BREAST CANCER EPIDEMIOLOGY BREAST CANCER EPIDEMIOLOGY AND BREAST PHYSIOLOGYAND BREAST PHYSIOLOGY

Benjamin O. Anderson, M.D.Director, Breast Health Clinic

Professor of Surgery and Global Health, University of WashingtonJoint Member, Fred Hutchinson Cancer Research Center

Seattle, Washington

U .W .S .O .M . F.H.C.R.C.

MYTH #1MYTH #1

““Cancer is an insignificant health care issue in Cancer is an insignificant health care issue in low and middle income countries (LMCs).”low and middle income countries (LMCs).”

FACT:FACT: Cancer is the second most common Cancer is the second most common cause of death in LMCs, more than respiratory cause of death in LMCs, more than respiratory infections and diseases, HIV/AIDS, diarrheal infections and diseases, HIV/AIDS, diarrheal diseases and tuberculosisdiseases and tuberculosis

NEJM 356:3, 2007 (from WHO 2005)NEJM 356:3, 2007 (from WHO 2005)

CAUSES OF DEATHCAUSES OF DEATH::Low-Income and Lower-Middle Income CountriesLow-Income and Lower-Middle Income Countries

CancerCancer 4.4 million4.4 million

Respiratory infections Respiratory infections 3.5 million3.5 million

Respiratory diseases Respiratory diseases 3.0 million3.0 million

HIV/AIDS HIV/AIDS 2.7 million2.7 million

Diarrheal diseases Diarrheal diseases 1.8 million1.8 million

Tuberculosis Tuberculosis 1.5 million1.5 million

MYTH #2MYTH #2

““Breast cancer REALLY Breast cancer REALLY only only affects countries affects countries of wealth.”of wealth.”

FACT:FACT: Breast cancer is the most common Breast cancer is the most common cancer among women around the globe, and cancer among women around the globe, and the most likely reason that a woman will die of the most likely reason that a woman will die of cancer.cancer.

BREAST CANCER EPIDEMIOLOGY: BREAST CANCER EPIDEMIOLOGY: Incidence and Mortality in U.S.Incidence and Mortality in U.S.

Breast cancer incidence rates– Most common cancer among women (31%)

Breast cancer mortality rates – Second most common cause of cancer deaths

among women (15%) – Lung cancer became leading cancer killer in

mid 1980’s

CA-A Journal for Clinicians 52:23, 2002CA-A Journal for Clinicians 52:23, 2002

CANCER INCIDENCE RATES FOR U.S. WOMEN, 1973-2005CANCER INCIDENCE RATES FOR U.S. WOMEN, 1973-2005

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CANCER DEATH RATES FOR U.S. WOMEN, 1930-2005CANCER DEATH RATES FOR U.S. WOMEN, 1930-2005A

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BREAST CANCER: BREAST CANCER: Incidence and Mortality in WorldIncidence and Mortality in World

Third most frequent cancer in world (male + female)

– 1990: 796,000 cases, 314,000 deaths

– 2002: 1,152,000 cases, 411,000 deaths

Most common cancer among women worldwide

– Most common cause female cancer deaths

– Most breast cancer deaths occur in less developed countries

CA Cancer J Clin: 49:33, 1999Globocan 2002 (IARC)

WORLD BREAST CANCER STATISTICS:WORLD BREAST CANCER STATISTICS:Incidence and 5-Year SurvivalIncidence and 5-Year Survival

CA Cancer J Clin: 50:37, 2000CA Cancer J Clin: 50:37, 2000

0102030405060708090

INCIDENCE (per 100,000) 5-YEAR SURVIVAL (%)

GHANAIAN CANCER EPIDEMIOLOGY:GHANAIAN CANCER EPIDEMIOLOGY:Age Standardized Rates (ASR) / 100,000 FemalesAge Standardized Rates (ASR) / 100,000 Females

Globocan 2002

BREAST CANCER EPIDEMIOLOGY:BREAST CANCER EPIDEMIOLOGY:Stage at diagnosis: United States vs. IndiaStage at diagnosis: United States vs. India

Sources: Sources: SEER Survival Monograph (NCI), SEER Survival Monograph (NCI), 2007;2007;

Chopra, Cancer Institute Chennai, India, Chopra, Cancer Institute Chennai, India, 20012001

STAGE EXTENT5 year

SURVIVAL

DISTRIBUTION

USA INDIA

0 Noninvasive 100% 16% ----

I Early stage disease 100% 40% 1%

II Early stage disease 86% 34% 23%

III Locally advanced 57% 6% 52%

IV Metastatic disease 20% 4% 24% INDIA:

76% locally advanced or metastatic at

diagnosis

USA:90% DCIS or early staged

invasive disease at diagnosis

THE HEALTHY BREAST:THE HEALTHY BREAST:In Utero Mammary DevelopmentIn Utero Mammary Development

GGEESSTTAATTIIOONN TTIIMMEE EEVVEENNTT IINN DDEEVVEELLOOPPMMEENNTT77--88 WWeeeekkss:: MMaammmmaarryy ddeevveellooppmmeenntt

ffiirrsstt aappppeeaarrssTThhiirrdd TTrriimmeesstteerr:: PPllaacceennttaall hhoorrmmoonneess

iinndduuccee dduucctt ffoorrmmaattiioonn3322--4400 WWeeeekkss:: BBrreeaasstt lloobbuulleess ((sseeccrreettoorryy

uunniittss)) ddeevveelloopp

THE HEALTHY BREAST:THE HEALTHY BREAST:Breast Maturation during PregnancyBreast Maturation during Pregnancy

GGEESSTTAATTIIOONN PPHHAASSEEDDoommiinnaanntt HHoorrmmoonnee

LLAACCTTAATTIIOONNAALL DDEEVVEELLOOPPMMEENNTT

FFIIRRSSTT TTRRIIMMEESSTTEERR::EEssttrrooggeenn

BBrreeaasstt eennllaarrggeemmeenntt ffrroomm dduuccttaall sspprroouuttiinngg aanndd ggrroowwtthh

SSEECCOONNDD TTRRIIMMEESSTTEERR::PPrrooggeesstteerroonnee

BBrreeaasstt mmaattuurraattiioonn aanndd ““ddiiffffeerreennttiiaattiioonn”” iinn lloobbuulleess

AAFFTTEERR DDEELLIIVVEERRYY::PPrroollaaccttiinn

MMiillkk pprroodduuccttiioonn && wwiitthhddrraawwaall ffrroomm ootthheerr hhoorrmmoonneess

PROGRESSION OF DISEASEPROGRESSION OF DISEASE METASTASISMETASTASIS

F.H.C.R.C.

UNIVERSITY OF WASHINGTONUNIVERSITY OF WASHINGTON

FRED HUTCHINSON CANCER CENTERFRED HUTCHINSON CANCER CENTER

CHILDREN’S HOSPITALCHILDREN’S HOSPITAL

SEATTLE CANCER CARE ALLIANCESEATTLE CANCER CARE ALLIANCE

UNIVERSITY OF WASHINGTONUNIVERSITY OF WASHINGTON

FRED HUTCHINSON CANCER CENTERFRED HUTCHINSON CANCER CENTER