title: Patterns of breast cancer mortality trends in Europe.
abstract: OBJECTIVE
  To identify patterns of variation in breast cancer mortality in Europe (1980-2010), using a model-based approach.
  
  
  METHODS
  Mortality data were obtained from the World Health Organization database and mixed models were used to describe the time trends in the age-standardized mortality rates (ASMR). Model-based clustering was used to identify clusters of countries with homogeneous variation in ASMR.
  
  
  RESULTS
  Three patterns were identified. Patterns 1 and 2 are characterized by stable or slightly increasing trends in ASMR in the first half of the period analysed, and a clear decline is observed thereafter; in pattern 1 the median of the ASMR is higher, and the highest rates were achieved sooner. Pattern 3 is characterised by a rapid increase in mortality until 1999, declining slowly thereafter.
  
  
  CONCLUSIONS
  This study provides a general model for the description and interpretation of the variation in breast cancer mortality in Europe, based in three main patterns.
authors.affiliation: Institute of Public Health of the University of Porto, Porto, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Amaro
authors.forename: Milton
authors.initials: M
authors.lastname: Severo
authors.forename: Sofia
authors.initials: S
authors.lastname: Vilela
authors.forename: Sérgio
authors.initials: S
authors.lastname: Fonseca
authors.forename: Filipa
authors.initials: F
authors.lastname: Fontes
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D055088:Early Detection of Cancer; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality / Q000639:trends; D055815:Young Adult