Social epidemiology of female breast cancer in the region of Varna-Bulgaria in 2013-2021 – A retrospective study

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We aim to follow up on the annual dynamics of its incidence, prevalence and mortality rates in the region of Varna, Bulgaria. Methods Data for the recent retrospective analyses was accessed through the information system of Marko Markov Specialized Hospital for Oncological Diseases of Varna for 2017-2021 and two most recent publications for 2013-2017, in accordance with the Medical University-Varna Ethical committee guidelines. Results The total number of newly registered cases of breast cancer in women aged between 24 and 95 years amounted to 1,341. Mean crude incidence rate in 2017-2021 was 108.83 per 100,000, ranging from 119.89 to 105.25 per 100,000 in 2017 and 2020, respectively. The age group of 61-70 years was most affected (26.55% of the cases). Mean crude prevalence rate during this period was 1496.32 per 100,000, varying from 1447.75 to 1549.71 per 100 000 in 2017 and 2020, respectively. The total number of deaths until the end of 2022 reached 310 with 2018 being the greatest in mortality rate (30.22% of the cases). In 2017-2021, bilateral breast cancer was diagnosed as synchronous in 15 women and metachronous in 9 women. Conclusions The regular regional epidemiological investigations could contribute to the enhancement of the effectiveness and quality of prevention, timely diagnosis and adequate complex treatment. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-1137", "name": "Social epidemiology of female breast cancer in the region of Varna-Bulgaria..." } } ] } Home Browse Social epidemiology of female breast cancer in the region of Varna-Bulgaria... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Yaneva G, Dimitrova T and Tasinov O. Social epidemiology of female breast cancer in the region of Varna-Bulgaria in 2013-2021 – A retrospective study [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1137 ( https://doi.org/10.12688/f1000research.147447.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Social epidemiology of female breast cancer in the region of Varna-Bulgaria in 2013-2021 – A retrospective study [version 1; peer review: 1 approved] Galina Yaneva 1 , Tsonka Dimitrova 1 , Oskan Tasinov https://orcid.org/0000-0001-7268-3937 2 Galina Yaneva 1 , Tsonka Dimitrova 1 , Oskan Tasinov https://orcid.org/0000-0001-7268-3937 2 PUBLISHED 07 Oct 2024 Author details Author details 1 Department of Biology, Faculty of Pharmacy, Medical University-Varna, Varna, Bulgaria 2 Department of Biochemistry, Molecular Medicine and Nutrigenomics, Faculty of Pharmacy, Medical University-Varna, Varna, Bulgaria Galina Yaneva Roles: Conceptualization, Data Curation, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Tsonka Dimitrova Roles: Data Curation, Visualization, Writing – Original Draft Preparation Oskan Tasinov Roles: Conceptualization, Data Curation, Funding Acquisition, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Female breast cancer remains the most common malignant disease and a leading cause of death worldwide. We aim to follow up on the annual dynamics of its incidence, prevalence and mortality rates in the region of Varna, Bulgaria. Methods Data for the recent retrospective analyses was accessed through the information system of Marko Markov Specialized Hospital for Oncological Diseases of Varna for 2017-2021 and two most recent publications for 2013-2017, in accordance with the Medical University-Varna Ethical committee guidelines. Results The total number of newly registered cases of breast cancer in women aged between 24 and 95 years amounted to 1,341. Mean crude incidence rate in 2017-2021 was 108.83 per 100,000, ranging from 119.89 to 105.25 per 100,000 in 2017 and 2020, respectively. The age group of 61-70 years was most affected (26.55% of the cases). Mean crude prevalence rate during this period was 1496.32 per 100,000, varying from 1447.75 to 1549.71 per 100 000 in 2017 and 2020, respectively. The total number of deaths until the end of 2022 reached 310 with 2018 being the greatest in mortality rate (30.22% of the cases). In 2017-2021, bilateral breast cancer was diagnosed as synchronous in 15 women and metachronous in 9 women. Conclusions The regular regional epidemiological investigations could contribute to the enhancement of the effectiveness and quality of prevention, timely diagnosis and adequate complex treatment. READ ALL READ LESS Keywords female breast cancer, incidence rate, prevalence rate, mortality rate, Region of Varna Corresponding Author(s) Oskan Tasinov ( [email protected] ) Close Corresponding author: Oskan Tasinov Competing interests: No competing interests were disclosed. Grant information: This work was supported by The European Union-Next Generation EU, through the National Recovery and Resilience Plan of the Republic of Bulgaria, project №BG-RRP-2.004-0009-C02 The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2024 Yaneva G et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Yaneva G, Dimitrova T and Tasinov O. Social epidemiology of female breast cancer in the region of Varna-Bulgaria in 2013-2021 – A retrospective study [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1137 ( https://doi.org/10.12688/f1000research.147447.1 ) First published: 07 Oct 2024, 13 :1137 ( https://doi.org/10.12688/f1000research.147447.1 ) Latest published: 07 Oct 2024, 13 :1137 ( https://doi.org/10.12688/f1000research.147447.1 ) Introduction During the last several years, breast cancer has been the most common malignant disease and a leading cause of death in women worldwide and in Bulgaria as well. In 2020, approximately 2,300,000 new breast cancer cases and 685,000 deaths in women were registered worldwide. 1 Breast cancer continues to be the most common cancer globally, affecting 7.8 million males and females at the end of 2020. The analysis of data on breast cancer outcomes obtained from the 2019 Global Burden of Disease Survey during the period between 1990 and 2019 in five big countries such as Brazil, Russia, India, China, South Africa as well as in 30 other Asian countries demonstrates that in 2019, there are 900,000 female breast cancer cases and 350,000 million deaths in these parts of the world. 2 China and India have the largest proportion of incident cases and deaths followed by Pakistan. High body mass index, high fasting plasma glucose, and a diet high in red meat contribute to the highest breast cancer death rates in most of these countries in 2019. In 2019, there were 19,726 breast cancer deaths in the nine Central and Eastern Europe countries: Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, and Slovenia. 3 These breast cancer deaths result in 267,184 years of life lost. The mean present value of future lost productivity in these countries is the following: €85 M in Poland, €46 M in Romania, €39 M in Hungary, €21 M in Slovakia, €18 M in Serbia, €16 M in Czech Republic, €15 M in Bulgaria, €13 M in Croatia, and €7 M in Slovenia. In 2019 alone, lost productivity costs due to premature breast cancer-related mortality exceed €259 million. The investigation of breast cancer burden in 28 European Union member states demonstrates age-standardized (world standard) incidence and mortality rates in adolescents and young adults aged 15-39 years in 2020 of 20.1 per 100,000 and 2.70 per 100,000, respectively, in Bulgaria only. 4 The age-adjusted mortality rate in Poland is 2.70 per 100,000, too. It is highest in Iceland (of 2.80 per 100,000) and lowest in Luxembourg (of 0,66 per 100,000) against a mean value in Europe of 1.94 per 100,000. The aim of this study was to follow up on the annual dynamics of the incidence, prevalence and mortality rates of female breast cancer in the region of Varna, Bulgaria, in the period from 2013 to 2021. Methods Analysed data We conducted a retrospective analysis of the statistical data devoted to the crude incidence, prevalence and mortality rates of breast cancer in women living in the region of Varna from the information system of Marko Markov Specialized Hospital for Oncological Diseases of Varna for 2017-2021. Study cohort includes 1341 diagnosed patients aged between 24 and 95 years, distributed by years and age. The information about the age-standardized incidence and prevalence rates from two most recent official Bulgarian publications 5 , 6 for 2013-2017 was also analysed. Statistical analyses The graphical presentation and statistical analyses were performed using, GraphPad Prism V.6 (San Diego, CA, USA). GraphPad Prism software is accessible online from https://www.graphpad.com/features . Results The total number of newly registered cases of breast cancer in women aged between 24 and 95 years stands at 1,341 ( Table 1 ). The incidence rate gradually decreases during the period from 2017 to 2021. Table 1. Annual dynamics of new breast cancer women according to age groups in the region of Varna. Age groups 2017 2018 2019 2020 2021 total 21-30 2 1 3 0 2 8 31-40 23 14 12 16 13 78 41-50 55 53 54 54 48 264 51-60 58 47 59 53 49 266 61-70 77 78 65 72 64 356 71-80 51 51 56 44 57 259 81-90 24 23 20 15 21 103 >90 0 1 5 0 1 7 Total 290 268 274 254 255 1341 As shown in Table 1 , the age group between 61 and 70 years is most frequently affected during the whole period (356 patients or 26.55% of the cases). There are eight young women, too (0.5% of the cases). The mean breast cancer crude incidence rate per 100,000 population decreases from 2017 to 2021 while mean breast cancer crude prevalence rate per 100,000 population varies considerably during this period ( Table 2 ). Table 2. Annual dynamics of the mean breast cancer crude incidence and prevalence rates per 100 000 population in the Region of Varna. Year Mean incidence rate Mean prevalence rate 2017 119.9 1447.7 2018 110.9 1500.0 2019 113.5 1519.4 2020 105.2 1549.7 2021 105.8 1464.8 Average 108.8 1496.3 The annual dynamics of the newly registered cases and of the death cases by year of diagnosis in the region of Varna during the period between 2013 and 2021 are illustrated in Figure 1 and Figure 2 , respectively. Figure 1. Annual dynamics of newly registered cases by year of diagnosis in the Region of Varna. Figure 2. Annual dynamics of deaths by year of diagnosis in the Region of Varna. The annual dynamics of the newly registered cases by year of diagnosis of female inhabitants in the city of Varna only during the period between 2017 and 2021 are displayed in Figure 3 . Figure 3. Annual dynamics of new cases by year of diagnosis of female inhabitants in the city of Varna only. The annual dynamics of the mean breast cancer age-standardized incidence and prevalence rates per 100,000 population in the region of Varna between 2013 and 2017 are presented in Table 3 . Table 3. Annual dynamics of the mean breast cancer age-standardized incidence and prevalence rates per 100 000 population in the Region of Varna. Year Mean incidence rate Mean prevalence rate 2013 70.8 18.7 2014 63.3 20.4 2015 60.1 16.0 2016 62.2 18.2 2017 67.9 16.0 Average 64.9 17.9 The total number of deaths until the end of 2022 amounts to 310 being the greatest 2018 (81 or 30.22%) and in 2017 (79 or 27.24% of the cases). We observed that since 2019 lethal cases are gradually reduced ( Figure 4 ). Figure 4. Annual dynamics of deaths by year of diagnosis after radical surgery in the Region of Varna. In 2017-2021, bilateral breast cancer is diagnosed in twenty-four women. The malignant neoplasm is synchronous in fifteen and metachronous in the rest nine patients. Of them, three women with a synchronous and one woman with a metachronous breast cancer decease. In 2013 and 2014, breast cancer age-adjusted incidence and mortality rates are much higher in the region of Varna than those in five other regions in North Eastern Bulgaria such as Ruse, Shumen, Dobrich, Razgrad, and Silistra. 7 Discussion There is a dramatic reduction of the number of lethal cases following the radical surgical intervention since 2019 proving the effectiveness of the timely application of this method of treatment ( Figure 4 ). Our findings are similar to these recently reported by foreign authors. During the period between 2004 and 2018, 915,417 new breast cancer cases are diagnosed in the USA. 8 Among all races, there is an increased incidence rate by 0.3% (between 0.1% and 0.4% at 95% confidence interval; p <0.001) per year during the study. There is a decreased mortality rate by 14.3% (between 18.1% and 10.4% at 95% confidence interval; p <0.001). This reduction is most outlined from 2016 to 2018 by 48.6% (between 52.6% and 44.3% at 95% confidence interval; p <0.001). The analysis of 1999 to 2020 overall mortality rate due to female breast cancer in the USA according to data from the Centres for Disease Control and Prevention and the National Centre for Health Statistics indicates that it decreases and varies by race/ethnicity, age group, and US Census region. 9 Its largest decrease is observed among non-Hispanic white women, women aged between 45 and 64 years, and women living in the Northeast, while its smallest decrease is established among non-Hispanic Asian or Pacific Islander women, women aged 65 years or older, and women living in the South. Within an inquiry study through a food frequency questionnaire of 6,157 North American women diagnosed with invasive breast cancer between 1993 and 2011 and followed-up through 2018 during a median time of 11.3 years, there are 1,265 deaths. 10 Women in the highest versus lowest quartile of adherence to the following four diet quality indices have a lower risk of all-cause mortality: the Healthy Eating Index-2015, Alternative Healthy Eating Index, Alternative Mediterranean Diet, and Dietary Approaches to Stop Hypertension. The values of multivariable-adjusted hazard ratios in terms of these indices are the following: 0.88 (between 0.74 and 1.4 at 95% at 95% confidence interval), 0.82 (between 0.69 and 0.97 at 95% confidence interval), 0.73 (between 0.59 and 0.92 at 95% confidence interval), and 0.78 (between 0.65 and 0.94 at 95% confidence interval). In 2023, 297,790 newly registered breast cancer cases are projected to occur in the United States of America. 11 The total number of these cases will reach up to 31% of the patients with ten most common malignant diseases. Besides the total number of death, cases due to breast cancer will reach up to 43,170 or to 15% of the patients with ten most common malignant diseases. Between 2014 and 2019, 55,465 breast cancer patients at a mean age of 55.7±12.0 years (range, 25 to 97 years) are diagnosed in Kazakhstan based on nationwide large-scale healthcare data from the National Registry. 12 Most patients (44.8% of the cases) are aged between 45 and 59 years. Incidence rate varies between 45 per 100,000 population in 2015 and 73 per 100,000 population in 2016 while prevalence rate increases from 304 per 100,000 population in 2014 up to 506 per 100 000 population in 2019. Mortality rates are stable and high in the senile patients aged between 75 and 89 years. Mortality is positively associated with diabetes mellitus (hazard ratio of 1.2; between 1.1% and 2.3 at 95% confidence interval) and negatively associated with arterial hypertension (hazard ratio of 0.42; between 0.4% and 0.5% at 95% confidence interval). Based on data on breast cancer incidence rate between 1999 and 2020 and breast cancer mortality rate between 1993 and 2021 in South Korea, the results from their projection by fitting a linear regression model indicate that in 2023, there will be 28,851 new cases (22.4% of ten most common malignant diseases) and 2,944 death cases (9.2% of these diseases). 13 Crude and age-adjusted (world standard) incidence rates of 111.9 per 100,000 population and 67.7 per 100,000 population as well as crude and age-adjusted (world standard) mortality rates of 11.4 per 100,000 population and 5.7 per 100,000 population, respectively, could be expected. Within a hospital-based retrospective cohort study in South Ethiopia, 302 female breast cancer patients diagnosed from 2013 to 2018 are followed-up for a total of 4685.62 person-months. 14 Their median survival time is 50.81 months. About 83.4% of them have advanced-stage disease at presentation. The overall survival probability at two and three years is 73.2% and 63.0%, respectively. Independent predictors of mortality are the following: patients residing in rural areas (adjusted hazard ratio of 2.71; between 1.44 and 5.09 at 95% confidence interval), travel time to a health facility ≥7 hours (adjusted hazard ratio of 3.42; between 1.05 and 11.10 at 95% confidence interval), patients presenting within 7-23 months after the onset of symptoms (adjusted hazard ratio of 2.63; between 1.22 and 5.64 at 95% confidence interval), patients presenting more than 23 months after the onset of symptoms (adjusted hazard ratio of 2.37; between 1.00 and 5.59 at 95% confidence interval), advanced stage at presentation (adjusted hazard ratio of 3.01; between 1.05 and 8.59 at 95% confidence interval), and patients having never received chemotherapy (adjusted hazard ratio of 6.69; between 2.20 and 20.30 at 95% confidence interval). During the period from 1999 to 2020, breast cancer mortality rate in South Africa increases from 9.82 per 100,000 to 13.27 per 100,000 at around of 1.4% per annum (between 0.8% and 2.0% at 95% confidence interval; p <0.001). 15 Young women aged 30-49 years present with a statistically significant mortality rate increase (by 1.1%-1.8%; p <0.001). Between 2009 and 2016, 10,124 deaths from breast cancer are recorded in the Mortality Information System in the city of São Paulo, Brazil, among women aged 20 years and over. 16 The following variables are associated with breast cancer mortality: travel time between one and two hours to work (relative risk of 0.97; between 0.93 and 1.00 at 95% credible interval), women being the head of the household (relative risk of 0.97; between 0.94 and 0.99 at 95% credible interval), and deaths from breast cancer in private health institutions (relative risk of 1.04; between 1.00 and 1.07 at 95% credible interval). During the period from 1999 to 2019, there are stable temporal trends of overall mortality coefficients for breast cancer (β=-0.006; between -0.02 and 0.01 at 95% confidence interval) in Passo Fundo, Rio Grande do Sul, Brazil. 17 A rising mortality trend is identified in women with up to 7 years of schooling and in older women as well. The analysis of data from the Polish National Cancer Registry shows that between 2000 and 2019, a total of 315,278 patients, 2,353 male patients and 312,925 female patients, are diagnosed with breast cancer. 18 The age-adjusted five- and ten-year net survival is statistically significantly higher in women than in men (77.33% versus 65.47%; p <0.001). There is a statistically significant increase only in female survival (by 7.32%; p <0.001) between the earliest period (2000-2004) and latest one (2015-2019). The standardized mortality ratios are considerably higher for women than for men (3.35 versus 2.89, respectively). In 2019, breast cancer age-standardized incidence rate is statistically significantly higher in Sweden (217.5 per 100 000) than in Crete (58.9 per 100,000) ( p <0.001). 19 During the period between 2005 and 2019, breast cancer age-standardized mortality rate decreases in Sweden from 25.5 per 100,000 down to 16.8 per 100,000 while it increases in Crete from 22.1 per 100,000 up to 25.3 per 100,000. Since 2015, there is a successive rise of survival rate with a five-year survival rate of 92% in Sweden but a decrease of the survival rate with a five-year survival rate of 85% in Crete. The results from a case-referent investigation of 1,571 women in Flanders, Belgium, during the period between 2005 and 2017 indicate that women who have participated in the Flemish population-based mammography screening program introduced in 2001 have a 51% lower risk of breast cancer-specific mortality compared to those who have not (adjusted odds ratio of 0.49; between 0.44 and 0.55 at 95% confidence interval). 20 During the recent years, there are relatively scanty regional epidemiological investigations dealing with breast cancer in women worldwide. It should be emphasized that the significant differences in terms of the dynamics of breast country incidence, prevalence and mortality rates in single regions in Bulgaria and in other European countries deserve a special attention by the public. The research in this interdisciplinary field accomplished by national and international collectives could shed light on a variety of unsolved issues associated not only with environmental and occupational factors but also with personal life-style improvement. Conclusion We establish a gradual improvement of the epidemiological parameters of female breast cancer in the region of Varna during the last few years. The performance of regular regional epidemiological research of the most common and socially significant malignant diseases in Bulgaria could contribute to the enhancement not only of the effectiveness and quality of their prevention, but also of their timely diagnosis and adequate complex treatment. Ethical considerations Recent retrospective study was approved by the Ethics Committee of Medical University-Varna, Bulgaria (protocol № 61/30.03.2017) on 30 th March 2017 and is in accordance with Declaration of Helsinki, 1964. Due to the retrospective nature of the study, the need for informed consent of the patients was waived by the committee. This study includes epidemiological analyses concerning patients, that are part of a larger previous study in which the ethics committee approved the use of these data. The data and results presented in this study have not been previously published. Data availability Figshare: Social epidemiology of female breast cancer in the Region of Varna-Bulgaria in 2013-2021_data.doc. https://doi.org/10.6084/m9.figshare.25028666 . 21 This project contains the following underlying data: • Data file 1, type - dataset: Social epidemiology of female breast cancer in the Region of Varna-Bulgaria in 2013-2021_data.doc. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Since the obligation of Marko Markov Specialized Hospital for Oncological Diseases of Varna to keep the privacy of patients individual data, there are not presented in this retrospective study, but grouped, organised and analysed statistical data for 2017-2021. In case scientists, readers need to access these private individual patients data they should apply by the Ethics Committee of Medical University-Varna, Bulgaria in accordance with Declaration of Helsinki, 1964 and Marko Markov Specialized Hospital for Oncological Diseases of Varna regulatory board. References 1. Mustafa M, Abbas K, Alam M, et al. : Molecular pathways and therapeutic targets linked to triple-negative breast cancer (TNBC). Mol. Cell. Biochem. 2023 [cited 2023 Oct 6]; 479 : 895–913. Springer. PubMed Abstract | Publisher Full Text 2. Mubarik S, Wang F, Nadeem AA, et al. : Breast cancer epidemiology and sociodemographic differences in BRICS-plus countries from 1990 to 2019: An age period cohort analysis. SSM - Popul Heal. 2023 Jun 1 [cited 2023 Oct 6]; 22 : 101418. Publisher Full Text | Free Full Text 3. Bencina G, Chami N, Hughes R, et al. : Breast cancer-related mortality in Central and Eastern Europe: years of life lost and productivity costs. J. Med. Econ. 2023; 26 (1): 254–261. PubMed Abstract | Publisher Full Text 4. Trama A, Stark D, Bozovic-Spasojevic I, et al. : Cancer burden in adolescents and young adults in Europe. ESMO Open. 2023; 8 (1): 100744. PubMed Abstract | Publisher Full Text | Free Full Text 5. National Oncological Hospital BNCR: Cancer Incidence in Bulgaria, 2014 and 2015.Valerianova Z, Atanasov T, Vukov M, editors. Bulgarian National Cancer Registry. Sofia, Bulgaria: “Paradigma“ 2017; 2017; Vol. XXV . . 6. University Specialized Hospital for Active Treatment in Oncology. Bulgarian National Cancer Registry.Valerianova Z, Atanasov T, editors. Bulgarian National Cancer Registry. Sofia, Bulgaria: Paradigma; 2020; Vol. XXVI . : 2017. 2017. Reference Source 7. Yaneva G: Breast cancer epidemiology in North-Eastern Bulgaria. Sci Work Union Sci Bulg Plovdiv. 2019; 22 : 394–397. 8. Bazzi T, Al-husseini M, Saravolatz L, et al. : Trends in Breast Cancer Incidence and Mortality in the United States From 2004-2018: A Surveillance, Epidemiology, and End Results (SEER)-Based Study. Cureus. 2023. 9. Ellington TD, Henley SJ, Wilson RJ, et al. : Trends in breast cancer mortality by race/ethnicity, age, and US census region, United States ─ 1999-2020. Cancer. 2023; 129 (1): 32–38. PubMed Abstract | Publisher Full Text | Free Full Text 10. Haslam DE, John EM, Knight JA, et al. : Diet Quality and All-Cause Mortality in Women with Breast Cancer from the Breast Cancer Family Registry. Cancer Epidemiol. Biomarkers Prev. 2023; 32 (5): 678–686. PubMed Abstract | Publisher Full Text | Free Full Text 11. Siegel RL, Miller KD, Wagle NS, et al. : Cancer statistics, 2023. CA Cancer J. Clin. 2023 Jan [cited 2023 Oct 6]; 73 (1): 17–48. PubMed Abstract | Publisher Full Text 12. Midlenko A, Mussina K, Zhakhina G, et al. : Prevalence, incidence, and mortality rates of breast cancer in Kazakhstan: data from the Unified National Electronic Health System, 2014–2019. Front. Public Health. 2023; 11 : 11. Publisher Full Text 13. Jung KW, Kang MJ, Park EH, et al. : Prediction of Cancer Incidence and Mortality in Korea, 2023. Cancer Res. Treat. 2023; 55 (2): 400–407. PubMed Abstract | Publisher Full Text | Free Full Text 14. Shita A, Yalew AW, Seife E, et al. : Survival and predictors of breast cancer mortality in South Ethiopia: A retrospective cohort study. PLoS One. 2023; 18 (3 March): e0282746. PubMed Abstract | Publisher Full Text | Free Full Text 15. Olorunfemi G, Libhaber E, Ezechi OC, et al. : Population-based temporal trends and ethnic disparity in breast cancer mortality in South Africa (1999-2018): Joinpoint and age–period–cohort regression analyses. Front. Oncol. 2023; 13 : 13. Publisher Full Text 16. de Aguiar BS , Pellini ACG, Rebolledo EAS, et al. : Intra-urban spatial variability of breast and cervical cancer mortality in the city of São Paulo: analysis of associated factors. Rev. Bras. Epidemiol. 2023; 26 : 26. Publisher Full Text 17. Pecinato V, Jacobo A, da Silva SG : Mortality trends of breast and cervical cancer in Passo Fundo, Rio Grande do Sul: an analysis by age and schooling, 1999-2019. Epidemiol. e Serv. Saude. 2022; 31 (3). Publisher Full Text 18. Caetano dos Santos FL, Michalek IM, Wojciechowska U, et al. : Changes in the survival of patients with breast cancer: Poland, 2000–2019. Breast Cancer Res. Treat. 2023; 197 (3): 623–631. PubMed Abstract | Publisher Full Text | Free Full Text 19. Roginski M, Sifaki-Pistolla D, Stomby A, et al. : Paradoxes of breast cancer incidence and mortality in two corners of Europe. BMC Cancer. 2022; 22 (1): 1123. PubMed Abstract | Publisher Full Text | Free Full Text 20. De Troeyer K, Silversmit G, Rosskamp M, et al. : The effect of the Flemish breast cancer screening program on breast cancer-specific mortality: A case-referent study. Cancer Epidemiol. 2023; 82 : 102320. Publisher Full Text 21. Yaneva G, Dimitrova T, Tasinov O: Social epidemiology of female breast cancer in the Region of Varna-Bulgaria in 2013-2021_data.doc. [Data]. 2024. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 07 Oct 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Biology, Faculty of Pharmacy, Medical University-Varna, Varna, Bulgaria 2 Department of Biochemistry, Molecular Medicine and Nutrigenomics, Faculty of Pharmacy, Medical University-Varna, Varna, Bulgaria Galina Yaneva Roles: Conceptualization, Data Curation, Resources, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Tsonka Dimitrova Roles: Data Curation, Visualization, Writing – Original Draft Preparation Oskan Tasinov Roles: Conceptualization, Data Curation, Funding Acquisition, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This work was supported by The European Union-Next Generation EU, through the National Recovery and Resilience Plan of the Republic of Bulgaria, project №BG-RRP-2.004-0009-C02 The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 07 Oct 2024, 13:1137 https://doi.org/10.12688/f1000research.147447.1 Copyright © 2024 Yaneva G et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Yaneva G, Dimitrova T and Tasinov O. Social epidemiology of female breast cancer in the region of Varna-Bulgaria in 2013-2021 – A retrospective study [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1137 ( https://doi.org/10.12688/f1000research.147447.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 07 Oct 2024 Views 0 Cite How to cite this report: Yıldız İ. Reviewer Report For: Social epidemiology of female breast cancer in the region of Varna-Bulgaria in 2013-2021 – A retrospective study [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1137 ( https://doi.org/ ) The direct URL for this report is: https://f1000research.com/articles/13-1137/v1#referee-response-331024 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Oct 2024 İbrahim Yıldız , Department of Medical Oncology, Acıbadem MAA University, Istanbul, Turkey Approved VIEWS 0 https://doi.org/ I have reviewed the article titled “Social Epidemiology of Female Breast Cancer in the Region of Varna-Bulgaria in 2013-2021.” The study provides significant insights into the incidence, prevalence, and mortality rates of breast cancer in the Varna region, offering valuable ... Continue reading READ ALL I have reviewed the article titled “Social Epidemiology of Female Breast Cancer in the Region of Varna-Bulgaria in 2013-2021.” The study provides significant insights into the incidence, prevalence, and mortality rates of breast cancer in the Varna region, offering valuable data for healthcare planning and policy-making. The authors present a thorough analysis of regional trends over an extended period, highlighting the importance of localized epidemiological studies for effective cancer control strategies. However, I believe the manuscript could be further strengthened with a few additional improvements. To enhance the comprehensiveness of the findings, I suggest including a section that compares the results from Varna with national Bulgarian data and, if possible, data from neighboring countries with similar demographic characteristics. This would place the regional findings in a broader context and provide more meaningful insights. Given the importance of screening in detecting breast cancer, it would be beneficial to discuss the current state of breast cancer screening programs in Varna or Bulgaria, along with their impact on incidence and mortality rates. This would highlight the role of screening in cancer prevention and control. Moreover, as genetic predisposition (e.g., BRCA1/BRCA2 mutations) is a known risk factor for breast cancer, it would be useful to include some discussion of genetic factors. Additionally, suggesting future research that explores the genetic components of breast cancer in the region would add depth to the study. Overall, this is a well-organized and informative study, and addressing these points would enhance its clarity and impact. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: İnternal Medicine Specialist and Medical Oncologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Yıldız İ. Reviewer Report For: Social epidemiology of female breast cancer in the region of Varna-Bulgaria in 2013-2021 – A retrospective study [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1137 ( https://doi.org/ ) The direct URL for this report is: https://f1000research.com/articles/13-1137/v1#referee-response-331024 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 07 Oct 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 07 Oct 24 read İbrahim Yıldız , Acıbadem MAA University, Istanbul, Turkey Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Yıldız İ. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 21 Oct 2024 | for Version 1 İbrahim Yıldız , Department of Medical Oncology, Acıbadem MAA University, Istanbul, Turkey 0 Views copyright © 2024 Yıldız İ. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I have reviewed the article titled “Social Epidemiology of Female Breast Cancer in the Region of Varna-Bulgaria in 2013-2021.” The study provides significant insights into the incidence, prevalence, and mortality rates of breast cancer in the Varna region, offering valuable data for healthcare planning and policy-making. The authors present a thorough analysis of regional trends over an extended period, highlighting the importance of localized epidemiological studies for effective cancer control strategies. However, I believe the manuscript could be further strengthened with a few additional improvements. To enhance the comprehensiveness of the findings, I suggest including a section that compares the results from Varna with national Bulgarian data and, if possible, data from neighboring countries with similar demographic characteristics. This would place the regional findings in a broader context and provide more meaningful insights. Given the importance of screening in detecting breast cancer, it would be beneficial to discuss the current state of breast cancer screening programs in Varna or Bulgaria, along with their impact on incidence and mortality rates. This would highlight the role of screening in cancer prevention and control. Moreover, as genetic predisposition (e.g., BRCA1/BRCA2 mutations) is a known risk factor for breast cancer, it would be useful to include some discussion of genetic factors. Additionally, suggesting future research that explores the genetic components of breast cancer in the region would add depth to the study. Overall, this is a well-organized and informative study, and addressing these points would enhance its clarity and impact. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise İnternal Medicine Specialist and Medical Oncologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Yıldız İ. Peer Review Report For: Social epidemiology of female breast cancer in the region of Varna-Bulgaria in 2013-2021 – A retrospective study [version 1; peer review: 1 approved] . F1000Research 2024, 13 :1137 ( https://doi.org/) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1137/v1#referee-response-331024 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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