Chinese Medical Journal

01/07/2025

Programmed death-ligand 1 tumor proportion score in predicting the safety and efficacy of PD-1/PD-L1 antibody-based therapy in patients with advanced non-small cell lung cancer: A retrospective, multicenter, observational study

Background:
This study aimed to investigate the safety and efficacy of programmed cell death-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) antibody-based therapy in treating patients with advanced non-small cell lung cancer (NSCLC) according to different PD-L1 expression statuses in a real-world setting.

Methods:
This retrospective, multicenter, observational study enrolled adult patients who received PD-1/PD-L1 antibody-based therapy in China and met the following criteria: (1) had pathologically confirmed, unresectable stage III–IV NSCLC; (2) had a baseline PD-L1 tumor proportion score (TPS); and (3) had confirmed efficacy evaluation results after PD-1/PD-L1 treatment. Logistic regression, Kaplan–Meier analysis, and Cox regression were used to assess the progression-free survival (PFS), overall survival (OS), and immune-related adverse events (irAEs) as appropriate.

Results:
A total of 409 patients, 65.0% ( n = 266) with a positive PD-L1 TPS (≥1%) and 32.8% ( n = 134) with PD-L1 TPS ≥50%, were included in this study. Cox regression confirmed that patients with a PD-L1 TPS ≥1% had significantly improved PFS (hazard ratio [HR] 0.747, 95% confidence interval [CI] 0.573–0.975, P = 0.032). A total of 160 (39.1%) patients experienced 206 irAEs, and 27 (6.6%) patients experienced 31 grade 3–5 irAEs. The organs most frequently associated with irAEs were the skin (52/409, 12.7%), thyroid (40/409, 9.8%), and lung (34/409, 8.3%). Multivariate logistic regression revealed that a PD-L1 TPS ≥1% (odds ratio [OR] 1.713, 95% CI 1.054–2.784, P = 0.030) was an independent risk factor for irAEs. Other risk factors for irAEs included pretreatment absolute lymphocyte count >2.5 × 10 9 /L (OR 3.772, 95% CI 1.377–10.329, P = 0.010) and pretreatment absolute eosinophil count >0.2 × 10 9 /L (OR 2.006, 95% CI 1.219–3.302, P = 0.006). Moreover, patients who developed irAEs demonstrated improved PFS (13.7 months vs. 8.4 months, P

orld setting. Methods: This retrospective, multicenter, observational study enrolled adult patients who received PD-1/PD-L1 antibody-based therapy in China and met the following criteria: (1) had pathologically confirmed, unresectable stage III–IV NSCLC; (2) had a baseline PD-L1 tumor proportion s...

01/07/2025

S6K1 overexpression enhances autophagy in breast cancer cells by inducing the translation of CLU

Background:
Ribosomal protein S6 kinase B1 (S6K1) is frequently amplified and correlates with drug resistance and poor prognosis in patients with breast cancer. Although S6K1 functions primarily in the process of translation, the genome-wide translational profiles regulated by S6K1 remain unclear. This study sought to clarify the pivotal role of S6K1 in translational regulation and investigate its novel targets in breast cancer.

Methods:
Ribosome profiling sequencing (Ribo-seq) was performed to explore genome-wide translational profiles regulated by S6K1 in breast cancer cells. Integrated multiomics analyses, including Ribo-seq, RNA sequencing, and mass spectrometry, were employed to identify a new target of S6K1 translational regulation, the autophagy-related gene clusterin ( CLU ). Western blotting and immunofluorescence were utilized to confirm that S6K1 regulated CLU translation, thus influencing autophagy in breast cancer cells. Bafilomycin A1 (a late-stage autophagy inhibitor) was used to demonstrate that S6K1 regulated autophagosome formation in breast cancer cells through affecting the translation of CLU .

Results:
S6K1 depletion resulted in the downregulation of global messenger RNA (mRNA) translation and affected translation in multiple pathways that play crucial roles in carcinogenesis, with autophagy-related pathways being the most prominently affected. The role of S6K1 in autophagy was further confirmed in breast cancer cells, and CLU was identified as a novel target regulated by S6K1 at the translational level. Additionally, the overexpression of S6K1 promoted the translation of CLU , thus facilitating the formation of autophagosomes.

Conclusion:
This study demonstrated that the overexpression of S6K1 promoted autophagy in breast cancer cells by facilitating the translation of the autophagy-related gene CLU .

ear. This study sought to clarify the pivotal role of S6K1 in translational regulation and investigate its novel targets in breast cancer. Methods: Ribosome profiling sequencing (Ribo-seq) was performed to explore genome-wide translational profiles regulated by S6K1 in breast cancer cells. Integrate...

01/07/2025

Guideline-driven clinical decision support for colonoscopy patients using the hierarchical multi-label deep learning method

Background:
Over 20 million colonoscopies are performed in China annually. An automatic clinical decision support system (CDSS) with accurate semantic recognition of colonoscopy reports and guideline-based is helpful to relieve the increasing medical burden and standardize the healthcare. In this study, the CDSS was built under a hierarchical-label interpretable classification framework, trained by a state-of-the-art transformer-based model, and validated in a multi-center style.

Methods:
We conducted stratified sampling on a previously established dataset containing 302,965 electronic colonoscopy reports with pathology, identified 2041 records representative of overall features, and randomly divided into the training and testing sets (7:3). A total of 5 main labels and 22 sublabels were applied to annotate each record on a network platform, and the data were trained respectively by three pre-training models on Chinese corpus website, including BERT-base-Chinese (BC), the BERT-wwm-ext-Chinese (BWEC), and ernie-3.0-base-zh (E3BZ). The performance of trained models was subsequently compared with a randomly initialized model, and the preferred model was selected. Model fine-tuning was applied to further enhance the capacity. The system was validated in five other hospitals with 3177 consecutive colonoscopy cases.

Results:
The E3BZ pre-trained model exhibited the best performance, with a 90.18% accuracy and a 69.14% Macro-F1 score overall. The model achieved 100% accuracy in identifying cancer cases and 99.16% for normal cases. In external validation, the model exhibited favorable consistency and good performance among five hospitals.

Conclusions:
The novel CDSS possesses high-level semantic recognition of colonoscopy reports, provides appropriate recommendations, and holds the potential to be a powerful tool for physicians and patients. The hierarchical multi-label strategy and pre-training method should be amendable to manage more medical text in the future.

his study, the CDSS was built under a hierarchical-label interpretable classification framework, trained by a state-of-the-art transformer-based model, and validated in a multi-center style. Methods: We conducted stratified sampling on a previously established dataset containing 302,965 electronic c...

01/07/2025

Real-world outcomes of isatuximab with pomalidomide and dexamethasone for relapsed and/or refractory multiple myeloma

Background:
The isatuximab, pomalidomide, and dexamethasone (Isa-Pd) regimen has shown survival benefits for relapsed and/or refractory multiple myeloma (RRMM) in several trials, while evidence of effectiveness and safety among Chinese patients is limited. This study aim to provide real-world evidence of Isa-Pd in Chinese patients with RRMM.

Methods:
In a prospective observational real-world study (IsaFiRsT), we enrolled Chinese RRMM patients who had received ≥2 prior therapies, including lenalidomide and proteasome inhibitors, and received the Isa-Pd regimen at Shanghai Jiaotong University School of Medicine, Ruijin-Hainan Hospital. A historical cohort of patients with RRMM who had received >1 additional line of treatment after ≥2 prior therapies was retrospectively included. The primary endpoint of the Isa-Pd cohort was the overall response rate (ORR). Inverse probability treatment weighting (IPTW) was used to balance confounding factors between the Isa-Pd cohort and historical cohort.

Results:
The Isa-Pd cohort comprised 24 patients with RRMM and reported an ORR of 82.6% (19/23, 95% confidence interval [CI]: 61.2–95.0%), a very good partial response or better rate of 73.9% (17/23) and a complete response or better rate of 43.5% (10/23). The median time to first response was 1.2 months (range: 0.9, 3.1 months). The median duration of response, progression-free survival (PFS), and overall survival (OS) were not reached, with a median follow-up of 8.4 months. The 6-month PFS and OS rates were 87.0% and 91.3%, respectively. The IPTW-adjusted ORR in the Isa-Pd cohort was 85.1% compared to 33.4% in the historical cohort, with a risk ratio of 2.55 (95% CI: 1.73–4.12). The most common grade >3 treatment-emergent adverse events in the Isa-Pd cohort were neutrophil count decreased (75.0%, 18/24), white blood cell count decreased (54.2%, 13/24), and anemia (45.8%, 11/24).

Conclusion:
The IsaFiRsT study reported that Isa-Pd provided a high rate of deep and rapid response in heavily pretreated Chinese RRMM patients, with an acceptable safety profile in a real-world setting, consistent with Isa-Pd trials.
https://doi.org/10.1097/CM9.0000000000003649

01/07/2025

Itaconate derivative 4-OI inhibits M1 macrophage polarization and restores its impaired function in immune thrombocytopenia through metabolic reprogramming

Background:
Macrophage polarization anomalies and dysfunction play a crucial role in the pathogenesis of immune thrombocytopenia (ITP). Itaconate is a Krebs cycle-derived immunometabolite synthesized by myeloid cells to modulate cellular metabolism and inflammatory responses. This study aimed to evaluate the immunoregulatory effects of an itaconate derivative on macrophages in patients with ITP.

Methods:
Peripheral blood-derived macrophages from patients with ITP and healthy controls were treated with 4-octyl itaconate (4-OI), a derivative of itaconate that can pe*****te the cell membrane. Macrophage polarization, antigen-presenting functions, and phagocytic capability were measured via flow cytometry and enzyme-linked immunosorbent assay (ELISA). Macrophage glycolysis in patients with ITP and the metabolic regulatory effect of 4-OI were detected using a Seahorse XFe96 Analyzer. An active murine model of ITP was used to evaluate the therapeutic effects of 4-OI in vivo .

Results:
4-OI reduced the levels of CD80 and CD86 in M1 macrophages and suppressed the release of tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 pro-inflammatory cytokines, suggesting that 4-OI could hinder the polarization of macrophages toward an M1 phenotype. We found that 4-OI pretreated M1 macrophages reduced the proliferation of CD4 + T cells and promoted the differentiation of regulatory T cells. In addition, after 4-OI treatment, the phagocytic capacity of M1 macrophages toward antibody-coated platelets decreased significantly in patients with ITP. In addition, the glycolytic function of M1 macrophages was elevated in individuals with ITP compared to those in healthy controls. 4-OI treatment downregulated glycolysis in M1 macrophages. The glycolysis inhibitor 2-deoxy-d-glucose (2-DG) also inhibited the polarization of M1 macrophages and restored their functions. In vivo , 4-OI treatment significantly increased platelet counts in the active ITP murine model.

Conclusions:
Itaconate derivative 4-OI inhibited M1 macrophage polarization and restored impaired functions through metabolic reprogramming. This study provides a novel therapeutic option for ITP.

to evaluate the immunoregulatory effects of an itaconate derivative on macrophages in patients with ITP. Methods: Peripheral blood-derived macrophages from patients with ITP and healthy controls were treated with 4-octyl itaconate (4-OI), a derivative of itaconate that can pe*****te the cell membran...

01/07/2025

Cancer and neurotransmitter receptors

In recent years, growing evidence indicates that the nervous system plays an indispensable role in tumor development and metastasis. Elucidating crosstalk between the nervous system and tumor progression has thrived as a hot-topic and a new direction for understanding cancer pathogenesis. Notably, many novel discoveries have suggested that neurotransmitter receptors (NRs) are not only widely expressed in cancer cells, but also play key roles in regulating cancer initiation and progression by diverse approaches. In this review, we summarized the latest advance in cancer neuroscience, especially emphasizing the important roles of different NRs in cancer development and prevention. The exemplary studies presented herein illustrate the emerging view that NRs are profoundly influential, manifested in tumor growth, apoptosis, angiogenesis, metastasis, resistance to drugs, and participate in the formation of neural–cancer interactions. In addition, NRs also regulate cellular metabolic processes and tumor microenvironment (TME) remodeling. More importantly, numerous basic and clinical studies have suggested that NRs may be potential targets for cancer treatments, and corresponding agonists or antagonists have been identified effectively in controlling tumor growth and metastasis. In conclusion, NRs are emerging as novel targets for anti-cancer drug exploration and clinical cancer treatments, while trying to uncover deeper mechanisms and connections between NRs and cancer is of high clinical significance and translational value.

, many novel discoveries have suggested that neurotransmitter receptors (NRs) are not only widely expressed in cancer cells, but also play key roles in regulating cancer initiation and progression by diverse approaches. In this review, we summarized the latest advance in cancer neuroscience, especia...

01/07/2025

Cardiomyocyte pyroptosis inhibited by dental pulp-derived mesenchymal stem cells via the miR-19a-3p/IRF-8/MAPK pathway in ischemia–reperfusion

Background:
The protective effect of mesenchymal stem cells (MSCs) on cardiac ischemia–reperfusion (I/R) injury has been widely reported. Dental pulp-derived mesenchymal stem cells (DP-MSCs) have therapeutic effects on various diseases, including diabetes and cirrhosis. This study aimed to determine the therapeutic effects of DP-MSCs on I/R injury and elucidate the underlying mechanism.

Methods:
Myocardial I/R injury model mice were treated with DP-MSCs or a miR-19a-3p mimic. The infarct volume, fibrotic area, pyroptosis, inflammation level, and cardiac function were measured. Cardiomyocytes exposed to hypoxia-reoxygenation were transfected with the miR-19a-3p mimic, miR-19a-3p inhibitor, or negative control. Pyroptosis and protein expression in the interferon regulatory factor 8/mitogen-activated protein kinase (IRF-8/MAPK) pathway were measured.

Results:
DP-MSCs protected cardiac function in cardiac I/R-injured mice and inhibited cardiomyocyte pyroptosis. The upregulation of miR-19a-3p protected cardiac function, inhibited cardiomyocyte pyroptosis, and inhibited IRF-8/MAPK signaling in cardiac I/R-injured mice. DP-MSCs inhibited cardiomyocyte pyroptosis and the IRF-8/MAPK signaling by upregulating the miR-19a-3p levels in cardiomyocytes injured by I/R.

Conclusion:
DP-MSCs protected cardiac function by inhibiting cardiomyocyte pyroptosis through miR-19a-3p under I/R conditions.

ermine the therapeutic effects of DP-MSCs on I/R injury and elucidate the underlying mechanism. Methods: Myocardial I/R injury model mice were treated with DP-MSCs or a miR-19a-3p mimic. The infarct volume, fibrotic area, pyroptosis, inflammation level, and cardiac function were measured. Cardiomyoc...

01/07/2025

Identification and validation of blood leukocyte DNA methylation biomarkers for early detection of colorectal neoplasm

Background:
Identifying high-risk populations for colorectal cancer (CRC) is critical for precise screening. This study aimed to develop a novel risk prediction model using blood DNA methylation biomarkers to identify individuals at high risk for colorectal neoplasms.

Methods:
The biomarker discovery phase involved 106 samples (56 advanced adenomas and 50 healthy controls) collected from the TARGET-C screening cohort between May 2018 and May 2021, which were analyzed using the Illumina Infinium MethylationEPIC v2.0 BeadChip, and 72 samples (22 CRC, 20 advanced adenomas, and 30 healthy controls) collected from clinical cohorts between July 2023 and July 2024, which were analyzed using reduced representation bisulfite sequencing (RRBS). Differentially methylated positions (DMPs) and regions (DMRs) were identified and independently validated in 147 samples (48 CRC, 50 advanced adenomas, and 49 healthy controls) collected from an independent clinical cohort between June 2022 and May 2024 using targeted bisulfite sequencing (TBS). A multi-marker prediction model was constructed using logistic regression, and its diagnostic performance was evaluated through receiver operating characteristic (ROC) curve analysis.

Results:
In the discovery set, 48 DMPs and 74 DMRs were identified, exhibiting significant differences between CRC/advanced adenomas and healthy controls. Of these, three DMPs and 11 DMRs were successfully validated in the independent set using TBS. Through machine learning approaches, five stable methylation markers were identified and incorporated into a multi-marker prediction model. This model demonstrated excellent diagnostic performance for detecting colorectal neoplasms, with an area under the curve (AUC) of 0.85 (95% confidence interval [CI]: 0.74–0.94), outperforming the traditional lifestyle score (AUC = 0.55, 95% CI: 0.46–0.68). Combining methylation markers with lifestyle scores further improved diagnostic accuracy, achieving an AUC of 0.89. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of the significant markers indicated their involvement in tumorigenesis through pathways regulating developmental processes, transcriptional activation, and cancer-related signaling.

Conclusions:
Blood leukocyte DNA methylation markers show significant potential for identifying high-risk populations for CRC. The identified markers could contribute to the development of novel, effective tools for CRC screening, facilitating precision screening strategies.

er discovery phase involved 106 samples (56 advanced adenomas and 50 healthy controls) collected from the TARGET-C screening cohort between May 2018 and May 2021, which were analyzed using the Illumina Infinium MethylationEPIC v2.0 BeadChip, and 72 samples (22 CRC, 20 advanced adenomas, and 30 healt...

01/07/2025

Association between family history and onset age of cancer in China

Background:
Family history (FH) of cancer is an established risk factor for early onset of cancer. However, reliable estimates on the difference in onset age between familial and sporadic cancers remain scarce in the Chinese population.

Methods:
This multicenter, hospital-based, cross-sectional study included 23 hospitals across 12 provinces. Patients diagnosed with cancers of the lung, stomach, esophagus, or colorectum between January 1, 2016 and December 31, 2017 were identified. Detailed information on sociodemographic characteristics, lifestyle factors, stage at diagnosis, and onset age was collected. We analyzed the association between FH and onset age across different cancer types using quantile regressions, and the potential bias was explored.

Results:
Among 41,072 eligible patients, 3054 (7.44%) reported a first-degree FH of cancer, and they were diagnosed at younger ages than those without FH (median difference: −1.19, 95% confidence interval [CI]: −1.59 to −0.79). Stratified by cancer type, the most pronounced difference was observed in colorectal cancer (median difference: −2.25, 95% CI: −3.31 to −1.19). Failure to account for lead time bias resulted in an overestimation of the FH effect, ranging from 3.4% to 15.4% across cancer types. Quantile regression analysis revealed that the impact of FH on age at diagnosis was more pronounced at the upper tail of the age distribution for all cancers combined and for each cancer type individually.

Conclusions:
Our findings suggest that FH of cancer is associated with the early onset of lung, stomach, esophageal, and colorectal cancers in China. Cancer screening at earlier ages is needed for individuals with an FH.

tional study included 23 hospitals across 12 provinces. Patients diagnosed with cancers of the lung, stomach, esophagus, or colorectum between January 1, 2016 and December 31, 2017 were identified. Detailed information on sociodemographic characteristics, lifestyle factors, stage at diagnosis, and o...

01/07/2025

P4HA1 mediates YAP hydroxylation and accelerates collagen synthesis in temozolomide-resistant glioblastoma

Background:
Temozolomide (TMZ) resistance is a significant challenge in treating glioblastoma (GBM). Collagen remodeling has been shown to be a critical factor for therapy resistance in other cancers. This study aimed to investigate the mechanism of TMZ chemoresistance by GBM cells reprogramming collagens.

Methods:
Key extracellular matrix components, including collagens, were examined in paired primary and recurrent GBM samples as well as in TMZ-treated spontaneous and grafted GBM murine models. Human GBM cell lines (U251, TS667) and mouse primary GBM cells were used for in vitro studies. RNA-sequencing analysis, chromatin immunoprecipitation, immunoprecipitation-mass spectrometry, and co-immunoprecipitation assays were conducted to explore the mechanisms involved in collagen accumulation. A series of in vitro and in vivo experiments were designed to assess the role of the collagen regulators prolyl 4-hydroxylase subunit alpha 1 (P4HA1) and yes-associated protein (YAP) in sensitizing GBM cells to TMZ.

Results:
This study revealed that TMZ exposure significantly elevated Collagen type I (COL I) expression in both GBM patients and murine models. Collagen accumulation sustained GBM cell survival under TMZ-induced stress, contributing to enhanced TMZ resistance. Mechanistically, P4HA1 directly binded to and hydroxylated YAP, preventing ubiquitination-mediated YAP degradation. Stabilized YAP robustly drove collagen type I alpha 1 ( COL1A1) transcription, leading to increased collagen deposition. Disruption of the P4HA1-YAP axis effectively reduced COL I deposition, sensitized GBM cells to TMZ, and significantly improved mouse survival.

Conclusion:
P4HA1 maintained YAP-mediated COL1A1 transcription, leading to collagen accumulation and promoting chemoresistance in GBM.

ng collagens. Methods: Key extracellular matrix components, including collagens, were examined in paired primary and recurrent GBM samples as well as in TMZ-treated spontaneous and grafted GBM murine models. Human GBM cell lines (U251, TS667) and mouse primary GBM cells were used for in vitro studie...

01/07/2025

Therapeutic effect of metformin on reversing gastric intestinal metaplasia

Background:
Currently, standard therapeutic agents are not available for treating gastric intestinal metaplasia (IM). However, emerging evidence suggests the potential efficacy of metformin in addressing this issue. Our aim was to assess the efficacy and safety of metformin in reversing IM.

Methods:
We initially investigated the impact of metformin on reversing gastric IM in mice. An open-label, prospective, randomized controlled trial was subsequently conducted at a tertiary hospital in China from April 2022 to May 2023. A total of 140 nondiabetic patients with pathologically confirmed IM and negative Helicobacter pylori tests were recruited. Patients were randomly assigned at a 1:1 ratio to receive either 500 mg of metformin daily for six months or 5 mg of folate three times daily as a control. The primary outcome was defined as the regression rate of IM in different groups at the end of the treatment.

Results:
Metformin improved gastric mucosal pathology in mice. A total of 158 patients were screened, 140 of whom were randomized to the two groups. Among these, 85/140 (60.7%) were male, and the mean age was 55.9 ± 8.3 years. Six-month follow-up data were available for 129 patients. Compared with folate users (control group), metformin users had a greater rate of regression of IM (48.6% [34/70] vs. 31.4% [22/70]; relative risk [RR] = 1.55, 95% confidence interval [CI] 1.01–2.36; P = 0.04) in the intention-to-treat population. Furthermore, in the per-protocol population, metformin users had a higher rate of regression of IM (53.1% [34/64] vs. 33.9% [22/65]; RR = 1.57, 95% CI 1.04–2.37; P = 0.03). The metformin group had a low incidence of self-alleviating mild adverse reactions.

Conclusion:
This randomized clinical trial revealed that metformin can be safely administered to promote the regression of IM in nondiabetic individuals without Helicobacter pylori infection.

Methods: We initially investigated the impact of metformin on reversing gastric IM in mice. An open-label, prospective, randomized controlled trial was subsequently conducted at a tertiary hospital in China from April 2022 to May 2023. A total of 140 nondiabetic patients with pathologically confirme...

01/07/2025

Global, regional, national incidence, and mortality of breast cancer in older women: A population-based cancer registry data analysis

Background:
The burden of breast cancer for older adults has been rising with the increasing population aging. This study aims to describe the burden of breast cancer in older adults worldwide, analyze the temporal trends for older breast cancer incidence, and assess the socioeconomic inequalities of breast cancer incidence and mortality with human development index (HDI) levels, which will provide valuable information in preventing and controlling the increasing breast cancer burden in older people.

Methods:
The incidence and mortality rates of specific cancer types in older individuals in 2022 were sourced from the Global Cancer Today database. Trends in breast cancer incidence acquired from the Cancer Incidence in Five Continents (CI5) database. HDI and other risk factors were obtained from the United Nations. We used a generalized linear model to estimate the rate ratio and 95% confidence interval (CI) between HDI levels and breast cancer burden in older people.

Results:
It was estimated approximately 1,058,466 newly diagnosed breast cancer cases and 383,774 breast cancer deaths in women ≥60 years, accounting for 18.9% and 12.7% of world cancer cases and deaths. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) were 172.9 and 57.7 per 100,000, ranking first and second among all cancer incidence and mortality in older women. The highest ASIR and ASMR were four-fold higher than the lowest, with ASIR ranging from a peak of 399.1 per 100,000 in Australia–New Zealand to a low of 90.6 per 100,000 in South Central Asia, and ASMR varying from a high of 118.6 per 100,000 in Melanesia to a low of 28.8 per 100,000 in East Asia. The largest increases in ASIR from 1998–2002 to 2013–2017 were observed in South Korea, China, and Estonia. The corresponding estimated 5-year average percentage changes (EAPC) were 6.01%, 2.89%, and 1.93%, respectively.

Conclusions:
The global burden of breast cancer in older women is increasing fast and varies greatly across countries. Effective prevention strategies are essential to address the increasing breast cancer burden for older people.

ties of breast cancer incidence and mortality with human development index (HDI) levels, which will provide valuable information in preventing and controlling the increasing breast cancer burden in older people. Methods: The incidence and mortality rates of specific cancer types in older individuals...