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BREAST CANCER EPIDEMIOLOGY AND BREAST PHYSIOLOGY. Benjamin O. Anderson, M.D. Director, Breast Health Clinic Professor of Surgery and Global Health, University of Washington Joint Member, Fred Hutchinson Cancer Research Center Seattle, Washington. MYTH #1. - PowerPoint PPT Presentation
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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
Ag
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ate
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Fem
ales
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ed I
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ate
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100
,000
Fem
ales
CANCER DEATH RATES FOR U.S. WOMEN, 1930-2005CANCER DEATH RATES FOR U.S. WOMEN, 1930-2005A
ge
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De
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100
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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