Rising Inpatient Burden of Female Breast Cancer in Sri Lanka: A Population-Based Analysis of Hospital Admissions and Deaths, 2017–2022

Rising Inpatient Burden of Female Breast Cancer in Sri Lanka: A Population-Based Analysis of Hospital Admissions and Deaths, 2017–2022 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Rising Inpatient Burden of Female Breast Cancer in Sri Lanka: A Population-Based Analysis of Hospital Admissions and Deaths, 2017–2022 Udari Apsara Liyanage, Yasas Dahamuna Kolambage, E A D Hiruni Amasha, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6884857/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 20 You are reading this latest preprint version Abstract Background : While breast cancer epidemiology in South Asia is widely studied, data on its actual hospital burden remains sparse. This study analyzed magnitudes and trends in hospital admissions and hospital deaths from female breast cancer compared to other common cancers, breast cancer incidence and mortality in Sri Lanka. Method: A retrospective analysis of hospital admissions and outcomes from 2017–2022 was conducted using the national eIMMR database, using standard descriptive statistics. Results: Breast cancer accounted for 22–27% of cancer-related hospital admissions in women annually, from 2017 to 2022. In 2022, it accounted for 26.6% of cancer admissions, requiring 13.1 times and 3.2 times more hospitalizations than thyroid and colorectal cancers in females. The highest hospital burden was observed in women aged 40–69 years, who accounted for nearly 80% of breast cancer admissions in 2022 (21.4% in 40–49 years, 30.17% in 50–59 years, and 28.05% in 60–69 years). Majority (63%) of breast cancer deaths occurred in hospitals, accounting for one in five female cancer-related hospital deaths in 2019. Conclusions : Breast cancer accounted for the highest number of hospital admissions and deaths, with a disproportionately high, increasing hospital burden, compared to other common cancers in women. Moreover, given that the majority of breast cancer deaths in Sri Lanka also occur in government hospitals, the study highlights the escalating high burden of breast cancer on Sri Lanka’s National Healthcare System. Breast cancer incidence hospital admissions hospital deaths hospital burden breast cancer management cancer burden LMIC eIMMR database Figures Figure 1 Figure 2 Figure 3 Figure 4 Background The global cancer burden is rising, with 35 million new cases projected by 2050—a 77% increase from 2022 estimates ( 1 ). This surge imposes significant strain on health budgets, necessitating strategic healthcare planning. Breast cancer is the most frequently diagnosed cancer in the world among females, and the leading cause of cancer-related deaths among women in 112 countries across the globe, including South Asia. Cancer incidence, mortality and cancer profiles however vary by region and human development levels. These differences reflect challenges in early detection, access to advanced diagnostics and treatment, and healthcare resources ( 1 )( 2 ). Addressing these issues requires robust data to guide health care policies and optimize resource allocation. Sri Lanka, a lower-middle income South Asian country, has a population of 22 million, with 51.5% being females ( 3 , 4 ). Breast cancer incidence of the country is rising, with age-standardized rates increasing from 19 per 100,000 in 2005 to 33 per 100,000 in 2019. Crude death rate for female breast cancer was 7.8 per 100000 women in 2019 ( 5 ). The Sri Lankan government provides free healthcare nationwide, with cancer care delivered at varying levels through a network of government hospitals including two National Cancer Hospitals. Inpatient care for breast cancer offered by the national health system mostly includes surgery and palliative management, and sometimes admissions related to diagnosis, while radiotherapy, chemotherapy, and post treatment follow-up care are typically offered as outpatient services. Dedicated end-of-life care, such as hospice services, remains extremely limited in Sri Lanka. While regional studies on breast cancer epidemiology are not sparse, data on the actual hospital burden in the region remains limited. Hence, this study examined magnitude and trends in hospital admissions and mortality outcomes for breast cancer in Sri Lanka using the National Electronic Morbidity and Mortality Records (eIMMR) system of the Ministry of Health, Sri Lanka from 2017–2022. The eIMMR systematically collects real-time data from all hospitals by admissions ( 6 )( 7 ). The eIMMR system in Sri Lanka was established in 2009, and by 2015, the system had achieved approximately 53% coverage ( 8 ). A recent study spanning the period from 2017 to 2020 revealed that the database successfully captured over 90% of yearly hospitalization episode in government hospitals ( 9 ). Breast cancer hospital admissions and deaths were compared to other common cancers in women and with epidemiological data from the National Cancer Control Program Sri Lanka (NCCP). This analysis provides valuable insights into the in-patient hospital burden of breast cancer in Sri Lanka, essential for health policy, guidelines and resource planning. It also holds broader implications for other LMICs facing similar challenges, contributing to the global understanding of inpatient demands for breast cancer management in resource-constrained settings. Methodology Data source and extraction methods This was a secondary data analysis based on the records of the eIMMR system of Sri Lanka. The eIMMR system includes hospital admission data related to diagnosed cases of malignant neoplasms classified according to the ICD 10 (ICD − 10 codes of C00–C97 for 36 cancer types (all cancers). The anonymized data on hospital admissions for this study, for the period from 01.01.2017 to 31.12.2022, were extracted from the national eIMMR database with institutional permission. The data extraction from the eIMMR system was carried out by the medical statistic Unit, Ministry of Health, Sri Lanka. A trained investigator (HA) generated yearly secondary datasets for further analysis, which were verified by another investigator (YK). Data analysis and statistical methods The crude admission rate for each year was calculated per 100,000 population by dividing the total number of hospital admissions for the relevant cancer types by the estimated mid-year population for that year. The mid-year population estimates were obtained from the publicly available online dataset published by the Registrar General’s Department of Sri Lanka ( 10 ) and National Cancer Incidence and Mortality Data- Sri Lanka published by the NCCP ( 11 )( 12 )( 13 )( 14 )( 15 ). Distribution of admissions, hospital deaths, and trends across the years were described by age and sex as appropriate. Results were also compared with National Cancer Incidence and Mortality Data -Sri Lanka published by the NCCP for 2017–2021.( 11 )( 12 )( 13 )( 14 )( 15 ) The NCCP collects data independent of the eIMMR database. 2022 data were not yet published by NCCP at the time of analysis. National mortality data was available for 2019, and incidence data was available up to 2021. Breast cancer admissions and hospital deaths were compared with admissions and hospital deaths from other common cancers in females. The top five commonest cancers in females for each year were identified as breast, thyroid, colorectal, cervix/uteri and ovarian as per NCCP data. ( 10 – 14 ). The ICD codes included in the study for breast cancer and other common cancers are given in Additonal file 1 (S1). Data was analyzed with standard descriptive statistics using IBM SPSS Statistics for Windows, version 22. Results Magnitude and trends in hospital admission rates for female breast cancer compared to admissions from all cancers in females are presented in Table 1 . Corresponding cancer incidence rates in Sri Lanka are also presented for comparison. Table 1 Comparison of crude admission rates for all cancers, breast cancer and crude incidence rates in females 2017 2018 2019 2020 2021 2022 Crude rate of admissions a (per 100,000 population) All cancers 648.8 788.0 802.0 714.4 660.6 798.1 Breast cancer 143.4 195.7 208.9 176.7 165.4 212.4 Proportion of breast cancer admissions 22.10% 24.83% 26.04% 24.74% 25.05% 26.61% Crude incidence rates b (per 100,000 population) All cancers 151.1 142.6 151.1 178.6 176.5 * Breast cancers 37.9 33.8 39.5 45.9 48 * Proportion of breast cancer incidence 25.08% 23.70% 26.14% 25.70% 27.20% Crude admission rates and crude incidence rates are given per 100,000 population a- eIMMR system; b- NCCP Sri Lanka( 11 )( 12 )( 13 )( 14 )( 15 ). *Data not published by the NCCP, Sri Lanka at the time of analysis. Total cancer admissions (both sexes), sex distribution of the breast cancer admissions and breast cancer incidence are given in Additional file 2 (S2). The crude admission rates for breast cancer have risen from 2017 to 2022, with a drop in 2020 and 2021. Breast cancer admissions as a proportion of all cancer admissions (proportion of breast cancer admissions) also demonstrated a similar trend from 2017 to 2022. The mean hospital duration per admission for breast cancer admissions across 2017–2022 was approximately 3 days (2.782 days). Figure 1 graphically represents a comparison between the magnitude and trends in breast cancer crude incidence rates and crude admission rates. The polynomial trend lines for both crude incidence rates (R 2 = 0.8528) and crude admission rates (R 2 = 0.9698) demonstrate relatively good fit of lines to the data. The higher magnitudes noted for admissions than incidence demonstrate the added hospital burden, both from incident cases and prevalent cases Distribution of admissions by age Figure 2 shows distribution of female breast cancer hospital admissions by age groups. In the year 2022, 21.40%, 30.17% and 28.05% of total breast cancer hospital admissions were from 40- 49-, 50-59- and 60–69-year-old age groups respectively, collectively accounting for nearly 80% of admissions. Percentage of admissions for adolescent and young adult breast cancers (AYA breast cancer) were 8.50%, 8.71%, 8.51%, 7.76%, 7.92% and 7.87% From 2017 to 2022. Percentage incidence for AYA breast cancer out of total female breast cancer cases were 9.87%, 8.81%, 8.39%, 8.07% and 7.51% from 2017 to 2021 respectively. Comparison of breast cancer admissions with other common cancers in females Breast cancer accounted for the highest number of hospital admissions rates among common cancers. Comparison of hospital admissions rates from breast cancer with the top five cancers among females in Sri Lanka from 2017 to 2022 is given in Additional file 3 (S3). Among females, breast cancer crude admission rates were 13.1 times higher than thyroid cancer (second commonest cancer in females) admissions, and 3.2 times higher than colorectal cancers (third commonest cancer in females), in the year 2022. Geographic distribution of the hospital burden Additional file 4 (S4) presents hospital burden categorized by districts in Sri Lanka. Figure 3 shows the distribution in 2022. Hospital burden was skewed, with highest admissions in Colombo District followed by Kandy and Galle. Outcomes of female breast cancer hospital admissions Outcome of each admission is categorized in eIMMR system as live discharge, transfer to another hospital, missing form hospital or death during same admission. Table 2 presents outcomes of female breast cancer hospital admissions by age groups. Hospital deaths from other common cancers in females (top five female cancers) from 2017 to 2022 are also included for comparison. Breast cancer had the highest number of hospital deaths among common cancers in females. Ovarian cancer claimed the second highest number of female hospital cancer deaths. Table 2 Outcomes of female breast cancer hospital admissions and comparison with other common cancers (2017–2022) 2017 2018 2019 2020 2021 2022 Outcomes of breast cancer hospital admissions Live discharges 15328 21189 22797 19231 18150 23253 Transfers to another hospital 106 129 134 197 207 181 Missing & other 0 1 0 0 2 3 Deaths 425 501 553 502 439 538 Hospital deaths from all cancers (female) Deaths 2236 2556 2817 2560 2284 2669 Deaths from other common cancers (females) Thyroid 40 36 52 42 24 43 Colorectal 158 152 182 161 149 198 Cervix uteri 110 137 141 144 120 126 Ovarian 226 253 249 256 220 254 Proportions of hospital deaths due to breast cancer 19.01% 19.60% 19.63% 19.61% 19.22% 20.16% Age distribution of breast cancer deaths 80 9 20 19 16 16 22 The highest number of female breast cancer hospital deaths were consistently reported in 50-59year-old age group. 40–49-year-old age group contributed to 14.83% and 17.29% of hospital breast cancer deaths respectively in 2019 and 2022. A 73% increase in deaths was noted from 30-39-year age group to 40-49-year age group in 2022. Figure 4 indicates a comparison of the proportion of hospital deaths of all cancers (2817/6929; 40.66%) with breast cancers (553/876; 63.13%) for 2019. This clearly indicates that more breast cancer patient deaths occur in hospital settings compared to other cancers. Moreover, NCCP reported 876 female breast cancer deaths out of a total of 6929 female cancer deaths in 2019, indicating that approximately one in eight (12.64%) population level female cancer deaths in Sri Lanka were due to breast cancer. This study revealed that breast cancer accounted for one in every five (20%) of female hospital cancer deaths that same year. Table 4 denotes fatality rates compared to hospital admissions in breast cancer. Table 4 Mortality outcomes of breast cancer admissions in females Year Total breast cancer admissions(females) Hospital deaths from breast cancer (females) Fatality rate** 2017 15865 425 2.68% 2018 21872 501 2.29% 2019 23491 553 2.35% 2020 19983 502 2.51% 2021 18909 439 2.32% 2022 24158 538 2.23% **Fatality rate = (total no. of hospital deaths from breast cancer in an year/ total number of breast cancer hospital admissions that year) x 100 Discussion Analysis of hospital admissions with an ICD diagnosis of breast cancer in Sri Lanka's national eIMMR database from 2017 to 2022 reveals an increase in crude admissions, except for a decline in 2020 and 2021, likely due to disruptions caused by the COVID-19 pandemic. This upward trend mirrors the increasing crude incidence rates in Sri Lanka, which rose from 37.9 to 48 per 100,000 population from 2017 to 2021( 11 – 15 ). Besides the true increase in incidence, this rise in hospital admissions may reflect improved breast cancer detection, enhanced reporting through the eIMMR system, and better access to government healthcare services. The greater magnitude of hospital admissions compared to incidence underscores the additional hospital burden, driven by both incident and prevalent cases. Notably, the proportion of breast cancer admissions relative to total cancer admissions had increased, indicating a faster growth rate in breast cancer admissions. This further underscores the escalating hospital burden posed by breast cancer on Sri Lanka's healthcare system. The geographic distribution of admissions was skewed across districts, with higher numbers in districts housing national cancer hospitals and teaching hospitals. Additionally, breast cancer, consistently accounting for the highest incident cancer in females, claimed disproportionally high numbers of hospital admissions among common cancers in females. In comparison, thyroid cancer, although ranked the second most common cancer in women by incidence, had markedly lower admissions than breast cancer, underscoring the importance of evaluating hospital burden alongside incidence rates to guide strategic resource allocation. Among women worldwide, breast cancer represented one in four cancer cases and one in six cancer deaths in 2022 ( 1 ). In Sri Lanka, approximately one in eight female cancer deaths in 2019 were due to breast cancer ( 15 ). The hospital mortality figures from our study were higher, with one in five female hospital cancer deaths resulting from breast cancer in 2022, reinforcing its major contribution to cancer mortality and hospital burden. Interestingly, nearly two-thirds (63%) of breast cancer deaths in Sri Lanka occurred in hospitals highlighting a reliance on hospital-based end-of-life care for breast cancer. Strengthening palliative care through outpatient, home-based, and hospice models to reduce unnecessary hospital admissions, improve symptom control and dignity in dying, appears to be a timely need in improving end-of-life care for breast cancer patients in Sri Lanka. Age-specific analysis revealed that 40 to 69-year-old women accounted for nearly 80% of hospital admissions in 2022, closely aligning with incidence data( 11 )( 12 – 15 ). Moreover, the considerable burden of admissions and hospital deaths from breast cancer in the 40–49 age group raises the need to reassess the current national age recommendation of 50 years for opportunistic mammographic screening ( 16 ). Furthermore, the burden of adolescent and young adult (AYA) breast cancer (ages 15–39) though remained stable at 7–9% annually, suggest the importance of promoting early detection strategies such as breast awareness among younger age groups. Hence these findings reinforce the need for age-specific and burden-driven strategies to effectively manage breast cancer in Sri Lanka. This study has several limitations. The eIMMR database lacked details on admission type (urgent or planned) and presenting complaints, limiting insights into clinical urgency and reasons for hospitalization. Details on oncology outpatient services, including breast cancer chemotherapy, radiotherapy, biopsies, and outpatient follow-ups, were not available in eIMMR database, and were therefore not included, underestimating the true healthcare burden. Although eIMMR system captured over 90% of yearly hospitalization episode in government hospitals, data collection from private sector was not streamlined during the period of study. Therefore, the actual burden on private and non-governmental healthcare providers are not fully represented in this study. Misclassification or underreporting in the eIMMR database could impact accuracy, and the absence of patient-level details, such as disease stage and treatment specifics, restricts further analysis. The disruptions during the COVID-19 pandemic could have complicated trends. Conclusion Breast cancer claimed the highest number of hospital admissions and deaths, with a disproportionately high, increasing hospital burden, compared to other common cancers in women. The burden in women aged 40–59-year-old age group, underscores the need to reassess current screening recommendations. Moreover, the increased reliance on hospitals for terminal care may reflect gaps in community-based or home-based palliative care options in Sri Lanka, emphasizing the necessity for better outpatient and hospice care systems. Our study provides novel insight into the growing operational burden of breast cancer within a public health framework in a resource-constrained setting, underscoring the need for age-specific, burden-driven interventions to guide future policy planning and resource allocation. Abbreviations eIMMR Electronic Morbidity and Mortality Records LMIC Low and Middle-Income Countries NCCP National Cancer Control Program ICD International Classification of Diseases AYA Adolescent and young adult Declarations Ethics approval and consent to participate Ethical clearance for the appropriate handling of information was granted by the Ethics Review Committee of the Faculty of Medicine, University of Colombo (EC/24/085). Consent for publication This study did not involve direct patient participation, as it was based on data analysis from a population database. Availability of data and materials The data that support the findings of this study are available from the medical statistic Unit, Ministry of Health, Sri Lanka. but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the medical statistic Unit, Ministry of Health, Sri Lanka. Competing interests The authors declare that they have no competing interests Funding Not applicable Authors' contributions Liyanage UAconceptualized the study design, analyzed and interpreted the data and drafted the manuscript. Amasha EADH analyzed the data and contributed to drafting the manuscript. Kolambage YD and Walpita YN contributed to designing the study, data interpretation and drafting the manuscript. Senevirathne SA, Dissanayake VHW, Dayaratne BMKDR critically reviewed the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable References Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin [Internet]. 2024 May [cited 2025 Feb 18];74(3):229–63. Available from: https://pubmed.ncbi.nlm.nih.gov/38572751/ World Health Organization. The Global Breast Cancer Initiative [Internet]. [cited 2025 Feb 18]. Available from: https://www.who.int/initiatives/global-breast-cancer-initiative World Bank. Sri Lanka | Data [Internet]. [cited 2025 Feb 18]. Available from: https://data.worldbank.org/country/sri-lanka Department of Census and Statistics, Lanka S. Labour force statistics: first quarter 2024 [Internet]. 2024 [cited 2025 Feb 18]. Available from: https://www.statistics.gov.lk/Resource/en/LabourForce/Bulletins/LFS_Q1_Bulletin_2024.pdf National Cancer Control Programme. Cancer incidence and mortality data – Sri Lanka, 2021 [Internet]. [cited 2025 Feb 18]. [PDF available]. Kariyawasam NC, Weerasekera VS, Dayaratne MKDRB, Hewapathirana R, Karunapema RPP, Bandara IR. eIMMR: the future of health statistics in Sri Lanka. Sri Lanka J Bio-Medical Inf. 2011;1(0):14. Medical Statistics Unit. eIMMR [Internet]. [cited 2025 May 7]. Available from: https://www.immrlkv5.com/ The Sunday Times Sri Lanka. eIMMR, the first eHealth system to be implemented islandwide – Special report [Internet]. [cited 2025 Feb 18]. Available from: https://www.sundaytimes.lk/150621/business-times/eimmr-the-first-ehealth-system-to-be-implemented-islandwide-special-report-153846.html Kolambage YD, Walpita YN, Liyanage UA, Dayaratne BMKDR, Dissanayake VHW. 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Available from: https://www.nccp.health.gov.lk/ National Cancer Control Programme. Cancer incidence and mortality data – Sri Lanka, 2020 [Internet]. [cited 2025 Feb 18]. Available from: https://www.nccp.health.gov.lk/ National Cancer Control Programme. Cancer incidence and mortality data – Sri Lanka, 2021 [Internet]. [cited 2025 Feb 18]. Available from: https://www.nccp.health.gov.lk/ Steliarova-Foucher E, Colombet M, Ries LAG, Moreno F, Dolya A, Bray F et al. International incidence of childhood cancer, 2001–10: a population-based registry study. Lancet Oncol [Internet]. 2017 Jun 1 [cited 2025 Feb 18];18(6):719–31. Available from: https://pubmed.ncbi.nlm.nih.gov/28410997/ Additional Declarations No competing interests reported. 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07:45:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88121,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in breast cancer admission rates and crude incidence\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6884857/v1/533b57ce31931817078a0b2b.png"},{"id":86134666,"identity":"528e62ee-be13-4bed-9421-1ec79fb9816b","added_by":"auto","created_at":"2025-07-07 07:37:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":31693,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of breast cancer hospital admissions by age categories in years\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6884857/v1/38be9aab4b2d3dbd5cd793bc.png"},{"id":86135767,"identity":"4cb12f6b-4d76-4388-a119-f2b5b077fb44","added_by":"auto","created_at":"2025-07-07 07:45:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1080100,"visible":true,"origin":"","legend":"\u003cp\u003eGeographical distribution of breast cancer hospital admissions in Sri Lanka\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6884857/v1/70bd628492df7dc04ecf342c.png"},{"id":86138926,"identity":"68da8fc4-8c7d-45fe-95bd-a4a8e984a25f","added_by":"auto","created_at":"2025-07-07 08:10:12","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":32472,"visible":true,"origin":"","legend":"\u003cp\u003eMortality from all female cancers and breast cancer in 2019*: comparison between eIMMR hospital mortality data with population data form \u003cem\u003eNational Cancer Incidence and Mortality Data -Sri Lanka 2021\u003c/em\u003e, published by the National Cancer Control Programme, based on population level cause of death from vital registration systems of Sri Lanka(15).\u003c/p\u003e\n\u003cp\u003e*Only 2019 data was available in NCCP publications\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6884857/v1/d14f377425f8fc53b4c82d4a.png"},{"id":86138932,"identity":"f6247c0d-9fba-4404-b4fa-59b097f2d696","added_by":"auto","created_at":"2025-07-07 08:10:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2316236,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6884857/v1/05b75b07-833c-4172-84ad-edcad48aaf42.pdf"},{"id":86134670,"identity":"8ff16135-25ad-4042-ad64-5a59b916103b","added_by":"auto","created_at":"2025-07-07 07:37:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":12763,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6884857/v1/893c321b84070462e10de90a.docx"},{"id":86134676,"identity":"4bbe4fd2-5f00-42c6-b576-8c2a23415567","added_by":"auto","created_at":"2025-07-07 07:37:36","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16075,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6884857/v1/85a96cebe0ab4899bf516d75.docx"},{"id":86134674,"identity":"24f42c0d-d18b-4d77-a642-497291684d61","added_by":"auto","created_at":"2025-07-07 07:37:36","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":17012,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile3.docx","url":"https://assets-eu.researchsquare.com/files/rs-6884857/v1/7235fdc9fcadf8544e9c3def.docx"},{"id":86135768,"identity":"b670ab21-299e-49d7-9097-dea3cad85245","added_by":"auto","created_at":"2025-07-07 07:45:36","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":16601,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile4.docx","url":"https://assets-eu.researchsquare.com/files/rs-6884857/v1/7faedb7a0dfb7a21f63fd8b2.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Rising Inpatient Burden of Female Breast Cancer in Sri Lanka: A Population-Based Analysis of Hospital Admissions and Deaths, 2017–2022","fulltext":[{"header":"Background","content":"\u003cp\u003eThe global cancer burden is rising, with 35\u0026nbsp;million new cases projected by 2050\u0026mdash;a 77% increase from 2022 estimates (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This surge imposes significant strain on health budgets, necessitating strategic healthcare planning.\u003c/p\u003e\u003cp\u003eBreast cancer is the most frequently diagnosed cancer in the world among females, and the leading cause of cancer-related deaths among women in 112 countries across the globe, including South Asia. Cancer incidence, mortality and cancer profiles however vary by region and human development levels. These differences reflect challenges in early detection, access to advanced diagnostics and treatment, and healthcare resources (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Addressing these issues requires robust data to guide health care policies and optimize resource allocation.\u003c/p\u003e\u003cp\u003eSri Lanka, a lower-middle income South Asian country, has a population of 22\u0026nbsp;million, with 51.5% being females (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Breast cancer incidence of the country is rising, with age-standardized rates increasing from 19 per 100,000 in 2005 to 33 per 100,000 in 2019. Crude death rate for female breast cancer was 7.8 per 100000 women in 2019 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The Sri Lankan government provides free healthcare nationwide, with cancer care delivered at varying levels through a network of government hospitals including two National Cancer Hospitals. Inpatient care for breast cancer offered by the national health system mostly includes surgery and palliative management, and sometimes admissions related to diagnosis, while radiotherapy, chemotherapy, and post treatment follow-up care are typically offered as outpatient services. Dedicated end-of-life care, such as hospice services, remains extremely limited in Sri Lanka.\u003c/p\u003e\u003cp\u003eWhile regional studies on breast cancer epidemiology are not sparse, data on the actual hospital burden in the region remains limited. Hence, this study examined magnitude and trends in hospital admissions and mortality outcomes for breast cancer in Sri Lanka using the National Electronic Morbidity and Mortality Records (eIMMR) system of the Ministry of Health, Sri Lanka from 2017\u0026ndash;2022. The eIMMR systematically collects real-time data from all hospitals by admissions (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The eIMMR system in Sri Lanka was established in 2009, and by 2015, the system had achieved approximately 53% coverage (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A recent study spanning the period from 2017 to 2020 revealed that the database successfully captured over 90% of yearly hospitalization episode in government hospitals (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Breast cancer hospital admissions and deaths were compared to other common cancers in women and with epidemiological data from the National Cancer Control Program Sri Lanka (NCCP). This analysis provides valuable insights into the in-patient hospital burden of breast cancer in Sri Lanka, essential for health policy, guidelines and resource planning. It also holds broader implications for other LMICs facing similar challenges, contributing to the global understanding of inpatient demands for breast cancer management in resource-constrained settings.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData source and extraction methods\u003c/h2\u003e\u003cp\u003eThis was a secondary data analysis based on the records of the eIMMR system of Sri Lanka. The eIMMR system includes hospital admission data related to diagnosed cases of malignant neoplasms classified according to the ICD 10 (ICD \u0026minus;\u0026thinsp;10 codes of C00\u0026ndash;C97 for 36 cancer types (all cancers). The anonymized data on hospital admissions for this study, for the period from 01.01.2017 to 31.12.2022, were extracted from the national eIMMR database with institutional permission. The data extraction from the eIMMR system was carried out by the medical statistic Unit, Ministry of Health, Sri Lanka. A trained investigator (HA) generated yearly secondary datasets for further analysis, which were verified by another investigator (YK).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData analysis and statistical methods\u003c/h3\u003e\n\u003cp\u003eThe crude admission rate for each year was calculated per 100,000 population by dividing the total number of hospital admissions for the relevant cancer types by the estimated mid-year population for that year. The mid-year population estimates were obtained from the publicly available online dataset published by the Registrar General\u0026rsquo;s Department of Sri Lanka (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) and National Cancer Incidence and Mortality Data- Sri Lanka published by the NCCP (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Distribution of admissions, hospital deaths, and trends across the years were described by age and sex as appropriate. Results were also compared with National Cancer Incidence and Mortality Data -Sri Lanka published by the NCCP for 2017\u0026ndash;2021.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) The NCCP collects data independent of the eIMMR database. 2022 data were not yet published by NCCP at the time of analysis. National mortality data was available for 2019, and incidence data was available up to 2021. Breast cancer admissions and hospital deaths were compared with admissions and hospital deaths from other common cancers in females. The top five commonest cancers in females for each year were identified as breast, thyroid, colorectal, cervix/uteri and ovarian as per NCCP data. (\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The ICD codes included in the study for breast cancer and other common cancers are given in Additonal file 1 (S1). Data was analyzed with standard descriptive statistics using IBM SPSS Statistics for Windows, version 22.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eMagnitude and trends in hospital admission rates for female breast cancer compared to admissions from all cancers in females are presented in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Corresponding cancer incidence rates in Sri Lanka are also presented for comparison.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of crude admission rates for all cancers, breast cancer and crude incidence rates in females\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eCrude rate of admissions\u003csup\u003ea\u003c/sup\u003e (per 100,000 population)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll cancers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e648.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e788.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e802.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e714.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e660.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e798.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBreast cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e143.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e195.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e208.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e176.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e165.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e212.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProportion of breast cancer admissions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.10%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.83%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.04%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24.74%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25.05%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26.61%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eCrude incidence rates\u003csup\u003eb\u003c/sup\u003e (per 100,000 population)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll cancers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e151.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e142.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e151.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e178.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e176.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBreast cancers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProportion of breast cancer incidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.08%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.70%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.14%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25.70%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27.20%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCrude admission rates and crude incidence rates are given per 100,000 population\u003c/p\u003e\u003cp\u003ea- eIMMR system; b- NCCP Sri Lanka(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e*Data not published by the NCCP, Sri Lanka at the time of analysis.\u003c/p\u003e\u003cp\u003eTotal cancer admissions (both sexes), sex distribution of the breast cancer admissions and breast cancer incidence are given in Additional file 2 (S2).\u003c/p\u003e\u003cp\u003eThe crude admission rates for breast cancer have risen from 2017 to 2022, with a drop in 2020 and 2021. Breast cancer admissions as a proportion of all cancer admissions (proportion of breast cancer admissions) also demonstrated a similar trend from 2017 to 2022.\u003c/p\u003e\u003cp\u003eThe mean hospital duration per admission for breast cancer admissions across 2017\u0026ndash;2022 was approximately 3 days (2.782 days).\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e graphically represents a comparison between the magnitude and trends in breast cancer crude incidence rates and crude admission rates.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe polynomial trend lines for both crude incidence rates (R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.8528) and crude admission rates (R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.9698) demonstrate relatively good fit of lines to the data.\u003c/p\u003e\u003cp\u003eThe higher magnitudes noted for admissions than incidence demonstrate the added hospital burden, both from incident cases and prevalent cases\u003c/p\u003e\n\u003ch3\u003eDistribution of admissions by age\u003c/h3\u003e\n\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows distribution of female breast cancer hospital admissions by age groups. In the year 2022, 21.40%, 30.17% and 28.05% of total breast cancer hospital admissions were from 40- 49-, 50-59- and 60\u0026ndash;69-year-old age groups respectively, collectively accounting for nearly 80% of admissions. Percentage of admissions for adolescent and young adult breast cancers (AYA breast cancer) were 8.50%, 8.71%, 8.51%, 7.76%, 7.92% and 7.87% From 2017 to 2022. Percentage incidence for AYA breast cancer out of total female breast cancer cases were 9.87%, 8.81%, 8.39%, 8.07% and 7.51% from 2017 to 2021 respectively.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eComparison of breast cancer admissions with other common cancers in females\u003c/h3\u003e\n\u003cp\u003eBreast cancer accounted for the highest number of hospital admissions rates among common cancers. Comparison of hospital admissions rates from breast cancer with the top five cancers among females in Sri Lanka from 2017 to 2022 is given in Additional file 3 (S3). Among females, breast cancer crude admission rates were 13.1 times higher than thyroid cancer (second commonest cancer in females) admissions, and 3.2 times higher than colorectal cancers (third commonest cancer in females), in the year 2022.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eGeographic distribution of the hospital burden\u003c/h2\u003e\u003cp\u003eAdditional file 4 (S4) presents hospital burden categorized by districts in Sri Lanka. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the distribution in 2022. Hospital burden was skewed, with highest admissions in Colombo District followed by Kandy and Galle.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eOutcomes of female breast cancer hospital admissions\u003c/h3\u003e\n\u003cp\u003eOutcome of each admission is categorized in eIMMR system as live discharge, transfer to another hospital, missing form hospital or death during same admission. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents outcomes of female breast cancer hospital admissions by age groups. Hospital deaths from other common cancers in females (top five female cancers) from 2017 to 2022 are also included for comparison. Breast cancer had the highest number of hospital deaths among common cancers in females. Ovarian cancer claimed the second highest number of female hospital cancer deaths.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOutcomes of female breast cancer hospital admissions and comparison with other common cancers (2017\u0026ndash;2022)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOutcomes of breast cancer hospital admissions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLive discharges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22797\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23253\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransfers to another hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e181\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing \u0026amp; other\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeaths\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e425\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e553\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e502\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e538\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHospital deaths from all cancers (female)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeaths\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2556\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2817\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2560\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2669\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDeaths from other common cancers (females)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThyroid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColorectal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCervix uteri\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e126\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOvarian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e254\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProportions of hospital deaths due to breast cancer\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.01%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.60%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.63%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19.61%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19.22%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20.16%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge distribution of breast cancer deaths\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e70\u0026ndash;79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe highest number of female breast cancer hospital deaths were consistently reported in 50-59year-old age group. 40\u0026ndash;49-year-old age group contributed to 14.83% and 17.29% of hospital breast cancer deaths respectively in 2019 and 2022. A 73% increase in deaths was noted from 30-39-year age group to 40-49-year age group in 2022.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e indicates a comparison of the proportion of hospital deaths of all cancers (2817/6929; 40.66%) with breast cancers (553/876; 63.13%) for 2019. This clearly indicates that more breast cancer patient deaths occur in hospital settings compared to other cancers.\u003c/p\u003e\u003cp\u003eMoreover, NCCP reported 876 female breast cancer deaths out of a total of 6929 female cancer deaths in 2019, indicating that approximately one in eight (12.64%) population level female cancer deaths in Sri Lanka were due to breast cancer. This study revealed that breast cancer accounted for one in every five (20%) of female hospital cancer deaths that same year.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e denotes fatality rates compared to hospital admissions in breast cancer.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMortality outcomes of breast cancer admissions in females\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal breast cancer admissions(females)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHospital deaths from breast cancer\u003c/p\u003e\u003cp\u003e(females)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFatality rate**\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15865\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e425\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.68%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21872\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.29%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23491\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e553\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.35%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19983\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e502\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.51%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18909\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.32%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e538\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.23%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e**Fatality rate = (total no. of hospital deaths from breast cancer in an year/ total number of breast cancer hospital admissions that year) x 100\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAnalysis of hospital admissions with an ICD diagnosis of breast cancer in Sri Lanka's national eIMMR database from 2017 to 2022 reveals an increase in crude admissions, except for a decline in 2020 and 2021, likely due to disruptions caused by the COVID-19 pandemic. This upward trend mirrors the increasing crude incidence rates in Sri Lanka, which rose from 37.9 to 48 per 100,000 population from 2017 to 2021(\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Besides the true increase in incidence, this rise in hospital admissions may reflect improved breast cancer detection, enhanced reporting through the eIMMR system, and better access to government healthcare services. The greater magnitude of hospital admissions compared to incidence underscores the additional hospital burden, driven by both incident and prevalent cases. Notably, the proportion of breast cancer admissions relative to total cancer admissions had increased, indicating a faster growth rate in breast cancer admissions. This further underscores the escalating hospital burden posed by breast cancer on Sri Lanka's healthcare system. The geographic distribution of admissions was skewed across districts, with higher numbers in districts housing national cancer hospitals and teaching hospitals.\u003c/p\u003e\u003cp\u003eAdditionally, breast cancer, consistently accounting for the highest incident cancer in females, claimed disproportionally high numbers of hospital admissions among common cancers in females. In comparison, thyroid cancer, although ranked the second most common cancer in women by incidence, had markedly lower admissions than breast cancer, underscoring the importance of evaluating hospital burden alongside incidence rates to guide strategic resource allocation.\u003c/p\u003e\u003cp\u003eAmong women worldwide, breast cancer represented one in four cancer cases and one in six cancer deaths in 2022 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Sri Lanka, approximately one in eight female cancer deaths in 2019 were due to breast cancer (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The hospital mortality figures from our study were higher, with one in five female hospital cancer deaths resulting from breast cancer in 2022, reinforcing its major contribution to cancer mortality and hospital burden.\u003c/p\u003e\u003cp\u003eInterestingly, nearly two-thirds (63%) of breast cancer deaths in Sri Lanka occurred in hospitals highlighting a reliance on hospital-based end-of-life care for breast cancer. Strengthening palliative care through outpatient, home-based, and hospice models to reduce unnecessary hospital admissions, improve symptom control and dignity in dying, appears to be a timely need in improving end-of-life care for breast cancer patients in Sri Lanka.\u003c/p\u003e\u003cp\u003eAge-specific analysis revealed that 40 to 69-year-old women accounted for nearly 80% of hospital admissions in 2022, closely aligning with incidence data(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)(\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Moreover, the considerable burden of admissions and hospital deaths from breast cancer in the 40\u0026ndash;49 age group raises the need to reassess the current national age recommendation of 50 years for opportunistic mammographic screening (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Furthermore, the burden of adolescent and young adult (AYA) breast cancer (ages 15\u0026ndash;39) though remained stable at 7\u0026ndash;9% annually, suggest the importance of promoting early detection strategies such as breast awareness among younger age groups. Hence these findings reinforce the need for age-specific and burden-driven strategies to effectively manage breast cancer in Sri Lanka.\u003c/p\u003e\u003cp\u003eThis study has several limitations. The eIMMR database lacked details on admission type (urgent or planned) and presenting complaints, limiting insights into clinical urgency and reasons for hospitalization. Details on oncology outpatient services, including breast cancer chemotherapy, radiotherapy, biopsies, and outpatient follow-ups, were not available in eIMMR database, and were therefore not included, underestimating the true healthcare burden. Although eIMMR system captured over 90% of yearly hospitalization episode in government hospitals, data collection from private sector was not streamlined during the period of study. Therefore, the actual burden on private and non-governmental healthcare providers are not fully represented in this study. Misclassification or underreporting in the eIMMR database could impact accuracy, and the absence of patient-level details, such as disease stage and treatment specifics, restricts further analysis. The disruptions during the COVID-19 pandemic could have complicated trends.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBreast cancer claimed the highest number of hospital admissions and deaths, with a disproportionately high, increasing hospital burden, compared to other common cancers in women. The burden in women aged 40\u0026ndash;59-year-old age group, underscores the need to reassess current screening recommendations. Moreover, the increased reliance on hospitals for terminal care may reflect gaps in community-based or home-based palliative care options in Sri Lanka, emphasizing the necessity for better outpatient and hospice care systems. Our study provides novel insight into the growing operational burden of breast cancer within a public health framework in a resource-constrained setting, underscoring the need for age-specific, burden-driven interventions to guide future policy planning and resource allocation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eeIMMR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eElectronic Morbidity and Mortality Records\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLMIC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow and Middle-Income Countries\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNCCP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Cancer Control Program\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Classification of Diseases\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAYA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdolescent and young adult\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance for the appropriate handling of information was granted by the Ethics Review Committee of the Faculty of Medicine, University of Colombo (EC/24/085).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not involve direct patient participation, as it was based on data analysis from a population database.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the medical statistic Unit, Ministry of Health, Sri Lanka. but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the medical statistic Unit, Ministry of Health, Sri Lanka.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLiyanage UAconceptualized the study design,\u0026nbsp;analyzed and interpreted the data and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eAmasha EADH\u0026nbsp;analyzed the data and contributed to drafting the manuscript.\u003c/p\u003e\n\u003cp\u003eKolambage YD\u0026nbsp;and\u0026nbsp;Walpita YN\u0026nbsp;contributed to designing the study, data interpretation and drafting the manuscript.\u003c/p\u003e\n\u003cp\u003eSenevirathne SA, Dissanayake VHW, Dayaratne BMKDR\u0026nbsp;critically reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. \u003cem\u003eCA Cancer J Clin\u003c/em\u003e [Internet]. 2024 May [cited 2025 Feb 18];74(3):229\u0026ndash;63. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/38572751/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/38572751/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. The Global Breast Cancer Initiative [Internet]. [cited 2025 Feb 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/initiatives/global-breast-cancer-initiative\u003c/span\u003e\u003cspan address=\"https://www.who.int/initiatives/global-breast-cancer-initiative\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Bank. Sri Lanka | Data [Internet]. [cited 2025 Feb 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://data.worldbank.org/country/sri-lanka\u003c/span\u003e\u003cspan address=\"https://data.worldbank.org/country/sri-lanka\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDepartment of Census and Statistics, Lanka S. Labour force statistics: first quarter 2024 [Internet]. 2024 [cited 2025 Feb 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.statistics.gov.lk/Resource/en/LabourForce/Bulletins/LFS_Q1_Bulletin_2024.pdf\u003c/span\u003e\u003cspan address=\"https://www.statistics.gov.lk/Resource/en/LabourForce/Bulletins/LFS_Q1_Bulletin_2024.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Cancer Control Programme. Cancer incidence and mortality data \u0026ndash; Sri Lanka, 2021 [Internet]. [cited 2025 Feb 18]. [PDF available].\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKariyawasam NC, Weerasekera VS, Dayaratne MKDRB, Hewapathirana R, Karunapema RPP, Bandara IR. eIMMR: the future of health statistics in Sri Lanka. Sri Lanka J Bio-Medical Inf. 2011;1(0):14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMedical Statistics Unit. eIMMR [Internet]. [cited 2025 May 7]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.immrlkv5.com/\u003c/span\u003e\u003cspan address=\"https://www.immrlkv5.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Sunday Times Sri Lanka. eIMMR, the first eHealth system to be implemented islandwide \u0026ndash; Special report [Internet]. [cited 2025 Feb 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sundaytimes.lk/150621/business-times/eimmr-the-first-ehealth-system-to-be-implemented-islandwide-special-report-153846.html\u003c/span\u003e\u003cspan address=\"https://www.sundaytimes.lk/150621/business-times/eimmr-the-first-ehealth-system-to-be-implemented-islandwide-special-report-153846.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKolambage YD, Walpita YN, Liyanage UA, Dayaratne BMKDR, Dissanayake VHW. The burden of hospital admissions for skeletal dysplasias in Sri Lanka: a population-based study. \u003cem\u003eOrphanet J Rare Dis\u003c/em\u003e [Internet]. 2023 Dec 1 [cited 2025 Feb 18];18(1):1\u0026ndash;8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ojrd.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://ojrd.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13023-023-02884-2\u003c/span\u003e\u003cspan address=\"10.1186/s13023-023-02884-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRegistrar General\u0026rsquo;s Department, Sri Lanka. Mid-year population estimates by age group and sex, 2014\u0026ndash;2022 [Internet]. [cited 2025 Feb 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.statistics.gov.lk/Resource/en/Population/Vital_Statistics/Mid-year_population_by_age_group.pdf\u003c/span\u003e\u003cspan address=\"http://www.statistics.gov.lk/Resource/en/Population/Vital_Statistics/Mid-year_population_by_age_group.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Cancer Control Programme. Cancer incidence and mortality data \u0026ndash; Sri Lanka, 2017 [Internet]. [cited 2025 Feb 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nccp.health.gov.lk/\u003c/span\u003e\u003cspan address=\"https://www.nccp.health.gov.lk/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Cancer Control Programme. Cancer incidence and mortality data \u0026ndash; Sri Lanka, 2018 [Internet]. [cited 2025 Feb 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nccp.health.gov.lk/\u003c/span\u003e\u003cspan address=\"https://www.nccp.health.gov.lk/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Cancer Control Programme. Cancer incidence and mortality data \u0026ndash; Sri Lanka, 2019 [Internet]. [cited 2025 Feb 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nccp.health.gov.lk/\u003c/span\u003e\u003cspan address=\"https://www.nccp.health.gov.lk/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Cancer Control Programme. Cancer incidence and mortality data \u0026ndash; Sri Lanka, 2020 [Internet]. [cited 2025 Feb 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nccp.health.gov.lk/\u003c/span\u003e\u003cspan address=\"https://www.nccp.health.gov.lk/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Cancer Control Programme. Cancer incidence and mortality data \u0026ndash; Sri Lanka, 2021 [Internet]. [cited 2025 Feb 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nccp.health.gov.lk/\u003c/span\u003e\u003cspan address=\"https://www.nccp.health.gov.lk/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSteliarova-Foucher E, Colombet M, Ries LAG, Moreno F, Dolya A, Bray F et al. International incidence of childhood cancer, 2001\u0026ndash;10: a population-based registry study. Lancet Oncol [Internet]. 2017 Jun 1 [cited 2025 Feb 18];18(6):719\u0026ndash;31. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/28410997/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/28410997/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, incidence, hospital admissions, hospital deaths, hospital burden, breast cancer management, cancer burden, LMIC, eIMMR database","lastPublishedDoi":"10.21203/rs.3.rs-6884857/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6884857/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: While breast cancer epidemiology in South Asia is widely studied, data on its actual hospital burden remains sparse. This study analyzed magnitudes and trends in hospital admissions and hospital deaths from female breast cancer compared to other common cancers, breast cancer incidence and mortality in Sri Lanka.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e A retrospective analysis of hospital admissions and outcomes from 2017–2022 was conducted using the national eIMMR database, using standard descriptive statistics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eBreast cancer accounted for 22–27% of cancer-related hospital admissions in women annually, from 2017 to 2022. In 2022, it accounted for 26.6% of cancer admissions, requiring 13.1 times and 3.2 times more hospitalizations than thyroid and colorectal cancers in females. The highest hospital burden was observed in women aged 40–69 years, who accounted for nearly 80% of breast cancer admissions in 2022 (21.4% in 40–49 years, 30.17% in 50–59 years, and 28.05% in 60–69 years). Majority (63%) of breast cancer deaths occurred in hospitals, accounting for one in five female cancer-related hospital deaths in 2019.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Breast cancer accounted for the highest number of hospital admissions and deaths, with a disproportionately high, increasing hospital burden, compared to other common cancers in women. Moreover, given that the majority of breast cancer deaths in Sri Lanka also occur in government hospitals, the study highlights the escalating high burden of breast cancer on Sri Lanka’s National Healthcare System.\u003c/p\u003e","manuscriptTitle":"Rising Inpatient Burden of Female Breast Cancer in Sri Lanka: A Population-Based Analysis of Hospital Admissions and Deaths, 2017–2022","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-07 07:37:31","doi":"10.21203/rs.3.rs-6884857/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-01T15:51:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-30T01:31:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-28T05:27:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-26T01:00:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-22T13:03:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-21T08:20:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229383898257746347989100145175816149930","date":"2025-07-21T00:01:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256292123016974542396262188751673304299","date":"2025-07-17T15:59:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229186333279327464716596781816432093684","date":"2025-07-16T01:12:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308252705534985196405236305013537674092","date":"2025-07-13T01:26:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214851847230702288558786881730622751472","date":"2025-07-12T20:34:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"252737588620360876228748081683633629323","date":"2025-07-10T16:38:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83707750883451723768459425259427135993","date":"2025-07-07T07:29:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126212161725051568875438072609152744618","date":"2025-07-05T11:01:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20950825378362452133782954520595566484","date":"2025-07-03T17:01:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-03T10:56:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-16T16:59:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-14T00:23:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-14T00:21:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2025-06-13T05:26:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0b0d346e-ccc5-4b94-a7a3-22a7399bbdc9","owner":[],"postedDate":"July 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-29T09:38:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-07 07:37:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6884857","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6884857","identity":"rs-6884857","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}