Behind the Breast Cancer Statistics
In their combined annual report to the nation on cancer incidence rates and mortality, the National Cancer Institute, the Centers for Disease Control and Prevention, and the American Cancer Society touted that overall cancer death rates continue to decline. However, a disturbing increase in breast cancer incidence continues-possibly due to dramatic increases in mammography screening.
According to the report, which was published in the Journal of the National Cancer Institute, the incidence of all cancers combined for both men and women declined an average of 1.1 percent per year between 1992 and 1998, reversing a trend of increasing rates that had started in 1973.
However, the number of new breast cancer cases increased at a rate of 1.2 percent per year from 1992 to 1998. In fact, the overall breast cancer incidence rate has jumped 40 percent since 1973. Most of this increase has been among women age 50 to 74, the group considered at highest risk.
According to the team of researchers, led by Dr. Holly Howe of the North American Association of Central Cancer Registries in Springfield, Illinois, this increased incidence is due largely to a significant increase in mammography screening rates. When you have more screening, you pick up more tumors.
This also explains why breast cancer death rates declined by 2.4 percent per year from 1992 to 1998 even though incidence rates increased during the same period. Although more breast cancers are being diagnosed, they are being detected at much earlier-and thus more treatable-stages, especially among older women.
As the above numbers indicate, many more women are not only surviving breast cancer, but living healthy disease-free lives long after their treatment ends. As a result, a recent article in the New England Journal of Medicine focused on the special needs of a growing population of breast cancer survivors-those who have survived the disease for up to five years after initial diagnosis, and longer.
Dr. Harold Burstein of the Dana-Farber Cancer Institute in Boston addressed many questions that primary care physicians and gynecologists are now encountering because of this growing population of long-term cancer survivors. These include concerns about fertility, managing menopause, and nutrition and lifestyle factors to minimize recurrence.
Many women diagnosed with breast cancer are still in their childbearing years, Burstein noted. Questions arise concerning their ability to get pregnant, the effects of chemotherapy on future fertility, and even what effect breast-conserving surgery may have on the ability to produce milk. Burstein called on the medical community to give more emphasis to long-term survivorship issues rather than focusing solely on immediate treatment planning.
SOURCES:
Journal of the National Cancer Institute, June 6, 2001; 93:824-842
National Cancer Institute (http://www.nci.nih.gov)
Cancer Statistics (http://www.seer.cancer.gov)
American Cancer Society (http://www.cancer.org)
New England Journal of Medicine, December 12, 2000; 343:15:1086-1094
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