title: Competing risks to breast cancer mortality in Catalonia.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Hospitalet de Llobregat Catalonia, Spain. evilaprinyo@cmb.udl.cat
authors.forename: Ester
authors.initials: E
authors.lastname: Vilaprinyo
authors.forename: Rosa
authors.initials: R
authors.lastname: Gispert
authors.forename: Montserrat
authors.initials: M
authors.lastname: Martínez-Alonso
authors.forename: Misericòrdia
authors.initials: M
authors.lastname: Carles
authors.forename: Roger
authors.initials: R
authors.lastname: Pla
authors.forename: Josep-Alfons
authors.initials: JA
authors.lastname: Espinàs
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rué
mesh_terms: D000328:Adult; D017677:Age Distribution; D001943:Breast Neoplasms / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015993:Life Tables; D008875:Middle Aged; D011336:Probability; D012306:Risk; D013030:Spain / Q000453:epidemiology