switzerland83.120 Guyana20.1
21 Israel80.5
22 Sweden80.4
Incidence and mortality rates are number of cases and number of deaths, respectively, per 100000 women. Both measures are age-standardized.
Table 2 Clinical stage of breast cancer patients by country-summary from the literature
Year(s)TNM staging system
SEER staging system
IIIIIIIVLocalizedRegionalDistant
High-income Countries:
Australia[9]2000-2007----55.938.16.0
Canada[9]2000-200741.038.113.37.6---
Denmark[9]2000-200729.347.215.87.7---
Germany (Saarland)[11]1996-1998----52.044.04.0
Northern Ireland[91]200630.443.619.66.4---
Norway[9]2000-200743.447.13.85.7---
Saudi Arabia[92]2004----27.856.216.0
Sweden[9]2000-200745.246.55.33.0---
United Kingdom[9]2000-200740.045.49.25.4---
United States[10]2002-2008----62.332.65.1
Low and middle-income countries:
Brazil
Goias[93]2002-200914.736.127.921.3---
Porto Alegre[94]1975-199716.054.019.011.0---
Sao Paulo[94]1979-198911.022.053.014.0---
Colombia (Bogota)[95]2006-2007----26.468.25.4
Egypt (South Cancer Inst.)[96]2001-200811.039.025.025.0---
Egypt (Gharbiah)[97]1999-2008----25.260.314.5
India[98]
Mumbai19957.857.428.45.9---
Trivandrum19964.442.340.512.8---
Chennai1.023.052.024.0---
Iraq (Kurdistan)[99]2006-20084.953.331.89.9---
Jordan[100]200929.030.023.010.0
Libya[22]2008-20099.025.554.011.5---
Malaysia (East Coast and Kuala Lumpur)[26]2005-20075.238.744.811.3---
Mexico
INCAN[101]-uninsured pop.200710.236.440.912.5---
IMSS[102]-insured pop.200213.839.633.912.7---
Nigeria (Lagos)[103]2009-20105.515.462.716.4---
Peru (Lima)[94]1985-19979.042.033.016.0---
South Africa[104]
Whites1970-199730.838.018.811.9---
Blacks5.416.941.636.1---
Thailand[36]200912.038.041.09.0---
Data are population-based, except for the following countries where data is hospital-based: Brazil, Colombia, Egypt, India, Iraq, Libya, Malaysia, Mexico, Nigeria, Peru, South Africa and Thailand. All percentages were corrected to exclude Non-Staged cancers.
Table 3 Time intervals for breast cancer care-findings from the literature
Country (region)YearnTotal interval
Patient interval
Provider/system intervals
DefinitionMedian/mean1> 3 mo(%)Median/mean1> 3 mo(%)ReportedintervalDefinitionMedian/mean1> 3 mo(%)
High-income countries
Canada (Quebec)[105]1992-199829606-----Treatment1st diagnostic study to surgery.42 d17.1
Canada[106]19964465-----DiagnosisAbnormal screening to diagnosis31 d-
France[30]200314941st abnormal screening to treatment start34 d---DiagnosisAbnormal screening to diagnosis7 d-
TreatmentDiagnosis to treatment start27 d-
Germany (Saarland)[11,107,108]1996-1998380Symptom discovery or abnormal screening to diagnosis-26.116 d17.4Provider1st consultation to treatment start15 d11.0
Italy (Campania)[56]1998-1999644Symptom discovery to surgery-35-20-1st medical consultation to hospital admission-11
Italy (Campania and Apulia)[109]2004-2006959-----Diagnosis1st consultation to diagnosis-60
Nether-lands[110]1996-20021503-----DiagnosisScreening to diagnosis-6.5
North Ireland[91]2006759-----TreatmentDiagnosis to treatment start15 d-
Scotland[111]2005-20071250---7 d-Referral1st consultation to referral1 d-
-SpecialistReferral by GP to 1st consultation by specialist18 d-
Spain (Catalonia)[112]2001-2002266-----TreatmentDiagnosis to treatment start35 d-
United Kingdom[113]1999-200025627Symptom discovery to diagnosis30 d-9 d--GP referral to diagnosis11 d-
United States[31]1991-19951659Abnormal screening to treatment start48 d22.9--Diagnosis1st abnormal screening to diagnosis32 d-
TreatmentDiagnosis to treatment start.10 d-
United States[54]1995-2005246957-----TreatmentDiagnosis to treatment start23 d-
United States (Califor-nia)[114]2003-2005921 low income womenSymptom discovery to biopsy39------
United States (North Carolina)[115]2000-20021786-----TreatmentDiagnosis to treatment start22 d-
Middle-income countries:
Brazil (Brasilia)[25]2010250Symptom discovery to treatment7.5 mo88.8-29.9Provider1st consultation to treatment start-77.6
Brazil (Rio)[24]2004104Symptom discovery to diagnosis8 mo-1 mo-Diagnosis1st consultation to diagnosis6.5 mo80
Bulgaria[23]2011448Symptom discovery to treatment3.9 mo1-1.2 mo1-Provider1st consultation to treatment start3.1 mo1-
Colombia[95,116]2006-2007852----20.3Provider1st consultation to treatment start4.5 mo31
Croatia[23]2011167Symptom discovery to treatment3.4 mo1-1.2 mo1Provider1st consultation to treatment start2.6 mo1-
Egypt[29]2010163---2.7 mo--1st consultation to hospital arrival18 d-
Ethiopia[117]200869---18 mo1-----
Haiti[118]201290---1 wk42%----
Hungary[23]2011167Symptom discovery to treatment4.0 mo1-24 d1-Provider1st consultation to treatment start3.6 mo1-
India[23]2011207Symptom discovery to treatment7.4 mo1-1.5 mo1-Provider1st consultation to treatment start6.2 mo1-
Iran[28]2000-2001200---3 mo42.5----
Latvia[23]2011111Symptom discovery to treatment4.4 mo1-1.5 mo1-Provider1st consultation to treatment start3.3 mo1-
Libya[22]2008-2009200Symptom discovery to diagnosis-70.0-54.5----
Lithuania[23]2011368Symptom discovery to treatment3.0 mo1-1.2 mo1-Provider1st consultation to treatment start2.1 mo1-
Malaysia[26]2005-2007328Symptom discovery to diagnosis5.5 mo72.62 mo43.3----
Mexico[34]200832Symptom discovery to treatment start7.5 mo10 dDiagnosis1st consultation to diagnosis2.8 mo
Mexico[27]2010-2011384Abnormal mammogram or symptom discovery to treatment start7.8 mo90.011 d20.6Provider1st consultation to treatment start4.7 mo73.7
Nigeria[103]2009-2010201----81----
Poland[23]2011557Symptom discovery to treatment2.9 mo1-25 d1-Provider1st consultation to treatment start2.4 mo1-
Romania[23]2011271Symptom discovery to treatment6.4 mo1-1.5 mo1-Provider1st consultation to treatment start7.4 mo1-
Russia[23]2011718Symptom discovery to treatment3.9 mo1-1.2 mo1-Provider1st consultation to treatment start3.1 mo1-
Slovakia[23]2011154Symptom discovery to treatment3.3 mo1-1.0 mo1-Provider1st consultation to treatment start2.7 mo1-
Serbia[23]2011663Symptom discovery to treatment3.2 mo1-1.1 mo1-Provider1st consultation to treatment start2.3 mo1-
Thailand[35]1994-199694---1 mo26.6Provider1st medical consultation to hospital admission1 mo24.4
Thailand[36]2009109---12 d17.0Provider1st consultation to treatment start21 d42.0
Turkey[23]2011694Symptom discovery to treatment3.4 mo1-1.2 mo1-Provider1st consultation to treatment start2.6 mo1-
1These correspond to mean intervals, instead of medians. Patient interval is not defined in the table because studies coincide in the accepted definition: symptom discovery or abnormal screening to first medical consultation.
Table 4 Studies of access or quality of care barriers related to provider delay
Access or quality barriersStudies
CountryYear of publicationSample size
Low socioeconomic statusEngland[47]200519760
Canada[48]2007696
Ethnic minoritiesUnited States[31]20001659
United States[51]2004831
United States[54]2011246957
Lack of health insuranceUnited States[54]2011246957
Patient’s old ageUnited States[54]2011246957
Patient’s young ageEngland[55]199936222
Italy[56]2001644
Scotland[57]20041069
Scotland[58]20045283
England[47]200519760
Travel time to hospitalThailand[36]2013180
Distance from hospitalThailand[36]2013180
Long waiting times to get medical appointmentsMexico[33]2011125
Consulting 3 or more different health services before arrival to a cancer centerMexico[33]2011125
Type of first health service contactedThailand[35]200094
Medical specialty of first provider consultedItaly[56]2001644
Medical errors in initial diagnosis, screening interpretation or pathology reviewUnited States[31]20001659
England[64]20001004
Thailand[35]200094
United States[65]2002454
Scotland[58]20045283
Netherlands[119]2004153969
Canada[48]2007696
Mexico[33]2011125