Breast Cancer Global Figures and Cancer Prevention
Early October 2007, Time published an extensive article about global breast cancer figures and the consequences for women’s health. The economic differences between countries clearly relate to the risk and outcome of patients. Breast cancer is the most lethal form of cancer for women in the world. An estimated 1 million cancers will be identified this year, and about 500 000 new and existing patients will die from the disease.
In the US and Western Europe, breast cancer will be diagnosed in 1 out of 8 women. But in China, as in most other emerging economies, breast cancer is a relatively new concern, something that both women and doctors are only learning how to treat and to prevent. Previously a illness that mostly afflicted white, affluent women in the industrial areas of North America and Western Europe, breast cancer is everywhere. Asia, Africa, Eastern Europe and Latin America have all seen their cases go up. By 2020, 70 % of all breast cancer cases worldwide will be in developing countries.
Worse, as the burden of the disease is expanding, the reach of diction and treatment isn’t. For a woman battling breast cancer in the industrialized West, new diagnosis and treatment options come along all the time. Not so elsewhere. The differences among 30 countries were stark. In the US, an estimated 68,1 billion is spent to diagnose and treat breast cancer each year, and the ubiquity of mammography machines, clinics and specialists shows what that money can buy. In Pune, India, by contrast, home to 3,5 million women, there is just one facility that provides comprehensive breast cancer services. Half of all Indian women with the disease go entirely without treatment. In South Africa, only 5 % of cancers are caught in the earliest phase of the disease. In the US, that figure is 50%. In Ukraine, where mammography machines are available, if not plentiful, a shortage of film requires that doctors choose between taking the recommended two-view image of a patient’s breasts and taking a one-view image of twice as many women. As for a desperately poor land like Kenya? If you can’t travel overseas for treatments, says a patient, ‘you just sit and wait for your death”. Says Mancy Brinker, founder of the Komen group: “Poverty is a known carcinogen”.
A cancer detected when 5 cm in diameter has a cure rate of 50 per cent, while a 1 cm cancer over 80 per cent. There is no treatment available that can offer more chances for cure than early detection. The global differences in survival from breast cancer reflect closely the diagnostic opportunities of the local health care systems. In countries where the access to diagnosis are to the state of the art, survival from breast cancer is beyond 80 and close to 90 per cent. If breast cancer services are not available the number of patients detected with curable cancers is inferior to 50 %.
Early detection of breast cancer includes adequate imaging, image reproducibility (breast compression) and a quality biopsy. Even some European countries struggle with the availability of adequate technological instruments to detect breast cancer. Sibiu, the second town in Roumania, does not provide enough radiological devices for the early detection of breast cancer. Most screening is done with less expensive ultrasound equipment. Screening with ultrasound is inferior to mammography. It is expected that the availability of adequate screening tools will be possible only in about 10 years from now and that breast cancer might increase a further 30 per cent in this time.
Clearly, Sibiu is not the only place on earth with insufficient tools. In fact, there are more areas with deficient health care than otherwise. And the first factor that is related to satisfactory technological competence is money. Mammographic devices are expensive, more costly than ultrasound machines. The same is true for the accessories to these devices and in particular for single use instruments. Even when a mammography can be acquired that does not mean that early detection is solved because the next issue is digitalization or the costs of films. And even when imaging can be realized, then comes the issue of biopsy.
In Venezuela some hospitals came to the level of purchasing a Mammotome for large biopsies. All but one hospital can not use the Mammotome because the disposables per procedures are impossible to pay. As Dr. Enrice said: “one procedure on the Mammotome costs 1000 USD. The device is in the hospital but isn’t used the last 3 years.”
With regard to tissue acquisition there are 2 traditional options: The tru-cut microbiopsy systems that are all single use instruments with a cost of about 20 USD per biopsy and the vacuum-assisted biopsies are in the order of 600 to 1000 USD with costs on disposables between 200 and 400 USD. Obviously, the macrobiopsy is out of the question in most centers on the globe. Even in industrialized area’s in Europe and the US, the macrobiopsy is unreachable. Many parts in the world can not afford even a microbiopsy for routine use.
Last and not in the least, breast cancer threat is related with socioeconomic status of the area and country. Individual hazard is determined how children eat, drink and behave. The cultural, social, even religion background of populations play important parts in the risk to cancer.
Clearly, the global trend of increasing breast cancer risk is not matched with adequate coverage on cancer prevention, either primary or secondary. The European Journal of Cancer Prevention (EJCP) has provided scientific literature in the last years that draws attention and gives answers to inequalities in health care facilities. It is time now to structure these issues on a more international level. The EJCP will offer sound data to rely on in the months to come and will continue to focus on global breast cancer risk issues.
Dr. Jaak Ph Janssens
Limburg University Centre, Belgium
References:
Marie Norredam et al. Differences in stage of disease between migrant women and native Danish women with cancer - results from a population based cohort study
Stefan Paepke et al. Attitudes towards breast cancer prevention amongst office-based gynaecologists in Germany: results of a survey
Nikolaus Becker et al. Retrospective quantification of background incidence of breast cancer for the mammography screening pilot project in Wiesbaden, Germany
ALVARO LUIS RONCO et al. BODY COMPOSITION, SOMATOTYPE AND BREAST CANCER: INITIAL RESULTS OF AN ON-GOING PILOT STUDY
Elena Cabeza et al. SOCIAL DISPARITIES IN BREAST AND CERVICAL CANCER PREVENTIVE PRACTICES
Anke Thomas et al. Attitudes towards breast cancer prevention amongst office-based gynaecologists in Germany: results of a survey
Magda Johanna Vandeloo et al. Effects of lifestyle on the onset of puberty as determinant for breast cancer
María Daniela Defagó et al. ALIMENTARY HABITS IN YOUNG CHILDREN: THEIR RELATIONSHIP TO FUTURE CANCER PREVENTION
Theodoros Agorastos et al. Molecular Basis of Pregnancy Induced Breast Cancer Protection.