world cancer report - iarc

cer in the contralateral breast (Chemoprevention,
p151), a property not seen with cytotoxic
adjuvant therapy. In postmenopausal
women who have had breast cancer, tamoxifen
can reduce the annual rate of death by
17%. However, long-term use has been associated
with endometrial thickening and
endometrial carcinoma. A new-generation
hormonal drug, anastrozole, has recently
been reported to be just as, if not more,
effective than tamoxifen in treating advanced
breast cancer and as adjuvant therapy.
The strongest predictive factor for survival
after diagnosis of breast cancer is the extent
of cancer as defined in the TNM classification
CLASSIFYING CANCERS:
EPIDEMIOLOGICAL
AND CLINICAL NEEDS
To monitor the impact of cancer within
populations, epidemiological records are
based on organ site (topography), liver
cancer, breast cancer, colon cancer
etc, using established codes (International
Classification of Disease, see
http://www.cdc.gov/nchs/about/otheract/
icd9/abticd10.htm). Accordingly, this terminology
applies to Chapters 1 and 2 of
this Report.
To describe the type of cancer (or tumour)
affecting an individual in terms which will
REFERENCES
1. Ferlay J, Bray F, Parkin DM, Pisani P, eds (2001)
Globocan 2000: Cancer Incidence and Mortality Worldwide
(IARC Cancer Bases No. 5), Lyon, IARCPress.
2. Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J,
eds (1997) Cancer Incidence in Five Continents, Vol. VII
(IARC Scientific Publication No. 143 and IARC Cancerbase
No. 2), Lyon, IARCPress.
3. Parkin DM, Pisani P, Ferlay J (1999) Estimates of the
worldwide incidence of 25 major cancers in 1990. Int J
Cancer, 80: 827-841.
4. Peto R, Boreham J, Clarke M, Davies C, Beral V (2000)
UK and USA breast cancer deaths down 25% in year 2000
at ages 20-69 years. Lancet, 355: 1822.
5. COMA Working Group on Diet and Cancer (1998)
Nutritional Aspects of the Development of Cancer (UK
Department of Health Report on Health and Social
Subjects No. 48), Norwich, HMSO.
6. Potter JD. (1997) Food, nutrition and the prevention of
cancer: a global perspective. Washington DC, American
Institute for Cancer Research.
(Box: TNM, p124). If the tumour is large, diffuse
or multicentric, mastectomy may be
appropriate. Involvement of axillary lymph
nodes is an indicator of high risk of relapse
from metastatic disease. An increasing number
of molecular markers of prognosis are
also becoming commonly assessed (Table
5.2) [14]. Metastatic disease is incurable;
once detected, average survival time is two
years. However, at least half the patients with
breast cancer will survive for five years,
including those living in the developing world.
Because of this relatively good prognosis,
there are an estimated 3.46 million women
alive who have had breast cancer diagnosed
indicate the prognosis and appropriate treatment,
reference to organ site alone is inadequate.
For clinical purposes, tumours are
identified by a naming system based on the
tissue or cell of origin. All organs involve multiple
tissue types including glandular or
secretory tissue, connective tissue of various
types (muscle, fat), blood and immunological
elements and nervous tissue. “Carcinoma”
indicates a malignant tumour of surface or
glandular tissue, “sarcoma” indicates connective
tissue, “blastoma” indicates embryonic
tissue, “leukaemia” involves elements of
blood and there are other specialist terms. Of
necessity, Chapters 5 and 6 of this Report
7. Harris J, Morrow M, Norton L (1997) Malignant tumors
of the breast. In: DeVita VTJ, Hellman,S, Rosenberg, SA
eds, Cancer Principles and Practice of Oncology,
Philadelphia, Lippincott-Raven Publishers, 1557-1616.
8. Marsden J, Baum M (1998) Breast cancer. In: Morris D,
Kearsley J, Williams C eds, Cancer: a comprehensive clinical
guide, Harwood Academic Publishers, 131-139.
9. Kerlikowske K, Grady D, Rubin SM, Sandrock C, Ernster
VL (1995) Efficacy of screening mammography. A metaanalysis.
JAMA, 273: 149-154.
10. Fletcher SW, Black W, Harris R, Rimer BK, Shapiro S
(1993) Report of the International Workshop on Screening
for Breast Cancer. J Natl Cancer Inst, 85: 1644-1656.
11. South East Health Public Health Unit. (2000)
Information for GPs: Risk of Breast Cancer.
www.sesahs.nsw.gov.au/cancerbulletins/. NSW Cancer
Control Program, Australia.
12. Eeles RA (1999) Screening for hereditary cancer and
genetic testing, epitomized by breast cancer. Eur J Cancer,
35: 1954-1962.
within the last five years. In Europe for example,
survival is an average of 72.5% at five
years (Fig. 5.21).
Patient follow-up involves the diagnosis and
treatment of recurrent disease, evaluation of
treatment effectiveness, monitoring for longterm
complications, patient rehabilitation
and psychological support. The combination
of various treatment modalities has led to an
improvement in survival for the last 20 years.
The challenge remains of also providing adequate
treatment in the developing world.
use this terminology. The existence of a
standardized classification system is of key
importance (WHO Classification of
Tumours).
In practice, particularly in the context of
broad generalizations about cancer, the
complexity implicit in comprehensive
tumour nomenclature is greatly reduced by
the practical consideration that over 90% of
the tumours afflicting humans are carcinomas.
As a result, for many purposes (and
often in common practice) “lung cancer”
may be equated with “carcinoma of the
lung”.
13. Bishop DT (1999) BRCA1 and BRCA2 and breast cancer
incidence: a review. Ann Oncol, 10 Suppl 6: 113-119.
14. Tavassoli FA, Stratton MR, eds (2003) World Health
Organization Classification of Tumours. Pathology and
Genetics of Tumours of the Breast and Female Genital
Organs, Lyon, IARC Press. In preparation.
15. Reviews (2001) Breast cancer. Curr Opin Oncol, 13:
415-449.
16. Early Breast Cancer Trialists' Collaborative Group
(2000) Favourable and unfavourable effects on long-term
survival of radiotherapy for early breast cancer: an overview
of the randomised trials. Lancet, 355: 1757-1770.
17. Mansel RE, Khonji NI, Clarke D (2000) History, present
status and future of sentinel node biopsy in breast cancer.
The Mary Beves Lecture. Acta Oncol, 39: 265-268.
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