A recent study by Shadmani et al. (2025) titled “Burden and mortality of breast cancer attributed to diabetes and smoking in women: a secondary analysis based on Global Burden of Disease 2019 in North Africa and the Middle East” published in BMJ open reveals that age-standardized mortality rates generally rose, with notable variations among countries.
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Breast cancer burden and mortality have risen in MENA, with diabetes, smoking, and passive smoking as key contributors. – Shadmani et al. 2025
The study examines the burden and mortality of breast cancer (BC) attributed to diabetes, smoking, and passive smoking among women in the Middle East and North Africa (MENA) region from 1990 to 2019. As the second most common cancer worldwide, BC presents a significant health challenge, particularly in MENA countries. This research, based on Global Burden of Disease 2019 data, analyzes trends across 21 nations using disability-adjusted life years (DALYs) and mortality rates to assess disease impact over three decades.
Findings reveal an overall increase in age-standardized DALYs due to BC, though a few countries, such as Kuwait, Bahrain, Jordan, and Turkey, experienced a decline. Similarly, age-standardized mortality rates generally rose, with notable variations among countries. Among the risk factors studied, diabetes emerged as the most influential contributor to the BC burden, followed by smoking and passive smoking.
While BC incidence has risen in recent years, mortality rates have stabilized, likely due to improved early diagnosis and treatment. These results underscore the importance of country-specific data in shaping cancer control policies and resource distribution. Moreover, addressing modifiable risk factors through education, public health initiatives, and lifestyle interventions is crucial in reducing BC-related morbidity and mortality. The study provides critical insights for policymakers to enhance breast cancer prevention and treatment strategies across the MENA region.
How the Study was Conducted
The study utilized a secondary analysis of the Global Burden of Disease (GBD) 2019 data to assess the impact of key risk factors on breast cancer burden and mortality in the Middle East and North Africa (MENA) region. Using data from the GBD study, which provides comprehensive insights into 369 diseases and injuries across 204 countries and territories, researchers analyzed disability-adjusted life years (DALYs) and age-standardized mortality rates to quantify the overall health burden of breast cancer.
Focusing on diabetes, smoking, and passive smoking as primary risk factors, the study employed the Population Attributable Fraction (PAF) metric to estimate the proportion of breast cancer burden attributable to these factors. Covering 20 MENA countries—including Algeria, Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Palestine, Oman, Qatar, Saudi Arabia, Syria, Tunisia, Turkey, UAE, Yemen, Afghanistan, and Sudan—the study examined trends from 1990 to 2019.
Through trend analysis, researchers evaluated variations in age-standardized DALYs and mortality rates over the 30-year period, presenting data for each country while analyzing percent changes in disease burden. The findings underscored the significant contribution of diabetes, smoking, and passive smoking to breast cancer incidence and mortality in the region, emphasizing the urgent need for targeted cancer control interventions and lifestyle modifications to mitigate these risks.
What the Authors Found
The study revealed a significant rise in the burden and mortality of breast cancer in the MENA region from 1990 to 2019. Age-standardized DALYs increased from 395 to 473 per 100,000, while mortality rates rose from 12.3 to 15.2 per 100,000. Diabetes emerged as the most impactful risk factor, surpassing smoking and passive smoking in its contribution to breast cancer burden. While some countries, such as Kuwait, Bahrain, Jordan, and Turkey, showed a decline in DALY trends, others experienced an increase, with Lebanon having the highest burden and Syria the lowest.
Why is this important?
Rising Incidence: Breast cancer is one of the most common cancers among women globally, and its incidence is rising in the MENA region. The study highlights the increasing burden and mortality rates due to breast cancer, which necessitate urgent public health interventions.
Diabetes, Smoking, and Passive Smoking: By identifying diabetes and smoking (including passive smoking) as significant risk factors, the study provides valuable insights into the contributors to breast cancer. Addressing these risk factors can help reduce the disease’s burden.
Informed decision-making: Policymakers can use the study’s findings to make informed decisions about resource allocation and cancer control strategies. The study underscores the need for targeted interventions to address lifestyle-related risk factors, which can lead to more effective prevention and treatment programs.
Variations Across Countries: The study’s detailed country-specific data allows for a better understanding of how breast cancer impacts different nations in the MENA region. This is crucial for tailoring interventions to each country’s unique context. The study also highlights the importance of improving the quality and completeness of data in some countries to better inform public health strategies.
Trends Over Time: The analysis of trends over a 30-year period provides a comprehensive view of how the burden and mortality of breast cancer have evolved, which is essential for evaluating the effectiveness of past and current interventions.
Promoting Healthier Lifestyles: The findings emphasize the need for educational and cultural initiatives to promote healthier lifestyles, reduce the prevalence of diabetes and smoking, and ultimately lower the risk of breast cancer.
What the Authors Recommended
- The authors emphasize the need to address diabetes, smoking, and passive smoking as significant risk factors for breast cancer. They recommend public health initiatives focused on reducing these risk factors through education, cultural initiatives, and lifestyle changes.
- The study highlights the importance of early diagnosis and treatment of breast cancer. Improving access to screening programs and promoting awareness about the importance of early detection can lead to better outcomes.
- The authors recommend developing country-specific cancer control interventions based on the unique needs and circumstances of each country in the MENA region. This approach can help allocate resources more effectively and target the most pressing issues.
- Enhancing the quality and completeness of data in some countries is crucial. Better data collection will enable more accurate assessments and inform public health strategies more effectively.
- The authors suggest promoting healthier lifestyles through educational programs and cultural initiatives. Addressing risk factors like diabetes and smoking can reduce the incidence of breast cancer.
- Policymakers should use the study’s findings to make informed decisions about resource allocation, cancer control strategies, and public health interventions. The study provides valuable data to support these decisions.
The study by Shadmani et al. (2025) provides crucial insights into the rising burden and mortality of breast cancer in the MENA region, highlighting the significant role of diabetes, smoking, and passive smoking as key risk factors. With age-standardized DALYs and mortality rates increasing over the past three decades, the findings underscore the urgent need for targeted public health interventions, enhanced screening programs, and lifestyle modifications. By prioritizing cancer prevention strategies, improving data collection, and implementing country-specific policies, policymakers can take meaningful steps to reduce breast cancer-related morbidity and mortality. Addressing modifiable risk factors and promoting healthier lifestyles will be essential in mitigating the impact of breast cancer and improving outcomes for women across the region.
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