Breast cancer mortality in Romania: trends, regional and rural-urban inequalities, and policy implications.

Background: Romania has the third highest preventable mortality rate in the European Union that is more than double the average rate in the European Union in 2018. Breast cancer (BC) is a significant driver of global preventable mortality but a few studies from Romania have quantified the degree to which BC influences mortality and morbidity. This study aimed to determine differences in BC mortality between Romania and the European Union. The study also examined urban/rural BC mortality across the eight regions of Romania.

Methods: Age-standardized BC mortality rates among women were calculated by urban/rural places of residence and by subnational region for 2000-2020, using data provided by the Romanian National Center for Statistics in Public Health, National Institute of Public Health. Age-standardized all-cause, all-cancer, and BC mortality rates were explored for Romania and the European Union for 2000-2017, using data obtained from Eurostat. Urban and rural age-standardized BC mortality rates among women were compared across regions of Romania to national and European rates to examine differences in BC mortality across the country and between urban and rural areas. Joinpoint Trend Analysis was employed to further analyze patterns in mortality rates.

Results: Age-standardized national BC mortality rate in Romania decreased from 39.60/100,000 women in 2000 to 38.35/100,000 women in 2020, however rates increased in several regions of the country. While BC mortality rates decreased more in urban areas (by 11.1%) than in rural areas (by 1.6%), urban areas still had a higher BC mortality (46.24/100,000 women in 2020) than rural areas (29.37/100,000 women in 2020) throughout the study period.

Conclusion: The higher BC mortality in Romania compared to other countries in the European countries, the higher mortality rates in urban than rural areas, and the regional variation in mortality rates call for future studies to investigate the possible health care system and care seeking behaviors and the environmental determinants that may have contributed to observed mortality profile. Improving the quality of incidence data in the country through efficient cancer registries could also lead to a better understanding of the variation in mortality rates, which is the premise for more targeted health policies.