Jo Anne Zujewski, MDClinical Investigations Branch

Cancer Therapy Evaluation ProgramDivision of Cancer Diagnosis and Treatment

May 2011

The Global Burden of Breast Cancer

Breast Cancer: Most common cancer in developed and

developing world• 1.38 million cases in 2008

– Most frequent cancer in women (23% of all cancers)

• Incidence – 19.3/100,000 women in East Africa– 89.7/100,000 women in Western

Europe

GLOBOCON

Globocon Breast Cancer Incidence 2008

Breast Cancer Mortality

• 6-19 per 100,000 due to more favorable survival in (high-incidence) developed regions

• Most frequent cause of cancer death in women in both developing (269,000 deaths) and developed regions (189,000 deaths).

Globocon Breast Cancer Mortality 2008

Thun, M. J. et al. Carcinogenesis 2010 31:100-110; doi:10.1093/carcin/bgp263

Number and distribution of cancer cases by level of economic development and year (assuming no change in the annual incidence rate)

Breast Cancer Rates are Rising…

• ‘Westernization' of lifestyles• Urbanization• Dietary habits and physical inactivity• Changes in reproductive factors such as

lower rates of childbearing • Exposure to exogenous estrogen

Trends in Mortality

Berry D.A., et al. N Engl J Med. 353:1784-92, 2005

Decrease in breast cancer mortality

Cancers in Women: Uzbekistan

Uzbekistan

Incidence 19.2/100,000 (2174 cases)

Mortality 10.2/100,000 (1111 deaths)

How effective is therapy for breast cancer?

stage 5 year survival

0 93 %

I 88 %

IIA 81 %

IIB 74 %

IIIA 67 %

IIIB 41 %

IIIC 49 %

IV 15 %

years 5 year survival

1974-1976 75 %

1983-1985 78 %

1992-1997 86 %

1995-2003 89 %

National Cancer Data Basebreast cancer diagnosis 2001 and 2002.

SEER, 1973-2003, DCP, NCI, 2009

No surgery

mastectomy

chemoTx + antiER

chemoTx + antiER + targeted

Incremental Benefit

Breast cancer rates increasing- approaches

require: • Guidelines that are evidence-based,

economically feasible, and culturally appropriate

• Early detection - metastatic disease is not treated successfully in ANY country

• Improved cancer registries and data collection

• Clinical trials in developing countries

In the name of life….