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Obstetrics and Gynegology2023№8
The prevalence of benign breast...

The prevalence of benign breast disease in the Ural Federal District

DOI
https://dx.doi.org/10.18565/aig.2023.131

Bashmakova N.V., Sevostyanova O.Yu., Chumarnaya T.V., Oboskalova T.A.

1) Ural State Medical University, Ministry of Health of Russia, Yekaterinburg, Russia; 2) Ural Research Institute of Maternity and Child Care, Ministry of Health of Russia, Yekaterinburg, Russia; 3) Institute of Immunology end Physiology, Ural Branch of the Russian Academy of Science, Yekaterinburg, Russia
Objective: To investigate the epidemiological situation regarding the incidence and prevalence of benign breast disease (BBD) among women in the Ural Federal District (UFD) between 2012 and 2021.
Materials and methods: This descriptive epidemiological study analyzed the incidence and prevalence of BBD in the UFD from 2012 to 2021. The study included adult women, including those older than working age.
Results: From 2012 to 2019, an increase in the incidence and prevalence of BBD was observed among adult women in the UFD. The average growth rates (AGR) of incidence and prevalence were 3.37% and 5.29%, respectively. During the same period, the incidence of BBD in women beyond working age showed a moderate upward trend and higher prevalence. The AGR was 1.91% and 6.03%, respectively. However, 2020–2021 witnessed a significant decrease in these indicators, with a negative AGR. This decline can be attributed to restrictive measures, suspended medical care, decreased preventive examinations, outpatient medical supervision, and outpatient care owing to the COVID-19 pandemic.
Conclusion: This study of the dynamics of BBD incidence and prevalence among adult women in the UFD from 2012 to 2021 provides valuable information for understanding the factors contributing to the pre-pandemic growth of these indicators. This knowledge can aid in the future planning and improvement of medical care, particularly with the aim of enhancing the quality of life of patients. It is important to consider regional characteristics, including sparsely populated and rural areas, when implementing such plans.

Authors' contributions: Bashmakova N.V. – manuscript editing; Sevostyanova O.Yu. – conception and design of the study, acquisition and analysis of data, drafting of the manuscript; Chumarnaya T.V. – statistical analysis, preparation of illustrative material (graphics); Oboskalova T.A. – manuscript editing.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Bashmakova N.V., Sevostyanova O.Yu., Chumarnaya T.V., Oboskalova T.A.
The prevalence of benign breast disease in the Ural Federal District.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (8): 103-110 (in Russian)
https://dx.doi.org/10.18565/aig.2023.131

Keywords

benign breast disease
incidence
prevalence
Ural Federal District

Benign breast disease (BBD) encompasses a group of conditions characterized by a variety of proliferative and regressive changes in the breast tissue, resulting in an imbalance between epithelial and connective tissue components [1]. In the Russian Federation (RF), BBD is recognized as an independent disease in the Russian Federation and can occur alongside other reproductive system disorders, particularly benign proliferative diseases and neuroendocrine syndromes. The prevalence of BBD symptoms among gynecological patients ranges from 40 to 87% and tends to increase with age [2, 3].

Breast pathology has received significant attention owing to the high prevalence of breast cancer (BC) and the similarities in clinical manifestations at certain stages. BC is a leading malignant tumor worldwide and in the Russian Federation [4, 5]. Over the past decade, an integrated healthcare approach has contributed to the early detection of first- and second-stage breast cancers in the Russian Federation, resulting in a decrease in the proportion of patients diagnosed with advanced forms of this malignancy [6, 7].

Since 2012, the organization and provision of medical care for benign breast diseases has been the responsibility of obstetric and gynecological services. This has led to the establishment of specialized units within antenatal clinics to facilitate early detection of breast diseases. Qualification requirements for obstetrician-gynecologists in this field have been established along with diagnostic algorithms, treatment protocols, and monitoring guidelines for affected women [8, 9]. The International Classification of Diseases, 10th revision, code N 60, and Federal Statistical Observation Form No. 12, entitled "Information on the number of diseases registered in patients living in the service area of a medical organization" (FSO No. 12), have been utilized to record BBD cases [10]. FSO No. 12 is an official document of sectoral statistics used to track the number of sick patients by appointment as well as cases detected during preventive and medical examinations of the adult population. Completed by medical organizations with an attached population, it is subsequently compiled by healthcare management bodies at the regional level and used to generate statistics at the federal district level and for the entire country for a given calendar year. This form serves as the basis for calculating the population incidence rates.

Overall, remaining vigilant about cancer and improving the quality of life for patients are core principles in the organization and provision of medical care for women with benign breast diseases [7, 11]. Against this backdrop, we believe that conducting an epidemiological analysis of the incidence and prevalence of BBD in the Ural Federal District (UFD) will not only provide insight into women's health but will also prove valuable in the planning and assessment of the effectiveness of medical care for this patient population.

This study aimed to investigate the epidemiological situation regarding the incidence and prevalence of BBD among women in the UFD between 2012 and 2021.

Materials and methods

This epidemiological descriptive study of the prevalence and incidence of BBD in the UFD was conducted from 2012 to 2021. We studied the incidence of BBD with a diagnosis established for the first time in life and the prevalence among the female adult population, including women older than the working age. The indicators of the Russian Federation, UFD, and six regions of the district were used: Kurgan, Sverdlovsk, Tyumen, Chelyabinsk, Khanty-Mansiysk Autonomous Okrug (KhMAO), and Yamalo-Nenets Autonomous Okrug (YNAO). These indicators were obtained from the statistical materials of the Department for Monitoring, Analysis, and Strategic Development of Healthcare of the Ministry of Health of the Russian Federation, Central Research Institute for the Organization and Informatization of Healthсare of the Ministry of Health of the Russian Federation on the websites of the Ministry for 2011–2017 (https://minzdrav.gov.ru/) and the Institute for 2018–2021 (https://mednet.ru/) [12–34]. The values are expressed as prosantimilles (0/0000). In this article, when describing the incidence, terminology was used in clinical epidemiology and was synonymous with the concepts specified in the sources of the Federal State Statistics Service, the Ministry of Health of the Russian Federation, and the Russian Research Institute of Health [35, 36]. The concept of “morbidity of BBD” corresponds to the term “incidence,” that is, the number of new cases developed within a defined population over a specific period of time), and “general morbidity of BBD” corresponds to the term “prevalence,” that is, the total number or proportion of individuals who have a specific disease or health condition within a defined population at a particular point in time or over a specific period [37]. Taking into account the effect of the second edition of the Procedure for the profile of "obstetrics and gynecology,” the BBD indicators in 2012 were considered as baseline indicators. Between 2020 and 2021, there was a massive spread of a new coronavirus infection (NCVI) in the Russian Federation, which was accompanied by a restriction of planned medical care, including preventive and medical examinations of the adult population, and a concentration of efforts to overcome a highly contagious viral disease. Therefore, the analysis distinguished between the pre-pandemic period (2012–2019) and the NCVI spread phase (2020–2021).

Statistical analysis

Statistical analysis was performed using Microsoft Office Excel 2016 and SPSS 27.0 (IBM, USA). Incidence and prevalence data are presented as intensive relative rates in prosantimilles (0/0000). This analysis was performed using descriptive statistics. To describe the dynamics of incidence and prevalence, time series were analyzed, and the absolute increase (decrease), growth (decrease) rate, growth (decrease) rate at baseline and chain basis, and average growth (decrease) rate (AGR) were considered. The growth rate and AGR are expressed as percentages. The long-term trend in the distribution of the indicators was determined using the average growth rate. If the AGR had a value of up to ±1%, then it was considered that there was no trend in the dynamics of the indicator, from ±1 to ±5% to moderate, and more than 5% was considered pronounced. The sign indicates the direction of the trend [38].

Results and discussion

The UFD includes six subjects of the Russian Federation: Kurgan, Tyumen, Sverdlovsk, and Chelyabinsk regions, KhMAO and YNAO, with a female population of 6579.056 thousand in 2021 [39]. In 2012, 27081 women were diagnosed with BBD for the first time. The incidence rate was 508.200/0000, and increased consistently between 2013 and 2019. compared to 2012 (Table 1).

103-1.jpg (114 KB)

In 2019, the largest number of newly diagnosed BBD cases (33,572 cases) resulted in the highest incidence, 641.0 per 100,000 adult female population. The excess of the 2012 indicator was 26%. In the pre-pandemic period, the AGR of the BBD incidence in the district was 3.37%, corresponding to a moderate upward trend (Fig. 1). When comparing the incidence of BBD in UFD with the average Russian indicator, it should be noted that during the period 2012–2017. These values were comparable. In 2018–2019, the UFD indicator exceeded the average Russian one: in 2018, by 14.92%; in 2019, by 13.80%, which was attributed to an increase in the incidence in three regions: YNAO, Kurgan, and Sverdlovsk. In 2012–2019, the AGR was 10.31% in the YNAO, 7.62% in the Kurgan region, and 5.23% in the Sverdlovsk region. In 2020–2021, in the UFD, there was a sharp decline in the incidence of BBD in the adult female population (Fig. 1).

In the first year of the pandemic (2020), the most pronounced decrease in the rate of increase in the incidence of BBD was observed in the UFD (-34%) and the Russian Federation (-29%). In 2020–2021, AGR in the UFD had a negative value, corresponding to the Russian situation and a pronounced trend in the dynamics of the indicator (Fig. 1).

The prevalence rate reflects not only the effect of the accumulation of pathology in the population and depends on the duration of the disease, its etiology, and other objective factors but also considers subjective aspects, including the availability and quality of medical care. In 2012, the prevalence of women with BBD in the UFD was 1369.90/0000 (Table 2). Throughout the pre-pandemic period, the prevalence increased annually compared with the 2012 baseline, peaking in 2019 at 40.7% above the 2012 level. The growth in the average Russian prevalence was less intensive and amounted to 34.4%, which was also confirmed by the lower AGR of the prevalence of BBD in the adult female population in the Russian Federation (Fig. 2).

The highest AGR of BBD prevalence was observed in four regions of the UFD: YNAO – 8.68%; Sverdlovsk region – 7.75%; Kurgan region – 5.59%; KhMAO – 4.43% against the background of the lack of dynamics in the Tyumen and Chelyabinsk regions: 0.93 and 0.65%, respectively. Notably, the prevalence and incidence of BBD in the adult female population were comparable to the national average. The prevalence of BBD in 2012–2019 was determined by the incidence rate in the same period. In 2020–2021, UFD and RF also showed an intensive decrease in BBD prevalence compared to 2019. In 2020, the rates of increase in the prevalence were -20.0% and -17.0%, respectively. The AGR of BBD prevalence in the adult female population of UFD during the first two years of the pandemic also had negative values and corresponded to a pronounced trend (Fig. 2).

Age is recognized as a significant risk factor for both benign breast disease (BBD) and breast cancer, underscoring the importance of monitoring morbidity among women of working age [5]. In 2012, 5888 working-age women in the Ural Federal District (UFD) were diagnosed with BBD for the first time, resulting in an incidence rate of 322.6 per 100,000 people. The proportion of first-time BBD cases among women of working age was 21.74%. The incidence rate of UFD did not deviate from the national average (Table 1). By 2019, the incidence of BBD among women beyond working age in the UFD had reached 368.2 per 100,000 women, marking a 14% decrease compared to the nationwide rate (Table 1). This decline was reflected in the average growth rate (AGR) of incidence, which was 1.91%. The national average exhibited a double increase at 3.88%. Notably, the period of 2020–2021 witnessed a substantial reduction in BBD incidence among older women in the UFD, as both the AGR and RF exhibited negative values of -21.0% and -21.72%, respectively.

Regarding BBD prevalence among women beyond working age in the UFD, the rate stood at 941.20 per 100,000 women in 2012. The prevalence continued to rise from 2013 to 2019, peaking in 2019 (Table 2). The AGR for this age group during the pre-pandemic period was 6.03%, corresponding to significant changes in this indicator. However, from 2012 to 2019, BBD prevalence among older women in the UFD remained consistently 13–24% lower annually than the nationwide prevalence. The RF exhibited an AGR of 5.24%. During 2020–2021, both UFD and RF experienced negative AGR values, demonstrating pronounced dynamics with rates of -9.62% and -11.81%, respectively.

103-2.jpg (78 KB)

This retrospective analysis offers insight into the long-term prevalence and incidence dynamics of BBD among women in the UFD population. The available literature presents limited information on this issue specific to the Russian Federation and its constituent entities, thus limiting the discussion of the results. Most publications focus on cohort studies of BBD occurrence among women with reproductive system diseases and extragenital endocrinopathies [1, 2, 40].

The findings of this study reveal an unstable epidemiological situation regarding BBD prevalence and incidence in UFD, particularly evident from 2018 to 2021. The indicators examined in this study serve various purposes, primarily characterizing the state of women's reproductive health. Therefore, the obtained information holds the potential for studying the factors contributing to indicator dynamics within UFD regions and predicting disease prevalence to aid in future medical care planning. Consequently, efforts should be directed toward personalized prevention, prompt BBD diagnosis within comprehensive preventive measures (medical check-ups, preventive examinations), effective patient monitoring, and seamless continuity of medical care stages. Such strategies should encompass an interdisciplinary collaboration between medical specialists and healthcare services. These efforts will persist within the UFD, including in sparsely populated and rural areas. Additionally, the analysis revealed a synchronous decline in the prevalence and incidence of BBD during the COVID-19 pandemic (2020–2021), highlighting the impact of accessible medical care at the outpatient stage (on-demand services, patient follow-up, preventive examinations, and adult healthcare) in diagnosing BBD.

Conclusion

Information on the changes in the incidence and prevalence of BBD among the adult female population of UFD in 2012–2021 provides valuable information for understanding the factors contributing to the pre-pandemic growth of these indicators. This knowledge can aid in future planning and improvement of medical care, particularly with the aim of enhancing the quality of life of patients. When implementing such plans, it is important to consider regional characteristics including sparsely populated and rural areas.

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Received 22.05.2023

Accepted 02.08.2023

About the Authors

Nadezhda V. Bashmakova, Dr. Med. Sci., Professor, Chief Researcher, Head of the Department of Assisted Reproductive Technologies, Ural Research Institute of Maternal and Child Care, Ministry of Health of Russia, +7(343)371-86-43, BashmakovaNV@niiomm.ru, https://orcid.org/0000-0002-9938-7684, 620028, Russia, Yekaterinburg,
Repin str., 1.
Olga Yu. Sevostyanova, Dr. Med. Sci., Associate Professor, Professor of the Department of Obstetrics and Gynecology, Ural State Medical University, Ministry of Health of Russia, +7(922)211-79-16, olsyava@gmail.com, https://orcid.org/0000-0002-0828-0479, 620028, Russia, Yekaterinburg, Repin str., 3.
Tatiana V. Chumarnaya, PhD, Senior Researcher, Institute of Immunology end Physiology, Ural Branch of the Russian Academy of Science, chumarnaya@gmail.com,
https://orcid.org/0000-0002-7965-2364, 620049, Russia, Yekaterinburg, Pervomayskaya str., 56.
Tatiana A. Oboskalova, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Ural State Medical University, Ministry of Health of Russia, oboskalova.tat@yandex.ru, https://orcid.org/0000-0003-0711-7869, 620028, Russia, Yekaterinburg, Repin str., 3.
Corresponding author: Olga Yu. Sevostyanova, olsyava@gmail.com

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