IARC 60th Anniversary - 19-21 May 2026
Session : 20/05/26 - Posters
Micro-geographic inequalities in breast cancer incidence across Europe: evidence from the EU4Health-funded ELISAH project
USSAI S. 1, MELZI C. 1, MAKSYMOVYCH O. 2, SYDOR U. 3, CARULLA M. 6, ZACHOU M. 7, MARNERI A. 8, TRALLERO J. 4, NIETO-ORTIZ A. 9, GEROMETTA A. 5, MANCUSO A. 10, TAGLIABUE G. 1, MAZZUCCO W. 11, CONTIERO P. 1
1 Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; 2 Carpathian Institute of Analytics, IVANO-FRANKIVSK, Ukraine; 3 UTILITY NON-PROFIT ENTERPRISE IVANO-FRANKIVSK CENTRAL CITY CLINICAL HOSPITAL (CCCH), IVANO-FRANKIVSK, Ukraine; 4 Girona Cancer Registry, Directorate Plan of Oncology, Epidemiology Unit and Girona Cancer Registry, Girona Biomedical Research Institute Dr. Josep Trueta (IDIBGI-CERCA), Catalan Institute of Oncology, Girona, Spain; 5 CITTADINI PER L' ARIA ONLUS (CPA), Milano, Italy; 6 Tarragona Cancer Registry, Cancer Epidemiology and Prevention Service, Hospital University Sant Joan de Reus, IISPV, Reus, Spain; 7 Department of Applied Medical Physics, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece; 8 Breast Unit, 1st Propedeutic Surgical Department, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece; 9 Institut d'Innovació i Recerca Glòria Compte, Fundació Salut Empordà, Figueres, Spain; 10 Salute Donna ONLUS, Milano, Italy; 11 AZIENDA OSPEDALIERA UNIVERSITARIA POLICLINICO PAOLO GIACCONE DI PALERMO (AOUPPA), Palermo, Italy
Background
Geographic variation in cancer incidence is a key indicator of population exposure to modifiable risk factors, yet most analyses focus on national or regional levels. Evidence on within-province and neighbourhood-level inequalities across countries remains scarce. Within the framework of the EU4Health-funded ELISAH project, which aims to link scientific evidence to actionable cancer prevention strategies, we investigated fine-scale geographic variations in breast cancer incidence across multiple European settings.
Objectives
To quantify micro-geographic inequalities in breast cancer incidence and explore their association with land use patterns across multiple European countries.
Methods
We conducted an individual-level retrospective cohort study using population-based breast cancer registries from Italy, Spain, Greece and Ukraine (2010–2021). Cancer incidence was analysed at sub-provincial level (districts, zip-code areas or raions, depending on country). Age-standardised incidence rates (ASRW) were calculated for each small area, and geographic inequalities were quantified using an Inequality Index defined as the ratio between mean ASRW in the highest and lowest deciles of the distribution. Land use characteristics were assessed using CORINE Land Cover data, and associations with incidence were evaluated using negative binomial regression models.
Results
A total of 105,470 breast cancer cases were included. Within-province geographic variations in ASRW were substantial and, in several settings, exceeded differences observed between countries. The Inequality Index ranged from 1.49 to 8.49 across provinces, indicating marked local disparities. Higher proportions of artificial surfaces were consistently associated with increased breast cancer incidence, with an estimated 0.4% increase in ASRW per 1% increase in artificial land cover.
Conclusions
Breast cancer incidence shows pronounced micro-geographic inequalities across Europe that are masked at higher geographic levels. Land use, particularly urbanisation and artificial surfaces, appears to contribute to these disparities. These findings support the need for neighbourhood-level cancer surveillance and urban planning policies that integrate cancer prevention objectives.