1. 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

2. 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

3. 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

4. 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.

5. 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

6. CANCER INCIDENCE RATES FOR U.S. WOMEN, 1973-2005 Age-adjusted Incidence Rate per 100,000 Females

7. CANCER DEATH RATES FOR U.S. WOMEN, 1930-2005 Age-adjusted Death Rate per 100,000 Females

8. 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)

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

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

11. 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

12. THE HEALTHY BREAST: In Utero Mammary Development

17. THE HEALTHY BREAST: Breast Maturation during Pregnancy

20. PROGRESSION OF DISEASE METASTASIS

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