Abstract PS7-09: Achievability of 2030 sustainable development goals in breast cancer control
Authors: Nemutlu Gizem Sultan , Thayumanavan Ethan , Blauvelt Barri , Chhatwal Jagpreet 
Published: February 2021

Abstract
Background
The United Nations Sustainable Development Goals (SDGs) target a one-third reduction in non-communicable disease (NCD) mortality between the years 2015 and 2030. Cancer accounts for 22% of NCD deaths, and breast cancer is the leading global cause of female cancer mortality, despite its high survivability. Therefore, reducing female breast cancer mortality is critical to any nation’s achievement of this goal. However, sex-based disparities in healthcare are evident in lower-resource settings, and lack of infrastructure for breast cancer control leads to greater underdiagnosis in low- and lower middle-income countries (LICs & LMICs). Mortality may be a biased indicator due to the impact of differing incidence rates. Therefore, the mortality-to-incidence ratio (MIR) was examined as a practical indicator of breast cancer control. We projected mortality and MIR for women with breast cancer in 195 countries to quantify progress in breast cancer control and assess the feasibility of achieving the 2030 NCD mortality target of the SDGs.
Methods
We used data on incidence and mortality rates for female breast cancer reported by The Global Burden of Disease Study 2017 for the years between 2000-2017. For each country, we projected mortality rate and MIR for female breast cancer by national income level from 2018-2030 using generalized linear mixed-effects models. We stratified our results by country’s Gross National Income per Capita (GNI/capita) and income group as defined by the World Bank.
Findings
Between 2017 and 2030, global breast cancer mortality is projected to increase by 12.4% from 19.02 (95% confidence interval [CI]: 17.36-20.64) to 21.38 ( 95% prediction interval [PI]: 19.03-23.93), while MIR is projected to decrease by 10.3% from 0.404 (95% CI: 0.385-0.425) to 0.362 (95% PI: 0.342-0.383). In 2017, MIR was 2.22 times higher in low-income countries (LICs) and 1.71 times higher in lower-middle income countries (LMICs) than in high income countries (HICs). Although MIR is projected to decrease between 2017 and 2030 across all income groups (15.9% in HICs, 10.61% in UMICs, 3.66% in LMICs, 10.2% in LICs), 2030 MIR is projected to be 2.37 times higher in LICs and 1.96 times higher in LMICs when compared to HICs.
Interpretation
Use of mortality to measure progress towards SDGs can be misleading in the context of breast cancer control. Simultaneously increasing mortality and incidence may still imply improvement, if mortality is increasing at a slower rate than incidence. Therefore, MIR is a better indicator of progress in breast cancer control. The decreasing global breast cancer MIR from 2015 to 2030, despite increasing mortality, indicates that global progress is being made in breast cancer. Despite globally decreasing MIR, the disparity between HICs and LICs may increase between now and 2030 in the absence of significant resource-stratified policy reform.
Citation Format: Gizem Sultan Nemutlu, Ethan Thayumanavan, Barri Blauvelt, Jagpreet Chhatwal. Achievability of 2030 sustainable development goals in breast cancer control [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-09.