title: Temporal Trends and Future Prediction of Breast Cancer Incidence Across Age Groups in Trivandrum, South India.
abstract: BACKGROUND
  Increasing breast cancer (BC) incidence rates have been reported from India; causal factors for this increased incidence are not understood and diagnosis is mostly in advanced stages. Trivandrum exhibits the highest BC incidence rates in India. This study aimed to estimate trends in incidence by age from 2005- 2014, to predict rates through 2020 and to assess the stage at diagnosis of BC in Trivandrum.
  
  
  METHODS
  BC cases were obtained from the Population Based Cancer Registry, Trivandrum. Distribution of stage at diagnosis and incidence rates of BC [Age-specific (ASpR), crude (CR) and age-standardized (ASR)] are described and employed with a joinpoint regression model to estimate average annual percent changes (AAPC) and a Bayesian model to estimate predictive rates.
  
  
  RESULTS
  BC accounts for 31% (2681/8737) of all female cancers in Trivandrum. Thirty-five percent (944/2681) are <50 years of age and only 9% present with stage I disease. Average age increased from 53 to 56.4 years (p=0.0001), CR (per 105 women) increased from 39 (ASR: 35.2) to 55.4 (ASR: 43.4), AAPC for CR was 5.0 (p=0.001) and ASR was 3.1 (p=0.001). Rates increased from 50 years. Predicted ASpR is 174 in 50-59 years, 231 in > 60 years and overall CR is 80 (ASR: 57) for 2019- 20.
  
  
  CONCLUSIONS
  BC, mostly diagnosed in advanced stages, is rising rapidly in South India with large increases likely in the future; particularly among post-menopausal women. This increase might be due to aging and/or changes in lifestyle factors. Reasons for the increased incidence and late stage diagnosis need to be studied.
authors.affiliation: Divisions of Cancer Epidemiology and Bio-statistics, Trivandrum, Kerala, India E-mail : aleyammamathewrcc@gmail.com.
authors.forename: Aleyamma
authors.initials: A
authors.lastname: Mathew
authors.forename: Preethi Sara
authors.initials: PS
authors.lastname: George
authors.forename: Asha
authors.initials: A
authors.lastname: Arjunan
authors.forename: Paul
authors.initials: P
authors.lastname: Augustine
authors.forename: Mc
authors.initials: M
authors.lastname: Kalavathy
authors.forename: G
authors.initials: G
authors.lastname: Padmakumari
authors.forename: Beela Sarah
authors.initials: BS
authors.lastname: Mathew
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001499:Bayes Theorem; D001943:Breast Neoplasms / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D013997:Time Factors