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 “Cancer is an insignificant health care issue in low and middle income countries (LMCs).” FACT: Cancer is the second most common cause of death in LMCs, more than respiratory infections and diseases, HIV/AIDS, diarrheal diseases and tuberculosis

NEJM 356:3, 2007 (from WHO 2005) CAUSES OF DEATH: Low-Income and Lower-Middle Income Countries  Cancer4.4 million  Respiratory infections 3.5 million  Respiratory diseases 3.0 million  HIV/AIDS 2.7 million  Diarrheal diseases 1.8 million  Tuberculosis 1.5 million

MYTH #2 “Breast cancer REALLY only affects countries of wealth.” FACT: Breast cancer is the most common cancer among women around the globe, and the most likely reason that a woman will die of cancer.

BREAST CANCER EPIDEMIOLOGY: 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, 2002

CANCER INCIDENCE RATES FOR U.S. WOMEN, Age-adjusted Incidence Rate per 100,000 Females

CANCER DEATH RATES FOR U.S. WOMEN, Age-adjusted Death Rate per 100,000 Females

BREAST CANCER: Incidence 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, 1999 Globocan 2002 (IARC)

WORLD BREAST CANCER STATISTICS: Incidence and 5-Year Survival CA Cancer J Clin: 50:37, 2000

GHANAIAN CANCER EPIDEMIOLOGY: Age Standardized Rates (ASR) / 100,000 Females Globocan 2002

BREAST CANCER EPIDEMIOLOGY: Stage at diagnosis: United States vs. India Sources: SEER Survival Monograph (NCI), 2007; Chopra, Cancer Institute Chennai, India, 2001 STAGE EXTENT 5 year SURVIVAL DISTRIBUTION USAINDIA 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: In Utero Mammary Development

THE HEALTHY BREAST: Breast Maturation during Pregnancy

PROGRESSION OF DISEASE METASTASIS

UNIVERSITY OF WASHINGTON FRED HUTCHINSON CANCER CENTER CHILDREN’S HOSPITAL SEATTLE CANCER CARE ALLIANCE UNIVERSITY OF WASHINGTON FRED HUTCHINSON CANCER CENTER