(updated June 2014)
Almost everyone knows someone or knows of someone who has been affected by breast cancer: a mother, sister, daughter, grandmother, aunt, colleague, friend, neighbour or more rarely, a father or brother.
The International Agency for Research on Cancer (IARC) in 2013 released the 2012 Globocan report. The global cancer burden rose to 14.1million new cases with 8.2million cancer-related deaths in 2012 and a marked increase in breast cancers (Globocan 2012). In 2008, the new cancers were 12.7million with 7.6million cancer related deaths. http://globocan.iarc.fr/
In 2012, worldwide, there were 1.7million women diagnosed with breast cancer. Breast cancer is also the most common cancer related death in women (522 000 deaths in 2012). It is also the most frequently diagnosed cancer in women in 140 out of 184 countries. It now represents 1 in 4 of all cancers in women. Deaths from breast cancer is higher in less developed countries compared to developed countries mainly because clinical advances may not be widely available in the developing/less developed regions of the world. The need now in cancer control is to develop effective and affordable approaches to the early detection, diagnosis and treatment of breast cancer in less developed countries.
There is a marked geographical variation in incidence rate. The incidence is highest in North Europe and North America, intermediate in the Mediterranean countries and South America and lowest in Asia and Africa. The mean age at diagnosis reported in most developing countries is around 50 years compared to 60 years in Western countries.
These variations have been attributed to variations in body size, diet, reproductive characteristics such as age of menarche (first period in females), parity (number of children), age at first childbirth, and age at menopause.
The incidence rates also vary with race, being higher in white women compared to black, Hispanic or Asian-American in the United States of America (USA). The incidence (number of new cancers) is steadily increasing. The statistics are more frightening in countries like the USA where about 232, 670 (female) and 2,360 (male) new cases of breast cancer are estimated to be diagnosed in 2014 (National Cancer Institute, NIH, USA).
The National Cancer Institute estimates that by age 50, one out of every 42 women will develop breast cancer. By age 70, it will rise to one in 26. If this risk is calculated over their lifetime, one in 8 women will develop invasive breast cancer. One in 3000 women develop breast cancer during pregnancy and pregnant women tend to develop them usually in their 30s. (Only 2% of breast cancers are diagnosed in pregnant women.)
Presented in another way:
- Every 3 minutes, one woman is diagnosed with breast cancer (USA)
- Every 11 minutes, one woman dies from breast cancer (USA)
- In 2011, more than 130 women every day was diagnosed with breast cancer
- whilst 32 died from breast cancer (UK)
- 350 men were diagnosed with breast cancer and 80 died from it in 2011 (UK)
More women are surviving breast cancer these days. In the UK, 8 out of 10 women live more than 5 years after diagnosis compared to in the 1970s where only 5 out of 10 women survived beyond 5 years. (Cancer Research, UK)
In countries where rates have been low, especially in Asia, the rate of increase has been the greatest with steep increases in the incidence as well as death rate (mortality).
Breast Cancer in Malaysia – the stark facts
- Breast cancer was the commonest overall cancer as well as the commonest cancer in women amongst all races from the age of 20 years in Malaysia for 2003 to 2007.
- Breast cancer is most common in the Chinese, followed by the Indians and then, Malays.
- Breast cancer formed 32.1% of newly diagnosed cancer cases in women in 2007
- The Age Standardised Rate (ASR) of female breast cancer is 47.4 per 100,000 population (National Cancer Registry Report 2003-2005). Amongst the Chinese, it is higher at 59.9 per 100,000 population, for the Indians, the ASR is 54.2 per 100,000 and it is lowest in the Malays at 34.9 per 100,000 population.
- In the 2007 National Cancer Registry Report, the ASR appeared lower at only 29.1 per 100,000 population. Chinese was still the highest at 38.1, whilst Indians and Malays had an ASR of 33.7 and 25.4 per 100,000 population respectively.
- The percentage of cancers detected at Stage 1 and 2 was 58%
- A woman in Malaysia has a 1 in 20 chance of getting breast cancer in her lifetime
- The cumulative life time risk of developing breast cancer for Chinese women, Indian women and Malay women were 1 in 16, 1 in 17 and 1 in 28 respectively.
- The peak incidence appeared to be 50-59 years old.
In comparison, the next (2nd) commonest cancer in Malaysian women in 2002 & 2003
was cancer of the cervix, which only formed 12% and 12.9% respectively of total female cancers. In 2007, the next commonest cancer in Malaysian women was colorectal cancer (10%) whilst cancer of the cervix was 3rd commonest at only 8.4% (equivalent ASR of 7.8 per 100,000 population).
The statistics for Malaysia was sourced from the National Cancer Registry Reports 2002 and 2003 and 2007. Over time, the pattern of cancers, including breast cancer will be better established. It is only with continued reliable data that important decisions on planning and policy management can be made for Malaysia.
Estimates by the International Agency for Research in Cancers (Globocan 2012) reported that in 2012, there were 5410 cases reported and 2572 deaths from breast cancer in Malaysia. This is a very significant rise in cases compared to the Globocan 2000 report where there were 3825 new cases and 1707 deaths from breast cancer in Malaysia. The ASR per 100,000 population of breast cancer was 38.7 in the Globocan 2012 report.
In 2008, breast cancer was listed 5th in the 5 principal causes of death (medically certified) amongst women in Malaysia (Dept of Statistics Malaysia). The percentage of deaths in Malaysia which are medically certified has now increased to 61%.
Breast Cancer in Singapore
The Singapore Cancer Registry 2008-2012 report has breast cancer listed as the top cancer in Singapore females (29.4%). Colorectal (13.6%) and lung (7.7%) are the next commonest cancers whilst cancer of the cervix ranks 10th commonest at 3.2%.
Over the years, the Age-standardised Incidence Rate has increased threefold from 22.0 per 100,000 in 1973-1977 to 62.4 per 100,000 in 2008-2012. For Chinese, Malays and Indians, the ASR is 63.7, 57.4 and 57.2 per 100,000 population respectively. Breast cancer was also the most common cause of death in females with an ASR of 14.2 per 100,000 population. However, the ASR death rates have remained relatively stable since 1988-1992.
The age-specific incidence increased sharply from age 30 upwards and peaked in the 60-69 year age group. There is then a gradual decline to 70 and above age group. The percentage of breast cancer patients diagnosed in Stage 1 and 2 of the disease remained similar, at 66.8% (2008-2012) and 64.7% (2003-2007). 80.7% of the patients diagnosed with breast cancer were Chinese, 10.6% Malays and 6.2% Indians in the 2008-2012 Registry. The peak age group at discovery was 45-54 years (31.9%).
The good news is a significant increase in survival of all breast cancer patients and among all ethnic groups. The 5-year age-standardised observed survival of breast cancer for all ethnicities was 70.27 per 100,000 population in the 2008-2012 compared to 66.22 in 2003-2007.