Working Paper of Public Health Volume 2012 - Azienda Ospedaliera ...

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Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 7/2012Note: ASR is the incidence of breast cancer based on Age-standardized rate (ASW); GDP (Gross Domestic Product),CT (Computed Tomography)Correlation with control variable Latitude, Magnetic Resonance Imaging (MRI) andComputed Tomography (CT) shows a high coefficient 62.8% between incidence of breastcancer based on Age-standardized rate (ASR W) and Gross domestic product (GDP) percapita by purchasing power parity - PPP (current international $) 1994-2000 period (table 9).Table 9. Correlation controlling Latitude, MRI and CTControl Variables ASR W 2008GDP 1994-2000PCCorrelation 1.000 .628ASR W 2008 Significance (2-tailed) . .000Latitudedf 0 39LN MRICorrelation 1.000LN CTGDP 1994-2000 PC Significance (2-tailed) .df 0Note: ASR is the incidence of breast cancer based on Age-standardized rate (ASW); GDP (Gross DomesticProduct), CT (Computed Tomography); MRI (Magnetic resonance Imaging)In addition, if: set 1 is represented by countries of temperate zone with average incidence of breastcancer based on Age-standardized rate (ASR W) equal to 59.38 (St. error 4.32). Thisgroup has also a higher GDP per capita. set 2 includes countries not in the temperate zone. Group 2 has an average incidence ofbreast cancer based on Age-standardized rate (ASR W) equal to 24.19 (St. Error 1.64).In short,µ temperate zone set 1 = 59.38 ASR Wµ temperate zone set 2 = 24.19 ASR WThese averages ASR W between these two sets are analyzed by ANOVA that assumesequality of variance across groups.Table 10. ANOVA of countries of temperate zone vs. Non temperate zone based on ASR W 2008Sum of Squares df Mean Square F Sig.Between Groups 14567.659 1 14567.659 33.547 .000Within Groups 21712.631 50 434.253Total 36280.290 51Note: ASR is the incidence of breast cancer based on Age-standardized rate (ASW);12
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 7/2012Table 10 shows the significance value of the F test in the ANOVA that is less than 0.001.Thus, we must reject the hypothesis H 0 that average incidence of breast cancer based on Agestandardizedrate (ASW) is equal across sets of countries in temperate and non temperatezone. Although the “variability within groups” is 59.85% of the total, the “variability betweengroups” displays a considerably high value, equal to 40.15%. Hence, the systematic effect ofgreater incidence of breast cancer based on Age-standardized rate (ASW) could be due tohigher GDP per capita that may spur behavior and style of life of populations that contributeto increase the breast cancer risk of woman.If ANOVA is repeated, mutatis mutandis, per three sets of countries: non temperate zone,temperate zone north and temperate zone south, results are in table 11.Table 11. ANOVA of countries of temperate zone North and South vs. Non temperate zonebased on ASR_W_2008Sum of Squares df Mean Square F Sig.Between Groups 15491.632 2 7745.816 18.257 .000Within Groups 20788.657 49 424.258Total 36280.290 51Note: ASR is the incidence of breast cancer based on Age-standardized rate (ASW);Table 11 confirms, de facto, previous results; the significance value of the F-test in theANOVA table that is less than 0.001: we must also here reject the hypothesis H 0 that averageincidence of breast cancer based on Age-standardized rate (ASW) is equal across these sets ofcountries in North/South temperate and non temperate zone. In this case “variability withingroups” is 57.30% of the total, whereas the “variability between groups” displays a highervalue than previous binomial case, equal to 42.70%. In addition the cumulative risk of breastcancer is higher in temperate zone about 6.35 (average between North and South) vs. 2.6 ofcountries in non temperate zone Hence, this analysis seem to display that the systematiceffect of higher incidence of breast cancer based on Age-standardized rate (ASW) could bedue to some drivers of socio-economic factors, mainly localized in richer countries that willbe discussed in the next section. In addition, ANOVA can provide an alternativeinterpretation of the theory of Oh et al. (2010) on the influence of latitude on breast cancer,focusing on socio-economic factors rather than biologic root causes.5. Discussion on socio-economic determinants of breast cancer incidenceStudies have estimated that approximately 50% of breast cancer incidence can be due togenetic, physiologic, environmental, or behavioral risk factors (alcohol consumption,13
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