Plastic Surgery Research Council

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The Global Macroeconomic Burden of Breast Cancer: Implications for Oncologic and Reconstructive Surgery
Kavitha Ranganathan, MD1, Puneet Singh, BS2, Edwin G. Wilkins, MD, MS1, Jennifer B. Hamill, MPH1, Oluseyi Aliu, MD, MS3, Lisa Newman, MD, MPH4, David Hutton, PhD2, Adeyiza O. Momoh, MD1.
1University of Michigan, Ann Arbor, MI, USA, 2University of Michigan School of Public Health, Ann Arbor, MI, USA, 3Johns Hopkins Hospital, Baltimore, MD, USA, 4Henry Ford Health Systems, Detroit, MI, USA.

Purpose: Although breast cancer mortality has decreased since 1990 in the United States, mortality in low and middle-income countries (LMICs) continues to be as high as 88%. In this study, we quantified the global macroeconomic burden of breast cancer across 94 countries between 2005 to 2015. Defining the global burden of breast cancer represents the first step towards expanding access to breast cancer care and reconstruction internationally.
Methods: Data from the Institute of Health Metrics and Evaluation (1990-2015) were used to calculate epidemiological statistics and temporal trends for 94 high, middle, and low-income countries. To characterize the economic burden of breast cancer, Welfare Loss was calculated by measuring disability-adjusted-life-years (DALYs) lost to breast cancer alongside the dollar equivalent of a value of statistical life year (VSLY), and as a function of each country's GDP. Known estimates of VSLY for the United States were used as the benchmark to compute peak VSLY for each country. As such, the economic burden of breast cancer was defined based on: 1. DALYs and VSLY, and 2. DALYs and a country's per capita GDP.
Results: Annual mortality rates among breast cancer patients were significantly greater in LMICs in South Asia (3.06%) and Sub-Saharan Africa (2.76%), compared to high-income countries like the United States (1.69%). From 2005-2015, mortality in South Asia and Sub-Saharan Africa increased by 27.9% and 19.7%, respectively (Figure 1). In 2015, the global prevalence, incidence, and deaths attributable to breast cancer were 21,361,7845, 2,421,698, and 533,598 respectively. Regions with the highest incidence/prevalence/DALYs were South Asia, Southeast Asia, and Latin America/Caribbean. These numbers superseded those of high-income North America. Countries in South Asia demonstrated the greatest increase in welfare lost to breast cancer over this time from 0.05% to 0.08% of GDP. In 2015, welfare lost to breast cancer was greatest in the US at 0.22% of GDP with minimal change over the 10-year study period.
Conclusions: Although epidemiological indicators of breast cancer remain stably high in the US, the burden of disease and economic impact are rising significantly in LMICs. Efforts to improve access to surgical care for women with breast cancer could reduce mortality, and mitigate the social and financial consequences of this disease in LMICs. These findings may also be relevant to interventions focused on improving access to care in low-resource settings in the United States as well.


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