Last week the American Cancer Society released Breast Cancer Facts and Figures 2007-2008. This report provides an estimate of how many new breast cancer cases and deaths are expected to occur this year. It also includes an overview of where we stand in terms of our overall knowledge about risk factors, prevention, detection and treatment.
Hereâ€™s some of the key points the ACS and the media have focused in on and what I think about them:
–The breast cancer death rate in the US continues to fall by around 2% a year, as it has since 1990.
–The death rate appears to be falling due to both advances in early detection and treatment.
–On average, the breast cancer death rate decreased by 2.2% each year between 1990 and 2004. Younger women saw an even more significant decline during that period.
This is really great! But we shouldn’t forget what is behind those numbers. As we all know, mammography is the best tool we have to find breast cancer early. Weâ€™ve been hit over the head with it. But whatâ€™s less likely to be discussed is the fact that as more women have regular mammograms, more women are having cancers detected that probably would never have spread outside of the breast.
Since we have no way of determining which cancers would spread and which wouldnâ€™t, we treat everyone the same, with surgery, radiation, and chemotherapy (slash, burn and poison). The treatment is hard and the long-term consequences are being born by many women unnecessarily. So, we need to celebrate the reduced death rate. But we also need to acknowledge that there are women who are undergoing these intense cancer treatments who would never have died from breast cancer. And that means we need to get really good at determining who has the bad kind of cancer and needs heavy-duty treatment and who does not. This is improving. The Oncotype DX test, for example, can predict the likelihood of a breast cancer recurrence in women with newly diagnosed, early stage invasive breast cancer and can assess the benefit from certain types of chemotherapy. This is a great start. Now, we need to push harder for more tools like this.
Really though, wouldn’t it be better to just prevent breast cancer rather than investing so much in treatment? That is why the Foundation is working to find the cells that are just thinking about being cancer when they grow up and to get rid of them or rehabilitate them before they grow up! You can learn more about our research here.
–The cancer death rate for white women and Latinas fell by 2.4% between 1995 and 2004, but only by 1.6% for African-American women. Death rates stayed virtually unchanged for Asian Americans, Pacific Islanders, American Indians, and Alaska Natives.
The fact that breast cancer deaths are not going down in African American women has been written off as being about access to care. Although access to mammography screening and care are important, itâ€™s not enough. Recent data shows that breast cancer occurs at a younger age in African-American womenâ€”and in younger women mammography is not a good tool for detection. Also, the research now indicates that African-American women have a higher percentage of â€œtriple-negativeâ€ and basal-type cancers.
Triple-negative cancers (ER and PR negative and HER2-negative) donâ€™t respond to hormone therapy or Herceptin, leaving chemotherapy as the only systemic treatment tool. Basal-type cancers are more aggressive and more deadly, are often triple-negative, and are less likely to respond to chemotherapy. More research has to be done to figure out both how to identify high-risk African-American women and how to treat these types of cancers. â€¢
–An estimated 178,480 new cases of invasive breast cancer in women will be diagnosed in 2007, and approximately 40,460 deaths will be recorded.
–Among women 50 and older, breast cancer incidence rates declined by about 4.8% per year since 2001. (Among women under age 50, incidence rates have remained basically the same since 1986.)
It gives me great delight to see the drop in breast cancer incidence in women over fifty. As a number of studies have now shown this decrease is due to the fact that women stopped taking HRT! As someone who has been warning about the risks of HRT for a long time, I am gratified to see this data. It accentuates, yet again, that short-term use of hormones to get over the hump may be okay but that long-term use for prevention is not safe.