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Breast Cancer Awareness Month 2014
22/10/2014

Big-Bullet-SQR.gif The Israel Cancer Association in collaboration with the Ministry of Health announced the launch of the Breast Cancer Awareness Month, to be marked in October 2014 in Israel and across the globe.

Key facts and up-to-date statistics on breast cancer in Israel:

 

Big-Bullet-SQR.gif Dr. Lital Keinan-Boker, Deputy Director of the National Disease Control Center of the Ministry of Health reports on National Cancer Registry and National Disease Control Center of the Ministry of Health statistics:

bul3 In Israel over 20,000 females who were diagnosed with breast cancer during 2007-2011 survived, or continue to cope with the disease.

bul3 Breast cancer accounted for 31% of all invasive tumors in women in Israel in 2011, and about a fifth of overall cancer-related mortality among women.

bul3 In 2011, 4,106 new female patients were diagnosed with invasive breast cancer, and 520 new female patients were diagnosed with breast cancer in situ.

bul3 About 1,000 women succumbed to the disease in 2011.

bul3 There is evidence of a downward trend and stability in breast cancer incidence rates among Jewish women since the early 2000s and among Arab women since the end of the first decade of the new millennium.

bul3 Additionally, a downward trend in breast cancer mortality rates has been seen, in Jewish women this trend began in the mid-90s and in Arab women, since the end of the first decade of the new millennium.

bul3 Morbidity and mortality rates have been observed mainly among women over age 50 (78% of female patients are over age 50, 12.5% of the deceased are under age 50).

bul3 The compliance to undergo mammography screening tests among the female population defined as eligible for the National Mammography Screening Program (ages 50-74), according to Prof. Gad Rennert, who supervised the National Breast Cancer Early Detection Program: Jewish and Arab females, approximately 70%, ultra-Orthodox females, about 63%.

bul3 According to the program statistics, of all the women diagnosed as a result of a screening test (who responded to an invitation to a periodic screening, and not due to symptoms) 78% were diagnosed at the initial stage (Stage 1 invasive stage + DCIS).

During the month of October, the Israel Cancer Association will mark Breast Cancer Awareness Month by launching numerous additional activities:

Big-Bullet-SQR.gif The events are presented according to dates in October:      

bul3 The Israel Cancer Association launched a new program called 'Prevention GENEration', aimed at heightening awareness of the importance of genetic counseling for women who have breast or ovarian cancer. A hereditary factor is indeed a risk factor, however its discovery increases the chances of preventing additional cancers in the woman undergoing the screening as well as in members of her family. This program is supervised by Prof. Ephrat Levy-Lahad - the Director of the Medical Genetics Institute at Shaare Zedek Hospital and the co-Director of the Israel Genetics Consortium, initiated by the Israel Cancer Association, and which receives financial support from The Northern Charitable Foundation, established by Mrs. Rosa Dembitzer, a breast and ovarian cancer patient.   This new program is accompanied by a brochure distributed free of charge to anyone who requests this information, and within the coming days, an online questionnaire will be uploaded to the Israel Cancer Association website which will enable the respondent to estimate his or her risk, and the need for genetic counseling.

bul3 The Estée Lauder Companies Israel, in collaboration with the Israel Cancer Association, are launching a new project - 'This Is A Pink Shirt' - as part of this initiative, a women's and men's black t-shirt was designed with the caption: 'This Is A Pink Shirt' in assorted colors: white, pink, gold and silver.  100% of the proceeds from t-shirt sales will be dedicated to ICA activity.

bul3 The launch event of this initiative was held on 29 September, at The Peres Center for Peace, which was lit up in pink by the former President of Israel, Mr. Shimon Peres and ICA Director General, Mrs. Miri Ziv.  Scores of opinion leaders, Knesset members, oncologists, female breast cancer patients and survivors and others took part in this event.

bul3 Throughout the month of October, the ICA will launch a unique collaborative effort with the 'On Life' Portal, a content and current events website for women, featuring professional articles, personal stories and other items.

bul3 October 11th will see the opening of a unique exhibit entitled 'the Party of Life' at the Amalia Arbel Gallery.  A portion of the proceeds of this exhibit will be dedicated to the ICA.  The exhibit was conceived by Michal Yaari, a woman who developed breast cancer, and due to her battle with the disease, began to design a collage composed of images relating to diverse everyday life topics, using buttons instead of breasts.

bul3 World Breast Reconstruction Awareness Day will be marked on the 15th of October, upon the initiative of the Israel Plastic and Reconstructive Surgery Association.  This activity will focus on a large-scale bicycle race in Israel - around Tel Aviv.

bul3 The ICA will hold a press conference on October 20th with the approach of the 'Door Knock Fundraising Campaign'.

bul3 ICA's annual 'Celebrating Life' Seminar will be held on October 28th at Kfar Hamaccabiya.   This seminar will feature leading experts who will present up-to-date information on breast cancer to hundreds of breast cancer patients, survivors and their families. This seminar will be held courtesy of Roche Pharmaceuticals, as part of the "Roche Lends a Hand to Patients" initiative.

bul3 The Israel Cancer Association is currently launching a new public service announcement entitled 'Sometimes a weight gain of just a few grams can prove to be a heavier burden than you thought'.    The ad emphasizes the ICA recommendation 'at any age and regardless of any health condition (even when you are pregnant or nursing), if you feel a lump or any kind of change in your breast, it is important to contact your doctor and ask for clarification of the nature of this lump or change'.  The ad was produced courtesy of Gitam BBDO.

ICA Breast Cancer Awareness Campaign 2014

bul3 The ICA will launch TV, radio and newspaper campaigns to enhance prevention awareness - to reduce risk and increase early detection.

bul3 Joint banners and content materials of Europa Donna - the European Breast Cancer Coalition and the ICA, Europa Donna's representative in Israel, will be posted on the ICA website and Facebook page. 

bul3 View the clip of Breast Health Day 2014 launched by Europa Donna and click here to view Europa Donna's website.

Breast Cancer Statistics in Detail:

 

Big-Bullet-SQR.gif Invasive Breast Cancer Incidence:

 

In 2011, 4,106 new patients were diagnosed with invasive breast cancer, of whom 3,574 were Jewish women (87%), 331 were Arab women (8%) and 201 were non-Arab Christian women and those who are unaffiliated with any particular religion ('other') (5%).

The incidence rates over the past five years from 2007-2011 were stable, among Jewish and Arab women alike.

The incidence rate in 2007 was 92.6 and 66.8 among Jewish and Arab women respectively, and in 2011, the rates were 90.1 and 57.1 respectively.

 

Big-Bullet-SQR.gif Breast Cancer In Situ Incidence:

 

In 2011, 520 new patients were diagnosed with breast cancer in situ, of whom 470 were Jewish women, 33 were Arab women and 17 were 'other' women.

 

The seasonal trends indicate an increase in incidence rates among Jewish and Arab women alike, which has been more significant since the outset of the 90s, upon the launch of the National Breast Cancer Early Detection Program, initiated by the ICA and the Ministry of Health.  Early detection has resulted in increased breast cancer in situ incidence rates, which attests to its potential to reduce mortality rates.

 

Big-Bullet-SQR.gif Disease Stage at Diagnosis:

 

The percentage of women diagnosed with the disease at an early stage (in situ, or with a local disease only) has increased in recent years.  In 2011, 64% of all new patients were diagnosed at this stage, as opposed to 58% of patients who were diagnosed at an early stage in 2005.    Early detection has been enabled by the National Mammography Screening Program, initiated by the ICA in collaboration with the Ministry of Health.

According to the National Early Detection Program, which has been monitored by Prof. Rennert, of all the women diagnosed as a result of a screening test (who responded to an invitation to a periodic screening, and not due to symptoms), 78% were diagnosed at an early and in situ stage, or with a local disease.

 

Big-Bullet-SQR.gif Breast Cancer Incidence Rates by Age:

 

Among Jewish women, 78% of the new patients diagnosed in 2011, were aged 50 and over, and 40% of the patients were aged 65 and over.  Among Arab women, 57% of the new patients who were diagnosed in 2011, were aged 50 and over and 22% were aged 65 and over.

It should be noted that the percentage of young women under the age of 50, was high among Arab women as opposed to Jewish women, 87% compared to 71%, therefore, respectively, there is a higher percentage of young women under the age of 50, among Arab female patients.  However, when each age group is examined separately, the percentage of Jewish female patients in each group is high compared to that of Arab female patients.

 

Big-Bullet-SQR.gif Additional statistics relating to breast cancer incidence rates by age and birthplace, may be found in the complete report attached (in Hebrew).


Big-Bullet-SQR.gif Breast Cancer Survival Rates:

 

There is a seasonal trend towards an increase in survival rates among Jewish and Arab women alike.

The survival rate is influenced by the disease stage at the time of diagnosis.

The five-year survival rate is 100% for Jewish women with carcinoma in situ, who were diagnosed with the disease during 2001-6.  Survival was 85% for women who were diagnosed with invasive carcinoma Stages II-V (invasive tumor with local spreading to nearby tissues and/or lymph nodes); the survival rate was 21% for Stage VII, (tumor with remote metastases).

 

Big-Bullet-SQR.gif Invasive Breast Cancer Mortality Rates:

 

The seasonal trends over a 22 year time period spanning from 1990-2011, demonstrate a continuous decline in the mortality rates among Jewish women in the mid-1990s.  Increased rates were observed in Arab women, up to 2011, the year that saw a marked increase in breast cancer incidence, and ever since that year, a downward trend in mortality rates (with fluctuations) has been observed.

 

The seasonal trends demonstrate a decline in mortality rates among Jewish women since the mid-90s.  Among Arab women in the 80s, the mortality rates were low, and gradually increased, corresponding with the increase in incidence, apparently due to the Western influence on Arab women's lifestyle (unhealthy food, increased body weight, lower birthrate and postponing the age of pregnancy, physical inactivity and other factors).  This trend came to a standstill concurrent to the increase in the adherence with mammography screening and the closing of the gaps in compliance rates between Jewish and Arab women.  From 2008 onward, a decline in mortality rates has been observed among Arab women as well.

 

Big-Bullet-SQR.gif Invasive Breast Cancer Mortality Rates By Age:

 

In 2011, the vast majority of deaths from breast cancer were observed at an older age (median age 69.3).  About 12% of the overall deceased patients were under the age of 50.

In 2011, the lowest breast cancer mortality rate was observed in women aged 30-34 (one woman succumbed to the disease even earlier than this age): 2.5 per 100,000 Jewish women.  The mortality rate for Jewish women aged 75 and older reached 187.2 per 100,000.

 

Big-Bullet-SQR.gif International Comparison:


New incidence rates for OECD countries have not yet been published; based on 2009 statistics, it emerges that in terms of incidence, Israel ranks above the OECD average, 4th highest, after Belgium, France and Holland.

 

However, the OECD published up-to-date statistics on breast cancer mortality rates (published in 2013).  Based on these data, it may be observed that Israel ranks above the OECD average, 7th highest, after Denmark, Belgium, Holland, Hungary, Ireland and Slovenia (who present higher rates).    In the previous publication regarding mortality statistics in 2009, Israel ranked 5th.

Annual Summary of the National Breast Cancer Early Detection Program 2013 overseen by Professor Gad Rennert:

Big-Bullet-SQR.gif Since the inception of the Program, and to date, over 6 million breast imaging exams (!) have been performed on over one million different women.

Big-Bullet-SQR.gif In total, among all the women screened in 2012, in the National Mammography Screening Program, 4,020 patients were diagnosed with cancer, 92% of whom were detected by the mammography screening.

Big-Bullet-SQR.gif The overall detection rate among ages 50-74 was 5.2 per 100,000, a statistic that exceeds our target of 4.5 per 100,000.

Big-Bullet-SQR.gif On the other hand, the rate of repeated screening was 11.3%, which should be reduced (the target is 5%).

Big-Bullet-SQR.gif Based on statistics of the National Mammography Program, it emerges that 20% of the patients who were diagnosed as part of the National Mammography Screening Program, were detected at the DCIS stage, and another 58% were detected at the early invasive stage (local disease), in other words, about 80% were detected at the very early stages of the disease.

The Israel Cancer Association Information Center Presents New Breast Cancer Research Studies:

 

Big-Bullet-SQR.gif Bra Wearing Associated with Breast Cancer Risk among Postmenopausal Women:

 

Questions have been raised in the various media, including the internet, about bra wearing and breast cancer risk.    A very small number of research studies that have been conducted in the past, which have found a relationship between aspects of bra wearing and breast cancer risk, have been investigated and were found to be significantly limited in study structure and analysis.

 

Researchers at the Fred Hutchinson Cancer Research Center in Seattle Washington have now sought to conduct an in-depth investigation of this subject.  The observed 1,044 postmenopausal women, who developed invasive breast cancer during 2000-2004: 454 women with Invasive Ductal Carcinoma and 590 women with Invasive Lobular Carcinoma.  The control group consisted of 469 women ages 55-74 who did not develop breast cancer and who shared similar characteristics to the two groups of breast cancer patients.

The patients were asked, through personal questionnaires, about various breast cancer risk factors in order to take them into account in the research results analysis.  These included, inter alia, age, origin, body mass index, alternative hormonal treatment for menopause symptoms and family history of breast cancer.  In addition, all patterns of bra wearing were assessed, including bra cup size, bra wearing frequency, number of hours per day they wore a bra, whether they wore a bra with an underwire, and at which age they started regularly wearing a bra.  

Following the quantification of all these factors, the investigators reached the conclusion that bra wearing did not emerge as a risk for breast cancer, and hope that this in-depth and comprehensive study will help diffuse the myth that associates bra wearing with increased breast cancer risk.

This study was published in the September 2014 issue of the Cancer Epidemiology Biomarkers Prevention Journal  

Big-Bullet-SQR.gif Breast Cancer in Men:

The U.S. Food and Drug Administration (FDA), wishes to draw public attention to the fact that breast cancer, which is normally associated with women, as reflected by pink ribbons and accessories, can also emerge in men, albeit rarely.

1% of patients diagnosed with breast cancer are men; in the United States about 2,000 men each year.  Despite the fact that the disease may appear at any age, it is usually diagnosed in men between the ages of 60 and 70.  One of the reasons behind the late-age and later-stage diagnosis is that men don't think of themselves as being at risk of breast cancer, and so even if they feel a lump they don't assume that it is breast cancer.    It should be noted that most men who are diagnosed are identified due to a lump being detected right in the center of the breast, underneath the nipple.

Men and women share similar risk factors for breast cancer: high levels of estrogen exposure, a family history of the disease, and a history of radiation to the chest.

Men who have a male or female first-degree relative who had breast cancer: their mother, father, brother, sister, are at slightly higher risk to develop the disease.  Men who are BRCA mutation carriers, a mutation in a gene that predisposes them to cancer, are at a great risk of developing the disease (5%-6% higher); however men who are BRCA2 mutation carriers have a 100-fold (!) greater risk of developing breast cancer than men in the general population.

Treatment options for breast cancer in men are similar to women's, including surgery to remove the breast (mastectomy) and sometimes partial removal (lumpectomy); additional treatments include radiation therapy, chemotherapy, biological and hormone therapy.

Treatments for men are based from trials that were conducted in women, due to the lack of trials for treatment of breast cancer in men, due to the rarity of their disease, and therefore the FDA encourages investigators to incorporate men who developed breast cancer in clinical trials that are conducted, in order to investigate treatment options for breast cancer in men.

The FDA recommends a genetic test for every man who has developed breast cancer, and suggests that family members inform the family physician of this, as breast cancer in men is often associated with hereditary breast cancer.

In Israel, in 2011, 49 men, 45 of whom were Jewish, and 4 of whom were Arab, were diagnosed with breast cancer; 87% of them were over the age of 60.

This document was published in the June 2014 issue of the FDA Consumer Health Information Journal.

Big-Bullet-SQR.gif Surprising findings regarding the relationship between cigarette smoking and postmenopausal breast cancer risk:

Researchers from several U.S. universities investigated in a prospective study (a study that investigates subjects along a timeline and documents the compiled data, as opposed to a study based on questionnaires that the subjects complete based on their memory), 186,159 women between the ages of 50 - 71 years who joined the study during 1995-1996 and filled out questionnaires. 

The subjects were asked whether they smoked more than 100 cigarettes during their lifetime, whether they currently smoke, and if they smoked in the past - when they quit and how many cigarettes they smoked per day.  They were asked about age at first menstrual period, and age at last menstrual period (menopause), about the use of hormone replacement therapy for menopause symptoms, and body mass index.  Their alcohol consumption was observed, as well as their physical activity, and family history of first-degree relatives who developed breast cancer.  Additional factors known as risk factors, such as age at first birth, previous breast biopsies, educational level and ethnicity, were also documented in the questionnaire.

The follow up of the subjects lasted 9.6 years and it emerged that 17% of them were regular smokers, 38% were former smokers and 45% were never smokers.  

In 2006, 7,481 women among the subjects were diagnosed with breast cancer, and it emerged that female smokers were at a 19% higher risk of developing breast cancer than never smokers, and those who were former smokers were at a 7% higher risk than never smokers.

When the investigators examined the family history of breast cancer of current smokers, it emerged that the risk for breast cancer among smokers without a family history was 24% higher than those with a family history of breast cancer.  Contrary to the fact that family history in and of itself, constitutes a significant risk factor.

The investigators discovered an additional surprising finding:  the women who were current smokers, who received their first period at a late age (15 and above), were at a 52% higher risk of developing the disease than those who were never smokers, while women who received their first period at an earlier age were at lower risk: those who received their period under the age of 12 - were at a 14% risk of developing the disease, whereas those who received their period between the ages of 13 and 14, were at an 18% risk.  These findings are inconsistent with what is known about early age at first period, as a factor which increases breast cancer risk.   The investigators attribute smoking to this contradiction and seek to continue to examine the effect of smoking on these hormonal factors.  

No direct association has been found between the risk of breast cancer and the amount of cigarettes that the subjects smoked, or the time that has elapsed since the women who were classified as former smokers quit the habit.

The investigators recommend continuing additional studies in order to understand the effect of smoking on DNA and breast tissue, so that we can better comprehend the associations that emerged in this study.

This study was published in the April 2014 issue of the British Journal of Cancer.

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