world cancer report - iarc
world cancer report - iarc
world cancer report - iarc
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graphic screening exists, and in fact for<br />
women generally, health education should<br />
include recognition of breast <strong>cancer</strong><br />
symptoms. Diagnosis of breast <strong>cancer</strong> is<br />
currently made by triple assessment of<br />
breast lumps – clinical history and examination,<br />
complemented by mammography<br />
and/or breast ultrasound plus fine needle<br />
aspiration cytology or biopsy [8]. Breast<br />
screening can have an impact on disease<br />
100<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
DIET AND DIET-RELATED FACTORS<br />
Increased weight (postmenopause) ↑<br />
Increased height ↑<br />
Western diet ↑<br />
High intake of fibre? ↓<br />
Alcohol ↑<br />
High intake of fresh fruit<br />
and vegetables ↓<br />
FAMILY HISTORY OF BREAST CANCER ↑<br />
including BRCA1, BRCA2, and p53<br />
germline mutations<br />
Fig. 5.18 Risk and protective factors for breast <strong>cancer</strong>. Factors associated with an increased (↑) or<br />
decreased (↓) risk of breast <strong>cancer</strong>.<br />
USA<br />
Black<br />
White<br />
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100<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
UK<br />
1960197019801990 2000<br />
mortality. Mammography is associated<br />
with a reduction of up to 30% in breast<br />
<strong>cancer</strong> mortality in the context of wellconducted<br />
trials [9]. Where adopted, population-based<br />
screening is commonly<br />
based on biennial examination from the<br />
age of 50 onwards. To realize the benefit<br />
of screening, prompt and adequate followup<br />
must be available to all women with a<br />
suspected malignancy [10].<br />
100<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
Denmark<br />
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100<br />
A woman may be considered to be at a<br />
potentially high risk of breast <strong>cancer</strong> if<br />
there are three or more first or second<br />
degree relatives on the same side of the<br />
family with breast or ovarian <strong>cancer</strong>, or<br />
two or more first or second degree relatives<br />
on the same side of the family with<br />
breast or ovarian <strong>cancer</strong> which has been<br />
diagnosed at age 40 or younger, bilateral<br />
disease, both breast and ovarian <strong>cancer</strong> in<br />
the same individual or breast <strong>cancer</strong> in a<br />
male [11]. The currently available approaches<br />
to the management of the high-risk<br />
woman are close surveillance (involving<br />
regular self and clinical breast examination<br />
and annual mammography), genetic<br />
counselling or prophylactic mastectomy (a<br />
procedure which does not, however, guarantee<br />
complete prevention of subsequent<br />
breast <strong>cancer</strong>).<br />
Pathology and genetics<br />
Ductal carcinoma in situ is a proliferation<br />
of presumably malignant epithelial cells<br />
and is confined to the mammary ducts<br />
and lobules. It carries a 30% chance of<br />
developing into invasive disease, although<br />
the natural history of this progression<br />
remains uncertain. The rate of detection<br />
of ductal carcinoma in situ has increased<br />
significantly with the introduction of<br />
mammography and questions have been<br />
raised regarding the possible overtreatment<br />
of this condition. It can be classified<br />
into comedo and non-comedo subtypes<br />
based on growth pattern, the comedo<br />
Fig. 5.19 Trends in mortality from breast <strong>cancer</strong>. In some countries, such the USA and UK mortality is decreasing; in almost all developing countries, mortality<br />
is increasing. D.M. Parkin et al. (2001) Eur J Cancer 37 Suppl 8: S4-66<br />
190 Human <strong>cancer</strong>s by organ site<br />
IONIZING<br />
RADIATION<br />
at times of<br />
breast<br />
development ↑<br />
FEMALE BREAST CANCER<br />
HORMONES AND<br />
REPRODUCTIVE FACTORS<br />
Young age at menarche ↑<br />
Regular, ovular menstrual cycle ↑<br />
Older age at first full-term birth ↑<br />
Nulliparity ↑<br />
Older age at menopause ↑<br />
Oral contraceptives ↑<br />
Infertility ↑<br />
Lack of breast feeding ↑<br />
BENIGN BREAST DISEASE ↑<br />
including atypical ductal<br />
hyperplasia<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
Japan<br />
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100<br />
50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
Costa Rica<br />
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50<br />
25<br />
10<br />
5<br />
2.5<br />
1<br />
Singapore<br />
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