Breast cancerBreast cancerin the menopausein the menopause

Anne Gompel, Geneviève

Plu-Bureau and Jean-Michel Foidart

*ASR = *ASR = age-standardized rate or age-adjusted

• 1,151,298 million newly diagnosed cases annually in the world– ASR* = 37.4/100,000/year

• 410,712 deaths from breast cancer– ASR* = 13.2/100,000/year

• 20–30% ofof all all cancerscancers in women in women

Breast cancer

http://www-dep.iarc.fr/

Globally, breast cancer is the most Globally, breast cancer is the most prevalent cancer in women prevalent cancer in women

ASR (incidence): 37.7

ASR (deaths): 13.2 http://www-dep.iarc.fr/ Globocan 2002, IARC

Breast

Cervix uteri

Colon and rectum

Lung

Stomach

Ovary, etc.

Corpus uteri

Liver

Esophagus

Other

1151289 (22.7%)

493243 (9.7%)

472687 (9.3%)

386891 (7.6%)

330518 (6.5%)

204499 (4.0%)

198783 (3.9%)

184043 (3.6%)

146723 (2.9%)

1491972 (29.5%)

New cancer cases (all ages), females 5,060,657

Socioeconomic status High Low

Oophorectomy < 40 years No Yes

Nulliparity Yes No

Age at first full-term pregnancy (years) ≥ 30 < 30

Age at menarche (years) ≤ 11 ≥ 15

Age at menopause (years) ≥ 55 < 45

Personal history of endometrial Yes Noor ovarian cancer

Obesity: postmenopausal breast cancer Obese Lean

Obesity: premenopausal breast cancer Lean Obese

Breast feeding (premenopausal cancer) > 12 months

Exercise > 2 hours/week

Risk factors, RR Risk factors, RR 1–21–2

High risk Low risk

Follow-up (years) 6.8 6.2 7.1

RR of BC (ITT) 1.27 1.26 0.80

95% CI 0.8–1.9 1.0–1.60.62–1.04

RR of BC (adherent) 1.49 0.67

95% CI 1.13–1.960.47–0.97

HERS II WHI

Randomized, controlled trials: Randomized, controlled trials: resultsresults

E + P E + P E

Hulley JAMA 1998; Chlebowski JAMA 2002, JAMA 2003; Stefanick, JAMA 2006

HT may promote pre-existing tumors HT may promote pre-existing tumors but does not induce new breast cancerbut does not induce new breast cancer

• In all recent studies, former HT users have no increased risk

• Breast cancer risk related to HT decreases rapidly after cessation of treatment

• HT increases the incidence of preinvasive (in situ) lesions in the Million Women Study in current users

DensityDensity

• Spontaneous increased density: RR increased 3–6 times

• Density during HT– Edema– Stroma (androgens?)– No increase in proliferation

• Breasts with increased density : RR increased by a low sensitivity – Increase the frequency of

mammograms in US