Epidemiologic Study Of Endogenous Hormones And Breast Cancer Risk
In contrast to clinical needs, in which discerning grossly abnormal from normal hormone levels is the focus, epidemiologic studies are usually aimed at relating modest differences within the normal range of levels to risk of subsequent cancer. Considerable laboratory error has been reported in studies of assay reproducibility. Low reproducibility could result in true exposure/disease associations being missed. Varying sensitivities and specificities of different laboratory assays have also complicated the comparison of results between studies.
Sc Takes Notice Of Increasing Breast Cancer Cases Summons Federal And Provincial Health Secretaries
The Supreme Court of Pakistan on Tuesday took notice of increasing breast cancer cases in the country and summoned the federal and provincial health secretaries in the next hearing.
Hearing the matter after taking notice of the growing number of breast cancer patients, a two-member bench headed by Chief Justice Gulzar Ahmed resented that no government hospital had the facilities of mammography, breast cancer treatment or tools for detection of the disease.
The chief justice noted that most of the women were not able to afford costly treatment of the disease.
Expressing dismay over the lack of treatment mechanism, Justice Ahmed directed authorities to induct women in panels of specialists treating the disease and also called for segregation of women patients at hospitals.
The top court adjourned the hearing for a month after issuing summons to the federal and provincial health secretaries.
Breast cancer mortality rates in Pakistan are said to be the highest in Asia. The extent of its prevalence can be gauged by the fact that at least 90,000 new cases are diagnosed every year in the country and, annually, some 40,000 women succumb to it.
Last month, the chief justice had inaugurated the building of the Pink Ribbon Hospital, the first-ever dedicated breast cancer hospital not only in Pakistan but worldwide.
How Many New Cancer Cases Are Diagnosed Each Year
One of the most frequently asked questions with regard to cancer is that how many people are diagnosed with cancer each year. Healthy people have a natural concern to know what their chances are of getting afflicted with any form of cancer. As per 2006 data available from Cancer.gov, 471.62 new cases of cancer per 100,000 of population are diagnosed each year in the United States. However, the good news is that the rate of new diagnoses of cancer as well as the rate of death from cancer has shown a decline in recent years in the United States. This trend has been observed across most ethnic and racial groups in the country and for both males and females.
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Trends In Incidence And Mortality In The United States
Incidence rates of breast cancer rose steadily until 2002, when a rapid drop in incidence was observed. Data from the SEER program, which began in 1973, confirm the trends in incidence most clearly monitored in the longstanding Connecticut registry. Increases have occurred in all age groups since 1935, although the magnitude of increase has been greater in older women. In the past few decades, incidence rates have increased more sharply among younger black women than white women according to SEER data, from 1975-2000, incidence rates among black women younger than 50 years increased by 22% compared with 10% among white women younger than 50 years. Among women aged 50 years and older, the increase over this interval was 40% for both black and white women.
Long-term trends in incidence rates of DCIS and invasive female breast cancer showed a rise in DCIS incidence between 1983 to about 1999 and then a relatively steady rate between 2000 and 2011 before a decrease of about 2.1% per year around 2012-2016. Women 50 years and older had the greatest DCIS incidence. For invasive breast cancer, the incidence was also greatest in women 50 years and older, with a rapid rise between 1987 to 2000 followed by a sharp drop between 1994 and 2004 .
Duration Of Use And Time Since Last Use
Most studies have observed no significant increase in breast cancer risk with long durations of use. Individual data from 54 epidemiologic studies were collected and analyzed centrally. In this large pooled analysis, data from 53,297 women with breast cancer and 100,239 women without breast cancer were evaluated, and no overall relationship was observed between duration of use and risk of breast cancer. Current and recent users of oral contraceptives had a significantly increased risk of breast cancer . This increased risk subsided within 10 years of stopping oral contraceptive use .
A modestly increased risk of breast cancer was observed among current and recent oral contraceptive users, and no independent effect of long duration of use on risk of breast cancer was observed, even among very young women. Thus, the increased risk of breast cancer observed among young long-term oral contraceptive users in past individual studies appear primarily due to recent use of oral contraceptive rather than to duration of use. These data suggest that oral contraceptives may act as late-stage promoters. Table 1 summarizes the excess cases of breast cancer that would be generated in a population of 10,000 women using oral contraceptives at different ages.
Table 1. Excess Cases of Breast Cancer Due to Use of Oral Contraceptives for 5 Years
|
Age at Starting Use, y |
Cases Among Users |
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Changing Trends Of Cancer Sites
While it is important to know how many people are diagnosed with cancer each year, it is also good to have an idea of the cancer site trends. Some types of cancers have shown very high rise in incidence rates in recent years, which include skin melanoma, kidney, renal pelvis and liver cancers, and cancers of the thyroid and bile duct. Some other cancers that have shown a rise in incidence rates include cancers of the pancreas and esophagus, non-Hodgkin lymphoma and leukemia.
However, there are several other cancer sites where the incidence rates have been declining. These include ovarian cancers, cervix uteri, larynx, pharynx and oral cavity cancers. Many researchers are of the opinion that in recent years, the marked decline in breast cancer diagnoses may be attributable to the decline in Hormone Replacement Therapy . These are some key trends emerging from the data which has been collected and analyzed in recent years.
Breast Cancer Diagnosis And Survival Rates Over The Last 27 Years
The incidence of breast cancer has risen dramatically over the last 27 years, rising from about 9,827 new cases a year in 1994, to over 20,000 new cases a year in 2021. As a result, 1 in 7 women will now be diagnosed in their lifetime.
From NBCFs inception in 1994, five-year relative survival for breast cancer improved from 76% to 91%. This improvement is a result of research. But despite the improved survival rate, this year around 9 Australians will lose their lives to breast cancer every day. In 2021, there was over 3,000 deaths from breast cancer, including 36 males and 3,102 females.
Unfortunately, despite improved survival rates, the number of deaths from breast cancer each year is still rising. This is being driven by the increase in diagnoses.
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Good News About Breast Cancer Trends
In recent years, perhaps coinciding with the decline in prescriptive hormone replacement therapy after menopause, we have seen a gradual reduction in female breast cancer incidence rates among women aged 50 and older. Death rates from breast cancer have been declining since about 1990, in part due to better screening and early detection, increased awareness, and continually improving treatment options.
Take Action To Change Young Adult Breast Cancer Statistics
When all young adults affected by breast cancer work together, we can raise awareness, improve our representation in research and make each other stronger. We are dedicated to these goals, working to turn our unique challenges into opportunities for shared success. Join the movement! Become an advocate for young women with breast cancer.
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What Are The Signs And Symptoms Of Breast Cancer
There are many different signs and symptoms of breast cancer, so regularly checking your breasts for anything different or new is important.
The earlier breast cancer is diagnosed, the better the chance of successful treatment. Getting to know what your breasts look and feel like normally means its easier to spot any unusual changes and check them with your doctor. Common breast cancer signs and symptoms include:
- A lump or swelling in the breast, upper chest or armpit. You might feel the lump, but not see it.
- Changes in the size or shape of the breast
- A change in skin texture i.e. puckering or dimpling of the skin
- A change in the colour of the breast – the breast may look red or inflamed
- Rash, crusting or changes to the nipple
- Any unusual discharge from either nipple
Almost half of women in the UK do not check their breasts regularly for potential signs of breast cancer.
According to a YouGov survey commissioned by Breast Cancer Now, one in 10 women have never checked their breasts for new or unusual changes. Meanwhile, a fifth of women check their breasts once every six months or less, while 13% do this once a year or less.
Asked what stops or prevents them from checking their breasts more regularly, almost half of women said they forget. This is concerning when most cases of the disease are detected because women have spotted new or unusual changes to their breasts.
Some factors are outside our control, including:
Breast Cancer Incidence Rates Worldwide
Breast cancer is the most common cancer in women worldwide.
Its estimated more than 2 million new cases of breast cancer occurred worldwide among women in 2020 .
Breast cancer incidence rates around the world vary
In general, rates of breast cancer are higher in developed countries than in developing countries .
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Metastatic Breast Cancer At Diagnosis
Most often, metastatic breast cancer arises months or years after a person has completed treatment for early or locally advanced breast cancer.
Some people have metastatic breast cancer when they are first diagnosed. This is called de novo metastatic breast cancer. In the U.S., 9 percent of men have metastases when they are first diagnosed with breast cancer .
Learn more about metastatic breast cancer.
How Common Is Breast Cancer
Breast cancer is the most common cancer in American women, except for skin cancers. The average risk of a woman in the United States developing breast cancer sometime in her life is about 13%. This means there is a 1 in 8 chance she will develop breast cancer. This also means there is a 7 in 8 chance she will never have the disease.
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Interactive Statistics With Seer*explorer
With SEER*Explorer, you can…
- Create custom graphs and tables
SEER*Explorer is an interactive website that provides easy access to a wide range of SEER cancer statistics. It provides detailed statistics for a cancer site by gender, race, calendar year, age, and for a selected number of cancer sites, by stage and histology.
Examples Of Rates Versus Numbers
Say, town A has a population of 100,000 and town B has a population of 1,000. Over a year, say there are 100 breast cancer deaths in town A and 100 breast cancer deaths in town B.
The number of breast cancer deaths in each town is the same. However, many more people live in town A than live in town B. So, the mortality rates are quite different.
In town A, there were 100 breast cancer deaths among 100,000 people. This means the mortality rate was less than one percent .
In town B, the mortality rate was 10 percent .
Although the number of deaths was the same in town A and town B, the mortality rate was much higher in town B than in town A .
Lets look at another example. In 2021, its estimated among women there will be :
- 100 breast cancer deaths in Washington, D.C.
- 720 breast cancer deaths in Alabama
- 4,730 breast cancer deaths in California
Of the 3, California has the highest number of breast cancers. However, that doesnt mean it has the highest rate of breast cancer. These numbers dont take into account the number of women who live in each state. Fewer women live in Alabama and Washington, D.C. than live in California.
Other factors may vary by state as well, such as the age and race/ethnicity of women. So, to compare breast cancer mortality , we need to look at mortality rates.
In 2021, the estimated mortality rates are :
- 26 per 100,000 women in Washington, D.C.
- 22 per 100,000 women in Alabama
- 19 per 100,000 women in California
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Incidence Rates And The Number Of New Cases
To know whether or not breast cancer rates are changing over time, you have to compare rates, rather than the number of new cases.
For example, lets compare the number of new cases of breast cancer in U.S. in 2009 to the number of new cases in 2016. In 2009, there were an estimated 192,370 new cases of breast cancer in U.S. women . In 2016, there were an estimated 246,660 new cases .
Although more breast cancer cases occurred in 2016 than in 2009, this doesnt mean the rate of breast cancer increased over this time period.
We expect the number of cases to increase over time because the population of the U.S. increases over time . The more people there are, the more cancers there will be.
Our population is also living longer . Since age increases the risk of breast cancer, we expect to have more breast cancers over time.
To know if breast cancer rates are changing over time, we look at incidence rates, rather than the number of new cases. The incidence rate shows the number of breast cancer cases in a set population size. Its usually written as the number of cases in a population of 100,000 people.
The breast cancer incidence rate among women in 2009 was 131 and the estimated breast cancer incidence rate in 2016 was also 131 . This means there were 131 breast cancer cases per 100,000 women in the U.S. population in both time periods.
So, although the number of breast cancer cases increased over time, breast cancer rates were fairly stable.
If The Cancer Has Spread Beyond The Breast
Some men are diagnosed with cancer that has already spread. Or the cancer might come back and spread some time after treatment. This is called secondary breast cancer, advanced breast cancer, or metastatic breast cancer.
In this situation your doctor might recommend:
- chemotherapy
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Global Cancer Statistics : Globocan Estimates Of Incidence And Mortality Worldwide For 36 Cancers In 185 Countries
Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
Corresponding Author: Freddie Bray, BSc, MSc, PhD, Section of Cancer Surveillance, International Agency for Research on Cancer, 150, cours Albert Thomas, F-69372 Lyon Cedex 08, France .
Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
Corresponding Author: Freddie Bray, BSc, MSc, PhD, Section of Cancer Surveillance, International Agency for Research on Cancer, 150, cours Albert Thomas, F-69372 Lyon Cedex 08, France .
DISCLOSURES:
For More Information See Breast Cancer On The Ncci Website
The National Cancer Control Indicators are a set of indicators across the continuum of cancer care, from Prevention and Screening through to Diagnosis, Treatment, Psychosocial care, Research and Outcomes. The NCCI website allows users to see visual representations of data on each indicator through interactive charts.
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Mammograms And Breast Density
After extensive family history of breast cancer, mammographic density is the strongest risk factor for the development of breast cancer. Women with dense breasts have 4 times the likelihood of developing breast cancer compared to women without dense breasts. It is also well known that breast tissue density increases in about 25%-30% of women who begin hormone replacement therapy and that, conversely, breast density decreases in some women who are placed on tamoxifen or raloxifene.
The authors have shown that single-nucleotide polymorphisms in the IGF pathway are related to risk of mammographically dense breasts and that the relation of mammographic density to increased breast cancer risk is independent of circulating hormone levels. These findings suggest long-term energy balance may operate to modify breast density and requires further evaluation of energy balance and the microbiome to refine our understanding.
Use Of Estrogen Plus Progestin
The addition of a progestin to estrogen regimens has become increasingly common, as it minimizes or eliminates the increased risk of endometrial hyperplasia and cancer associated with using unopposed estrogens. In the United States, by the mid-1980s, almost 30% of postmenopausal hormone prescriptions included a prescription for progestin. The impact of an added progestin to the risk of breast cancer has been evaluated only in the last 20 years.
Two of the first studies to assess this relationship suggested that the addition of a progestin could decrease breast cancer risk. However, these studies were small, and potentially important confounders were not accounted for in the analyses. Since this time, additional studies have assessed this relationship and together indicate that there is no protective effect of typical doses used in postmenopausal hormone therapy. More recent studies also support this increase in risk with combination estrogen plus progestin.
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