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Peer-reviewedCC BY 4.0PLOS One

Survival and disease burden of breast cancer (Monastir, Tunisia): A population-based cohort study (2002–2022)

  • Imen Zemni1
  • Amani Maatouk2
  • Wiem Boufrikha3
  • Cyrine Bennasrallah4
  • Wafa Dhouib5
  • Meriem Kacem6
  • Hela Abroug7
  • Manel Ben Fredj8
  • Inès Bouanene9
  • Islem Jridi10
  • Hiba Arfa11
  • Amina Ben Salem12
8 more authors
  • Leila Njim
  • Sonia Zaied
  • Raja Faleh
  • Karawen Sakka
  • Badreddine Sriha
  • Lilia Jaîdane
  • Meriem Mehdi
  • Asma Belguith Sriha
12 affiliations
  1. 1Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba Hospital of Monastir, University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
  2. 2Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06, University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
  3. 3Department of Hematology, University maternity Center of Monastir, University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
  4. 4Department of Hospital Hygiene, Fattouma Bourguiba Hospital of Monastir, University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
  5. 5Department of community and Preventive Medicine Regional Hospital of Ksar Hellal, University of Monastir, Faculty of Medicine of Monastir, MonastirTunisia
  6. 6Department of Family Medicine, University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
  7. 7Department of Radiology, University Maternity Center of Monastir, University of Monastir, Faculty oF Medicine of Monastir, Monastir, Tunisia
  8. 8Department of Pathology, Fattouma Bourguiba Hospital of Monastir, University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
  9. 9Department of Oncology, University Maternity Center of Monastir, University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
  10. 10Department of Gynecology, University Maternity Center of Monastir, University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
  11. 11Cancer Registry of the Center of Tunisia, University Hospital Farhat Hached of Sousse, University of Sousse, Sousse, Tunisia
  12. 12Department of Reproductive Biology, University Maternity Center of Monastir, University of Monastir, Faculty of Medicine of Monastir, Monastir, Tunisia
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Abstract

Background: Population-based evidence on Breast Cancer (BC) survival and disease burden in Tunisia remains limited. This study aimed to describe BC survival and temporal trends, quantify the BC burden, and assess the impact of early diagnosis on survival and burden. Methods: We conducted a descriptive population-based cohort study of women diagnosed with BC in Monastir between 2002 and 2014, with follow-up through January 2022. Overall survival was estimated using Kaplan-Meier methods, and factors associated with mortality were assessed using multivariable Cox regression. BC burden was quantified using disability-adjusted life years (DALYs), comprising years of life lost (YLLs) and years lived with disability (YLDs). Relative risks (RRs) and related measures were used to assess the association between stage at diagnosis and mortality. Results: Among 1,075 incident BC cases identified between 2002 and 2014, 21.4% were diagnosed at stage IV. By 2022, vital status information was available for 959 women. The crude and age-standardized mortality rates were 11.9 (95% CI, 8.5–15.4) and 12.5 (95% CI, 8.9–16.0) per 100,000 WY, respectively. Median survival was 187 months (95% CI, 163.7–210.2), reaching 226 months among women diagnosed at stages 0–I. Three-, five-, and ten-year survival rates were 77.0%, 70.0%, and 45.2%, respectively. Ten-year relative survival showed a significant upward trend among women aged 30–64 years, corresponding to the target population of the national BC early detection program (APC, 5.37%; 95% CI, 2.03–8.82; p = 0.005). The total BC burden was 10,665.4 DALYs, including 10,362 YLLs (97.3%). Median DALYs per patient was 28.0 years (IQR, 13.74–36.95). Diagnosis at stages 0–II was associated with a 22% reduction in ten-year mortality (RR, 0.78; 95% CI, 0.67–0.91), with an NND of 9. Diagnosing 61 women at stages 0–II rather than III–IV would avoid one DALY. Conclusion: The significant upward trend in ten-year survival among women targeted by the national BC early detection program, together with the avoidance of one DALY per 61 women diagnosed at stages 0–II rather than III–IV, supports continued investment in early detection and BC control in Tunisia.

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Cite

BibTeXRIS
BibTeX
@article{zemni2026survival,
  title = {{Survival and disease burden of breast cancer (Monastir, Tunisia): A population-based cohort study (2002–2022)}},
  author = {Imen Zemni and Amani Maatouk and Wiem Boufrikha and Cyrine Bennasrallah and Wafa Dhouib and Meriem Kacem and Hela Abroug and Manel Ben Fredj and Inès Bouanene and Islem Jridi and Hiba Arfa and Amina Ben Salem and Leila Njim and Sonia Zaied and Raja Faleh and Karawen Sakka and Badreddine Sriha and Lilia Jaîdane and Meriem Mehdi and Asma Belguith Sriha},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0360398},
  url = {https://doi.org/10.1371/journal.pone.0360398},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Survival and disease burden of breast cancer (Monastir, Tunisia): A population-based cohort study (2002–2022)
AU  - Imen Zemni
AU  - Amani Maatouk
AU  - Wiem Boufrikha
AU  - Cyrine Bennasrallah
AU  - Wafa Dhouib
AU  - Meriem Kacem
AU  - Hela Abroug
AU  - Manel Ben Fredj
AU  - Inès Bouanene
AU  - Islem Jridi
AU  - Hiba Arfa
AU  - Amina Ben Salem
AU  - Leila Njim
AU  - Sonia Zaied
AU  - Raja Faleh
AU  - Karawen Sakka
AU  - Badreddine Sriha
AU  - Lilia Jaîdane
AU  - Meriem Mehdi
AU  - Asma Belguith Sriha
PY  - 2026
DA  - 2026/10/14
JO  - PLOS One
DO  - 10.1371/journal.pone.0360398
UR  - https://doi.org/10.1371/journal.pone.0360398
AB  - Background: Population-based evidence on Breast Cancer (BC) survival and disease burden in Tunisia remains limited. This study aimed to describe BC survival and temporal trends, quantify the BC burden, and assess the impact of early diagnosis on survival and burden. Methods: We conducted a descriptive population-based cohort study of women diagnosed with BC in Monastir between 2002 and 2014, with follow-up through January 2022. Overall survival was estimated using Kaplan-Meier methods, and factors associated with mortality were assessed using multivariable Cox regression. BC burden was quantified using disability-adjusted life years (DALYs), comprising years of life lost (YLLs) and years lived with disability (YLDs). Relative risks (RRs) and related measures were used to assess the association between stage at diagnosis and mortality. Results: Among 1,075 incident BC cases identified between 2002 and 2014, 21.4% were diagnosed at stage IV. By 2022, vital status information was available for 959 women. The crude and age-standardized mortality rates were 11.9 (95% CI, 8.5–15.4) and 12.5 (95% CI, 8.9–16.0) per 100,000 WY, respectively. Median survival was 187 months (95% CI, 163.7–210.2), reaching 226 months among women diagnosed at stages 0–I. Three-, five-, and ten-year survival rates were 77.0%, 70.0%, and 45.2%, respectively. Ten-year relative survival showed a significant upward trend among women aged 30–64 years, corresponding to the target population of the national BC early detection program (APC, 5.37%; 95% CI, 2.03–8.82; p = 0.005). The total BC burden was 10,665.4 DALYs, including 10,362 YLLs (97.3%). Median DALYs per patient was 28.0 years (IQR, 13.74–36.95). Diagnosis at stages 0–II was associated with a 22% reduction in ten-year mortality (RR, 0.78; 95% CI, 0.67–0.91), with an NND of 9. Diagnosing 61 women at stages 0–II rather than III–IV would avoid one DALY. Conclusion: The significant upward trend in ten-year survival among women targeted by the national BC early detection program, together with the avoidance of one DALY per 61 women diagnosed at stages 0–II rather than III–IV, supports continued investment in early detection and BC control in Tunisia.
SN  - 1932-6203
ER  -