Breast cancer has long been recognized as the most prevalent cancer affecting women worldwide. However, despite its global prominence, the distribution and burden of this disease exhibit significant variations, particularly along sex lines and across geographic and socioeconomic landscapes. A recent in-depth study focusing on Indonesia, a populous Southeast Asian nation with unique healthcare challenges, shines a revealing light on the sex-disaggregated patterns of breast cancer incidence. Leveraging the robust data resources offered by the World Health Organization’s Health Equity Assessment Toolkit (HEAT), the research paints a nuanced picture of breast cancer trends in Indonesia from 2000 to 2019, revealing persistent disparities that call for urgent public health interventions.
The analysis adopts a technically rigorous approach by examining age-standardized breast cancer incidence rates per 100,000 population, a crucial metric that allows the comparison of cancer burden across different populations and time periods while accounting for the age structure. The data, derived from WHO HEAT, is grounded in the Institute for Health Metrics and Evaluation (IHME), which amalgamates comprehensive cancer registry data and health surveys, thereby ensuring high credibility and richness of the source material. Such a methodological foundation enables the authors to dissect the trajectory of breast cancer incidence not only among women, who bear the overwhelming majority of cases, but also among men, a typically understudied group in breast cancer epidemiology.
Between 2000 and 2019, Indonesia witnessed a gradual yet significant decline in age-standardized breast cancer incidence, falling from 19.1 to 16.0 per 100,000 individuals. This downward trend, though encouraging, belies the marked and enduring disparities between sexes. In 2019, the incidence rate among women was 37.4 per 100,000 — a figure that starkly contrasts with the male rate of 0.4 per 100,000. This disparity translates to women being over one hundred times more likely to develop breast cancer than men, an epidemiological reality consistent with global patterns but particularly accentuated within the Indonesian context.
Quantifying sex disparities through multiple sophisticated inequality indicators—Difference, Ratio, Population Attributable Fraction (PAF), and Population Attributable Risk (PAR)—provides a multidimensional understanding of the magnitude and implications of the burden borne by women. The absolute difference in breast cancer incidence between females and males widened over the examined period, increasing from 31.0 to 37.1, while the ratio underscored women’s disproportionately high risk. Furthermore, the PAF values consistently indicated that nearly all breast cancer cases in the population were attributable to the female sex, underscoring the biological and potentially socio-environmental underpinnings of this disparity.
These quantitative markers do more than depict a static snapshot; they reveal evolving disparities shaped by a complex interplay of genetics, hormonal factors, reproductive history, lifestyle, environmental exposures, and health system factors unique to Indonesia. The spatial inconsistencies in the country’s healthcare infrastructure, coupled with variable access to early detection and treatment services, compound the challenge of reducing breast cancer mortality, especially in lower-resource and rural settings. Thus, understanding these disparities is paramount for policymakers aiming to craft equitable and effective health strategies.
Breast cancer screening remains a pillar of early detection and improved survival, yet Indonesia’s expansive archipelagic geography and unequal healthcare access may hinder comprehensive screening coverage. This study’s findings emphasize the critical need for scaling up organized breast cancer screening initiatives, ensuring they are accessible and culturally appropriate to reach women across diverse Indonesian regions. Such programs must be bolstered by public education campaigns that dispel stigma, enhance symptom awareness, and foster proactive health-seeking behaviors.
On the diagnostic and treatment front, the research underscores the necessity of enhancing Indonesia’s healthcare infrastructure to widen availability and affordability of advanced diagnostic tools and specialized treatment modalities. Targeted investments in oncology services, especially in underserved areas, complemented by training healthcare providers in early signs of breast cancer, could dramatically reduce diagnostic delays that adversely impact prognosis.
Moreover, the sex-disaggregated data call attention to the unique biological and lifestyle-related risk factors women face. The study advocates for future research directed at elucidating these female-specific risks within the Indonesian population context. Hormonal and reproductive determinants, including age at menarche, parity, breastfeeding practices, and hormonal therapy use, may vary across regions and ethnic groups, influencing incidence rates. Lifestyle factors such as diet, physical activity, and exposure to environmental carcinogens further complicate the risk landscape and merit detailed investigation.
Equally critical is the recognition that breast cancer disparities are not solely biological but intricately tied to social determinants of health, including education, income, and health literacy. Women from marginalized socioeconomic backgrounds may encounter compounded vulnerabilities due to limited health awareness and financial barriers to accessing care. Hence, integrated public health frameworks that address these social inequities are crucial to achieve meaningful reductions in breast cancer disparities.
Indonesia’s demographic transition characterized by urbanization and shifting reproductive patterns adds layers of complexity to breast cancer epidemiology. The interplay between traditional practices and modern lifestyles necessitates culturally sensitive research and policy responses that respect diverse experiences while promoting evidence-based prevention and control measures.
In confronting breast cancer disparities, multidisciplinary collaboration among government agencies, healthcare providers, researchers, and community organizations will be essential. Such partnerships can facilitate data sharing, mobilize resources, and implement regionally tailored interventions that resonate with women’s lived realities across Indonesia.
The rigor of this sex-disaggregated analysis serves as a model for other low- and middle-income countries seeking to unravel health inequalities within their cancer burdens. By illuminating Indonesia’s breast cancer landscape through a gender-sensitive lens, the study advances global understanding and reinforces the imperative for equity-driven cancer control strategies.
In summation, while breast cancer incidence in Indonesia shows a modest decline over two decades, the disproportionate risk borne by women remains an urgent public health concern. Addressing this requires a multifaceted approach, integrating enhanced screening accessibility, robust public education, improved treatment infrastructure, and focused research on female-specific risk factors. Such efforts hold promise to not only reduce breast cancer morbidity and mortality but also to advance health equity in Indonesia and similar contexts worldwide.
As breast cancer continues to shape women’s health outcomes profoundly, Indonesia’s experience underscores the necessity of leveraging comprehensive, sex-disaggregated data and embracing targeted interventions. The imperative now is to translate these insights into action that empowers women, strengthens health systems, and ultimately narrows the chasm of cancer disparities for future generations.
Subject of Research: Breast cancer incidence and sex disparities in Indonesia using WHO Health Equity Assessment Toolkit data.
Article Title: Breast cancer incidence in Indonesia: a sex-disaggregated analysis using WHO health equity assessment toolkit data.
Article References: Osborne, A., Adnani, Q.E.S. & Ahinkorah, B.O. Breast cancer incidence in Indonesia: a sex-disaggregated analysis using WHO health equity assessment toolkit data. BMC Cancer 25, 986 (2025). https://doi.org/10.1186/s12885-025-14332-4
Image Credits: Scienmag.com
DOI: https://doi.org/10.1186/s12885-025-14332-4
