Overview of Breast Cancer Control : Importance of Early Detection

1
Overview of Breast Cancer Control Importance of
Early Detection Treatment
Professor Robert Burton MD PhD, Monash
University School of Public Health Preventive
Medicine, Australia
2
Breast Cancer Overview

• World and Regional Cancer and Breast Cancer
  Burdens
• Breast Cancer Survival developed and developing
  countries

3
Female Breast Cancer Incidence ASR/100,000 -
1990 (CI5)
36.0
86.3
62.5
21.5
35.1
20.6
71.7
67.2
4
All Cancers Mortality/Incidence ratios 2002 for
selected countries
J. Ferlay, F. Bray, P. Pisani and D.M. Parkin.
GLOBOCAN 2002. Cancer Incidence, Mortality and
Prevalence Worldwide. IARC CancerBase No. 5,
version 2.0. IARCPress, Lyon, 2004.
5
Mortality Incidence Ratios for Breast Cancer in
EMRO and Developed Countries

• Region Mortality Incidence Ratio
• North Africa 13.2
  18.6 71
• West Asia 11.2
  26.1 43
• Egypt 14.2
  20.1 71
• Developed Countries 30.9
  103.7 30
• Australia 27.2
  114.1 24
• Crude Rates per 100,000
• GLOBOCAN 2002. IARC. Lyon, 2004

6
FIVE YEAR RELATIVE SURVIVAL FROM BREAST CANCER
Period 198289 198892 198385 198693 198084 198
892 198795 198693
5YS 51 57 64 70 74 78 82 86
Place IndiaMadras Lithuania England USABlack Can
ada Norway AustraliaNSW USAWhite
AD139
7
USA Five-year Relative Survival () During Three
Time Periods by Cancer Site
Site
1975-1977
1984-1986
1996-2002
     

• All sites 50 53 66
• Breast (female) 75 79 89

Source Surveillance, Epidemiology, and End
Results SEER Program, 1975-2003, Division of
Cancer Control and Population Sciences, National
Cancer Institute, 2006.
8
BREAST CANCER SURVIVAL NSW 1980-1996Pre-Menopausa
l vs Screening Age vs Elderly

• National Mammographic Screening Program

9
Breast Cancer Overview

• Breast Cancer Survival by Stage

10
CANCER OF THE BREAST FIVE YEAR SURVIVAL NSW
19731995
Age-standardised mortality per 100,000
100
80
60
Relative survival ()
40
LOCALISED
20
REGIONAL
DISTANT
0
0
3
4
1
2
5
Years after diagnosis
AD102
11

• Breast Cancer Survival by Stage in the UK 1980s

12
Survival by Stage in UMMC 1993-1997 (n423)
Stage 2
Stage 3
Stage 4
p lt 0.05
Mohd Taib NA, Yip CH, Mohamed I. Survival
analysis of Malaysian women with breast cancer
results from the University Malaya Medical
Centre. Asian Pac J Cancer Prev 2008
Apr-Jun9(2)197-202    
13
Breast Cancer Overview

• Breast Cancer Stage at Diagnosis developed vs
  developing countries
• Tumour Size at Diagnosis

14
BREAST CANCER STAGE AT DIAGNOSIS ASIAN POPULATION
DATA
Stages () Registry Years I II
III IV Australia 1995
59 33 6 1 Vietnam Can
Tho 1997 3 37 60 Hanoi 2003
20 70 10
15
Manila Cancer Registry - 1995 Distribution of
stage at diagnosis (N 769)
In situ 1
Stage I 4
Stage gt II 94
Unknown 13
IV 8
Stage II 50
Stage III 23
16
Penang Malaysia Cancer Registry 1994-1998

• Stage 1 15.4
• Stage 2 46.9
• Stage 3 22.2
• Stage 4 15.5

17
Incident cases- year and size (cm)

• AUSTRALIA Versus PHILIPPINES INCIDENT BREAST
  CANCER by TUMOUR SIZE
• Population Data Registry and Population
  Treatment surveys

lt2 2.0 - 4.9 5 Victoria-
Pre-mammography Clinical 1986 38
52 10
635 Australia-Mammography 1995 48
40 12 4217 Manila
Registry 1996-97 1.3 54.3
44.2 669
18
Breast Cancer Overview

• Impact of Treatment on Mortality
• Impact of Evidence Based Clinical Practice
  Guidelines

19
Breast Cancer Treatment

• Surgery
• Endocrine Therapy Tamoxifen, Aromatase
  inhibitorsOvariectomy premenopausal agelt50
• Chemotherapy
• Radiotherapy
• Biological Therapy ??cost effectiveness
• Herceptin for pre-menopausal erb2/neu
• Stage at diagnosis is a key parameter
• Treatment must be the optimal possible for
  Stage and ER/PR EGF Receptor Expression

20
Breast cancer mortality England Wales ASR by
year
44
1985-1997 - 22
42
40
38
36
34
32
30
1970
1975
1980
1985
1990
1995
2000
1st round screening
21
THE 22 REDUCTION in UK BREAST CANCER MORTALITY
1987-1997 is 22 for Ages 20-49 22 for Ages
50-69 12 for Ages 70-79 It has been
ALL attributed to treatmentLancet 2000
355-1822 versus about ¼ screening and ¾
treatment for the ages 55-69 years Screening
ProgramBMJ 2000 321665
22
AS TREATMENT IMPROVES The IMPACT of SCREENING on
SURVIVAL may DIMINISH or DISAPPEARassuming
clinical presentation is Stage IFor example
mammographic screening and survival from breast
cancer in some developed countries
23
The Mammographic Breast Screening Program in
Australia 1991-2005

• Percent Decrease in Breast Cancer Mortality
• Ages Rates 91/92 to 04/05 Decrease
• 40-49 29.7 to 21.0
  29.3
• 50-69 55.0 to 42.3 23.1
• 70-79 108.1 to 84.8
  21.6
• World ASR per 100,000, Mammographic screening
  program

24
Breast Cancer Treatment impact of National
Clinical Practice Guidelines

• Treatment 1995
  1999 p
• National Guidelines were distributed in October
  1995
• Conservative Surgery 54
  69 lt0.01
• Adjuvant Radiotherapy 59
  80 lt0.01
• Endocrine Treatment ER 69
  90 lt0.01
• Endocrine Treatment ER- 39
  17 lt0.01
• Chemotherapy lt50 years 57
  72 lt0.01
• Chemotherapy gt50 years 17
  29 lt0.01
• Treatment surveys for April-September Victoria,
  Australia, for Early
• Stage I and Stage II Breast Cancer

25
Breast Cancer Overview Conclusion

• STAGE at DIAGNOSIS is a KEY SURVIVAL
• DETERMINANT Treatment must be the
• OPTIMAL EFFECTIVE POSSIBLE
• for STAGE