对于绝经前与绝经后患者，乳腺癌的原因、预后、结局和影响不同。
2020年7月23日，英国《柳叶刀》旗下《全球卫生》发表加拿大艾伯塔省卫生厅、卡尔加里大学、美国癌症学会、世界卫生组织国际癌症研究机构的研究报告，根据绝经前后，分析了全球乳腺癌的发病率、死亡率及其变化趋势。
该人群研究利用2018年国际癌症研究机构全球癌症统计报告GLOBOCAN数据，计算按年龄分组的乳腺癌发病率和死亡率，对全球绝经前和绝经后女性的乳腺癌发生率和死亡率进行分析。根据年龄对绝经状态进行划分，将年龄≥50岁定义为绝经后。利用国际癌症研究机构五大洲癌症数据库，计算年平均百分比变化，对1998～2012年41个国家地区44个人群乳腺癌发病变化趋势进行评定。
结果，2018年全世界绝经前、绝经后乳腺癌患者：
发病：64万4753例、144万4096例
死亡：13万2624例、49万4055例
根据联合国开发计划署人类发展指数，不发达国家与发达国家相比，绝经前乳腺癌的发病和死亡比例较高。
人类发展指数指数极高国家的乳腺癌发病率最高：
绝经前：每10万女性30.6例
绝经后：每10万女性253.6例
人类发展指数指数中低国家的乳腺癌死亡率最高：
绝经前：每10万女性8.5例
绝经后：每10万女性53.3例
按年龄分组的乳腺癌发病率变化趋势：
绝经前：20个人群显著增加，主要见于发达国家
绝经后：24个人群显著增加，主要见于发展中国家
因此，该研究结果表明，全世界绝经前、绝经后乳腺癌的发病率和死亡率不断增加。虽然中低收入国家的早期诊断和获得治疗仍然至关重要，但是世界各个地区都必须加强一级预防，以减少已知乳腺癌风险因素、减轻未来的乳腺癌负担。
对此，尼日利亚伊巴丹大学、美国芝加哥大学发表同期评论：全球乳腺癌结局差异的新视角、不平等现象、待解答问题。
Lancet Glob Health. 2020 Jul 23;8(8):e1027-e1037.
Global burden and trends in premenopausal and postmenopausal breast cancer: a population-based study.
Emily Heer, Andrew Harper, Noah Escandor, Hyuna Sung, Valerie McCormack, Miranda M Fidler-Benaoudia.
Alberta Health Services, Calgary, AB, Canada; American Cancer Society, Atlanta, GA, USA; International Agency for Research on Cancer, Lyon, France; University of Calgary, Calgary, AB, Canada.
BACKGROUND: Breast cancer has distinct causes, prognoses, and outcomes and effects in patients at premenopausal and postmenopausal ages. We sought to assess the global burden and trends in breast cancer by menopausal status.
METHODS: We did a population-based analysis of global breast cancer incidence and mortality among premenopausal and postmenopausal women. Menopausal status was defined using age as a proxy, whereby breast cancer cases or deaths at age 50 years or older were regarded as postmenopausal. Age-standardised breast cancer incidence and mortality in 2018 were calculated using GLOBOCAN data. Incidence trends for 1998-2012 were assessed in 44 populations from 41 countries using the Cancer in Five Continents plus database, by calculating the annual average percent change.
FINDINGS: Approximately 645000 premenopausal and 1.4 million postmenopausal breast cancer cases were diagnosed worldwide in 2018, with more than 130000 and 490000 deaths occurring in each menopausal group, respectively. Proportionally, countries with a low UNDP human development index (HDI) faced a greater burden of premenopausal breast cancer for both new cases and deaths compared with higher income countries. Countries with a very high HDI had the highest premenopausal and postmenopausal breast cancer incidence (30.6 and 253.6 cases per 100000, respectively), whereas countries with low and medium HDI had the highest premenopausal and postmenopausal mortality, respectively (8.5 and 53.3 deaths per 100000, respectively). When examining breast cancer trends, we noted significantly increasing age-standardised incidence rates (ASIRs) for premenopausal breast cancer in 20 of 44 populations and significantly increasing ASIRs for postmenopausal breast cancer in 24 of 44 populations. The growth exclusively at premenopausal ages largely occurred in high-income countries, whereas the increasing postmenopausal breast cancer burden was most notable in countries under transition.
INTERPRETATION: We provide evidence of a rising burden of both premenopausal and postmenopausal breast cancer worldwide. Although early diagnosis and access to treatment remain crucial in low-income and middle-income countries, primary prevention efforts seeking to decrease exposure to known breast cancer risk factors are warranted in all world regions to curb the future breast cancer burden.
DOI: 10.1016/S2214-109X(20)30215-1
Lancet Glob Health. 2020 Aug;8(8):e978-e979.
Global disparities in breast cancer outcomes: new perspectives, widening inequities, unanswered questions.
Mojisola Oluwasanu, Olufunmilayo I Olopade.
University of Ibadan, Ibadan, Nigeria; University of Chicago, Chicago, IL, USA.
DOI: 10.1016/S2214-109X(20)30307-7
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