{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:56:29Z","timestamp":1792000589706,"version":"4.4.0"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u201315.4) and 12.5 (95% CI, 8.9\u201316.0) per 100,000 WY, respectively. Median survival was 187 months (95% CI, 163.7\u2013210.2), reaching 226 months among women diagnosed at stages 0\u2013I. 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\u201364 years, corresponding to the target population of the national BC early detection program (APC, 5.37%; 95% CI, 2.03\u20138.82; p\u2009=\u20090.005). 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\u201336.95). Diagnosis at stages 0\u2013II was associated with a 22% reduction in ten-year mortality (RR, 0.78; 95% CI, 0.67\u20130.91), with an NND of 9. Diagnosing 61 women at stages 0\u2013II rather than III\u2013IV would avoid one DALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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\u2013II rather than III\u2013IV, supports continued investment in early detection and BC control in Tunisia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360398","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:34:33Z","timestamp":1791999273000},"page":"e0360398","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Survival and disease burden of breast cancer (Monastir, Tunisia): A population-based cohort study (2002\u20132022)"],"prefix":"10.1371","volume":"21","author":[{"given":"Imen","family":"Zemni","sequence":"first","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba Hospital of Monastir"]},{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amani","family":"Maatouk","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba Hospital of Monastir"]},{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiem","family":"Boufrikha","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Hematology, University maternity Center of Monastir"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrine","family":"Bennasrallah","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba Hospital of Monastir"]},{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafa","family":"Dhouib","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba Hospital of Monastir"]},{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meriem","family":"Kacem","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba Hospital of Monastir"]},{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hela","family":"Abroug","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06"]},{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Hospital Hygiene, Fattouma Bourguiba Hospital of Monastir"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manel","family":"Ben Fredj","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06"]},{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of community and Preventive Medicine Regional Hospital of Ksar Hellal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00e8s","family":"Bouanene","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba Hospital of Monastir"]},{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Technology and Medical Imaging Research Laboratory - LTIM - LR12ES06"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Islem","family":"Jridi","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Family Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiba","family":"Arfa","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Family Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amina","family":"Ben Salem","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Radiology, University Maternity Center of Monastir"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7835-3530","authenticated-orcid":true,"given":"Leila","family":"Njim","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Pathology, Fattouma Bourguiba Hospital of Monastir"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Zaied","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Oncology, University Maternity Center of Monastir"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja","family":"Faleh","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Gynecology, University Maternity Center of Monastir"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karawen","family":"Sakka","sequence":"additional","affiliation":[{"name":"University of Sousse","place":["Sousse, Tunisia"],"department":["Cancer Registry of the Center of Tunisia, University Hospital Farhat Hached of Sousse"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Badreddine","family":"Sriha","sequence":"additional","affiliation":[{"name":"University of Sousse","place":["Sousse, Tunisia"],"department":["Cancer Registry of the Center of Tunisia, University Hospital Farhat Hached of Sousse"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilia","family":"Ja\u00eedane","sequence":"additional","affiliation":[{"name":"University of Sousse","place":["Sousse, Tunisia"],"department":["Cancer Registry of the Center of Tunisia, University Hospital Farhat Hached of Sousse"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meriem","family":"Mehdi","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Reproductive Biology, University Maternity Center of Monastir"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5167-5102","authenticated-orcid":true,"given":"Asma","family":"Belguith Sriha","sequence":"additional","affiliation":[{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Department of Epidemiology and Preventive Medicine, Fattouma Bourguiba Hospital of Monastir"]},{"name":"University of Monastir","place":["Monastir, Tunisia"],"department":["Technology and Medical Imaging Research Laboratory - 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Costa","year":"2024","journal-title":"Breast"},{"issue":"5","key":"pone.0360398.ref039","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1111\/tbj.13062","article-title":"Trends and current challenges of breast cancer in Tunisia: A retrospective study of 1262 cases with survival analysis","volume":"24","author":"I Belaid","year":"2018","journal-title":"Breast J"},{"key":"pone.0360398.ref040","first-page":"665","article-title":"Reasons for late diagnosis of breast cancer in Tunisia","volume":"96","author":"L Ben Fatma","year":"2018","journal-title":"Tunis Med"},{"issue":"2","key":"pone.0360398.ref041","doi-asserted-by":"crossref","first-page":"99","DOI":"10.4048\/jbc.2024.0190","article-title":"Breast cancer in older patients aged 70 years and above: Treatment adherence and oncologic outcomes","volume":"28","author":"JH Kim","year":"2025","journal-title":"J Breast 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