world cancer report - iarc

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