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 in Israel and other countries across the globe.
Dr. Lital Keinan-Boker, Deputy Director of the National Disease Control Center of the Ministry of Health, reports on National Cancer Registry of the Ministry of Health up-to-date statistics:
In 2012, 4,396 new female patients were diagnosed with invasive breast cancer, and 571 new female patients were diagnosed with breast cancer in situ.
In Israel 21,155 females who were diagnosed with breast cancer during 2008-2012 survived, or continue to cope with the disease.
Morbidity rates for invasive breast cancer have been observed mainly among women over age 50, 79% of new patients diagnosed in 2012 were over age 50.
The relative 5-year survival rates are on a seasonal upward trend both among Jewish females and Arab females alike (87.2%, 78.4% respectively).
In 2012, 994 women in Israel succumbed to invasive breast cancer.
Mortality rates increase with age and are higher among Jewish women as compared to Arab women.
The lowest mortality rate for breast cancer was observed among women between the ages of 30 and 34.
Trends in morbidity rates: over the past five years, 2008-2012, incidence rates (morbidity) were on a downward trend and have become stabilized.
Trends in mortality rates: there is evidence of a downward trend in mortality rates among Jewish women since the mid-90s and a decrease in mortality among Arab women since 2001.
During the month of October, the Israel Cancer Association will mark Breast Cancer Awareness Month by launching numerous activities:
With the approach of Breast Cancer Awareness Month, The Estée Lauder Companies Israel, has partnered with the Cofix coffee chain, to launch a new initiative. As part of this collaboration, Cofix coffee will be sold in pink paper cups featuring the slogan: "Good coffee saves you in the morning-a simple test can save your life!"
In addition - packages containing two granola cookies will be sold at the franchise outlets for the price of 5 ILS and proceeds from sales will be dedicated to ICA activity.
This collaborative effort will begin on October 13, and will run until the end of October at all Cofix outlets across Israel.
On October 14 the ICA will hold a press conference as the 'Door Knock' fundraising campaign approaches.
On October 26, in keeping with tradition, the ICA's Annual 'Celebrating Life' Seminar will be held at Kfar Hamaccabiya. This event will feature leading experts who will present up-to-date information about 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.
With the approach of Breast Cancer Awareness Month, the ICA is launching new public information booklets:
'Breast cancer' - a comprehensive and up-to-date information booklet, covering all aspects related to the disease. This booklet was produced courtesy of Pfizer.
'A how-to manual for women diagnosed with a pathologic finding in their breast' - a new and unique booklet containing milestones/stages in coping with a pathologic finding in one's breast, accompanied by explanations and questions and answers provided by various healthcare professionals along the disease trajectory. The booklet was produced courtesy of Roche Pharmaceuticals.
'To partners of women coping with breast cancer' - an information and support booklet for partners accompanying breast cancer patients.
These booklets are available free of charge through the Telemeida teleinformation hotline at: 1-800-599-995, or by clicking on the following links:
Click here to view the booklets (PDF file, in Hebrew):
How-to manual for women diagnosed with a pathologic finding in their breast
To partners of women coping with breast cancer
The ICA has produced new public service announcements to convey important messages:
A new public service announcement entitled 'Sometimes the slightest feeling or change means something. Go get yourself checked'. The important message behind this PSA is that at any age, or in any condition, if you feel a lump or change in your breast, it is imperative that you contact your doctor and request to clarify the nature of this lump/change. This PSA was produced pro bono by Gitam BBDO. Click here to view the PSA.
Click here to view the PSA "Sometimes the slightest feeling or change means something. Go get yourself checked".
A new PSA for the 'Prevention GENEration' program entitled 'You never know what genes may be passed down, don't ignore the chances of preventing additional cancers - get hereditary risk factors detected'. The message behind this PSA is that if a woman has a family history of breast or ovarian cancer among first-degree relatives, she should seek genetic counseling. The PSA refers individuals to an interactive online questionnaire on the ICA website, which can help determine if a woman's genetic makeup puts her at risk.
Click here to view the "Prevention GENEration" PSA.
During the course of Breast Cancer Awareness Month, the ICA will launch public information campaigns through the various media channels - TV, radio, websites, and newspapers.
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.
Click here to view one of the content materials, a video "For the sake of keeping your breasts healthy", featuring health recommendations.
Click here to get information about Breast Health Day, available on the Europa Donna website.
2015 Breast Cancer Statistics in Detail:
Invasive Breast Cancer Incidence Rates and Trends
In 2012, 4,396 new patients were diagnosed with invasive breast cancer, of whom 3,800 (86%) were Jewish women, 367 were Arab women (8%) and 229 were other patients (Christian women and those unaffiliated with any particular religion).
Breast cancer accounts for a third of all invasive tumors among women in Israel.
Trends in incidence show a decrease and stabilization in invasive breast cancer morbidity among Jewish women since the early 2000s, and among Arab women since 2007.
Breast Cancer In Situ Incidence Rates and Trends
In 2012, 571 new patients were diagnosed with breast cancer in situ, of whom 523 were Jewish women (92%), 32 were Arab women (6%) and 16 were Christian women and those unaffiliated with any particular religion.
The launching of the National Breast Cancer Early Detection Program, initiated by the ICA in conjunction with the Ministry of Health in the 90s, increased awareness of the importance of early detection, and consequently, the number of women undergoing screening increased, as did breast cancer in situ rates.
Disease Stage at Diagnosis
It has been proven that early detection through the screening program decreases mortality and enables the modification of the disease trajectory.
Upon the initiative of the ICA, in partnership with the Ministry of Health, a National Mammography Screening Program was established in Israel in the 90s, and one of the parameters of the program's efficacy is the increase in the percentage of women diagnosed with the disease in its early stages.
In 2012, 65% of all new patients were diagnosed at an early stage (in situ, or with local metastasis only), as opposed to a mere 58% of patients who were diagnosed at an initial stage in 2005.
Breast Cancer Incidence Rates by Age
There is a higher percentage of breast cancer morbidity among women aged 50 and over. 79% of the newly diagnosed Jewish patients and 60% of the newly diagnosed Arab patients in 2012 were over age 50.
Breast Cancer Survival Rates
In 2012, breast cancer accounted for a fifth of overall cancer mortality among Jewish and Arab women.
The seasonal trends indicate a decrease in mortality rates among Jewish women since the mid-90s and among Arab women since 2001.
The vast majority of deaths from breast cancer were observed at an older age, about 14% of all cases of death occurred in women under age 50.
Diagram: Breast Cancer Mortality Trends in Israel: 1990-2012
Green - Arab women
Blue - Jewish women
Click here to read the full report (in Hebrew).
The Israel Cancer Association Information Center Presents New Breast Cancer Research Studies:
Does weight gain among breast cancer survivors cause an increased risk for recurrence?
Researchers of the John Hopkins Medical Center in Maryland conducted a study among women with a familial risk of developing breast cancer, which examined weight gain among women who contracted and survived breast cancer, as compared to cancer-free women.
Higher body mass index is considered to be one of the risk factors for breast cancer and has been associated with increased risk for cardiovascular disease and diabetes among the general population. Among breast cancer survivors, and particularly women at familial risk, obesity constitutes a risk factor for an additional primary cancer and recurrence.
In this study, the researchers examined the weight change rates of women who have a family history of breast cancer, during the study period: 303 women who developed breast cancer and survived, and 307 women who did not develop the disease; both groups had similar statistics in terms of their age and their level or familial risk of developing the disease. A fourth of the women, in both groups, were premenopausal.
Significant weight gain was observed in this study, among the breast cancer survivor cohort, as compared to women without cancer. A quick and significant increase (over 3 kg) was observed among survivors who developed invasive breast cancer that is insensitive to estrogen (the most prevalent among young women), during the first 5 years after their diagnosis. This significant increase was not observed among women who developed estrogen-sensitive breast cancer.
Moreover, women who underwent chemotherapy were at a 2.1-fold higher risk of gaining at least 5 kg during the monitoring period, as compared to cancer-free women, and among women who took statins (drugs to lower cholesterol), during chemotherapy, an even greater weight gain was recorded. No weight gain was observed among breast cancer survivors after having received hormone therapy alone.
To sum up, the researchers indicate that this study is the first one that demonstrates the risk of a quick weight gain among breast cancer survivors, particularly among women who took statins while undergoing chemotherapy treatment, and which may serve as a basis for the development of an intervention plan to prevent weight gain, particularly among young women, breast cancer survivors, with a family history of the disease.
This study was published in the August 2015 issue of the journal: Cancer Epidemiology, Biomarkers & Prevention
In order to increase awareness of the importance of physical activity and make it part of one's routine, the ICA runs a "Steps to a Healthy Life" Program. This program runs in 18 oncology centers across Israel. As part of the program, physiotherapists, trained by Prof. Naama Constantini, who serves as the program consultant on a volunteer basis, instruct all cancer patients, and particularly breast cancer patients, in the principles of physical activity and the importance of incorporating it into their everyday activities.
The association between scope and intensity of physical activity on the one hand and breast cancer on the other
Researchers from various medical centers in Canada examined how physical activity impacts weight loss, body measurements and fat percentages among postmenopausal women. These obesity parameters are considered to be risk factors for breast cancer, and the standard global guideline for risk reduction is moderate physical activity for 2.5 hours a week.
For the purposes of this research study, the researcher scientists sought to compare 2.5 hours of moderate physical activity a week with 5 hours of intense aerobic activity a week. 384 women without concomitant diseases aged 50-74, who do not routinely engage in physical activity, participated in this research study. Prior to the outset of this study, the women's weight was measured, as were their waist and thigh measurements, sub-cutaneous belly fat, and visceral belly fat. The women's body mass index (BMI) ranges from 22 to 40 (normal weight is measured according to a BMI of less than 25, and obesity is measured according to a BMI that exceeds 30).
The women were divided into 2 groups that worked out 5 days a week for one year: one group engaged in moderate-intensity physical activity for 2.5 hours a week, for half an hour each time, and the second group engaged in high-intensity physical activity for 5 hours a week, for one hour each time.
Each group worked out 3 days a week, under the supervision of a fitness instructor, on the elliptical bike, treadmills, steppers, and other apparatus, and on the two other days, the women chose cardio exercises such as jogging, bike riding, according to the level that was set for them, according to their cohort.
Based on the study results, it emerges that the general fat mass of the groups that worked out for 2.5 hours a week dropped by 0.4%, as compared to a 1.6% drop in the group that worked out 5 hours a week in high-intensity activity, and a significant difference was observed in the decrease in sub-cutaneous belly fat measurements, and in the waist and thigh measurements between the group that works out in moderate-intensity activity, and the group that works out in high-intensity. When the researchers examined the group of women who are obese (BMI exceeding 30), they found that they were significantly influenced by the intensity of the activity, as compared to the rest of the women.
The research scientists indicate that as a result of the reduction in BMI, the risk for breast cancer was reduced by an estimated 4.6%, among the group of women who were engaged in moderate-intensity exercise, as opposed to a 6.9% among the women who were engaged in high-intensity exercise. Regarding the women who had excess weight, the risk for breast cancer was reduced by an estimated 4.8%, among women who were engaged in moderate-intensity exercise, as opposed to a 10.3% risk reduction among these women who engaged in high-intensity exercise.
In conclusion, the researchers indicated that high-intensity exercise for 5 hours a week is of greater efficacy than activity for only 2.5 hours a week, in the reduction of fat mass and body measurements among postmenopausal women mainly among women who have excess weight. The researchers emphasize that this activity may help reduce the risk of breast cancer, due to the relationship between excess fat and breast cancer risk. The explanation for this lies in the fact that the fat tissues are the initial source of sex hormones, after menopause, which may accelerate the malignant process and they also play a role in the immune system, which copes with inflammatory processes in the body, an additional process that is linked to the development of cancer.
This research was published in the July 2015 issue of the JAMA Oncology Journal
Can yoga exercise alleviate symptoms in breast cancer survivors?
Several studies report a relationship between yoga exercise and the relief of various treatment-related symptoms among breast cancer survivors.
According to a research study that was published in the March 2015 issues of the Cancer journal, researchers from medical centers in Germany and Australia sought to estimate the effect of activity which incorporates yoga and meditation on reducing menopausal symptoms among breast cancer survivors. Women who have developed breast cancer often experience early onset menopause, due to hormonal changes resulting from the treatments they have undergone for their disease. This difficulty is compounded by the physical and emotional coping with the disease.
40 women with an average age of 49, and who suffer from moderate symptoms of menopause and those of greater severity, participated in this research study. The participants were randomly divided into a group of women who did yoga exercises and meditation for 12 weeks, and a control group that did not engage in this activity. The yoga group met once a week for 90 minutes. Each lesson included relaxation, breathing exercises, and various physical and meditation exercises, which were adapted to the needs and capacities of the participants.
The researchers examined and measured how the women felt prior to the beginning of the exercises and the changes in how they felt immediately upon the conclusion of the intervention – after 12 weeks, and 24 weeks (3 months) thereafter. In their examination, the researchers used various measurements to estimate menopausal symptoms: physical signs, such as hot flashes, dizziness, changes in pulse and blood pressure, etc., emotional distress, such as nervousness, anxiety and fatigue, and symptoms occurring in the urinary and reproductive systems, such as vaginal dryness and/or bleeding and urination disorders; similarly, the researchers used known measurements to estimate the level of fatigue and quality of life according to physical, social, and emotional functioning, and specific fears related to breast cancer.
Both during the 12th week and the 24th week of the research study, the yoga group reported a significant decrease in physical and emotional symptoms, as well as in urinary system disorders, a significant reduction in fatigue and pains resulting from emotional stress, and general improvement in quality of life. For example – 16 of the women in the yoga and meditation group reported a significant improvement in their general feeling, as opposed to 3 women in the control group. Improvement in all the aforementioned measurements was also observed among women who received supplementary hormone therapy.
To conclude, the researchers believe that yoga combined with meditation may be considered a safe and effective supplementary treatment for breast cancer survivors experiencing menopausal symptoms.
2 new studies examined the impact of yoga exercises on skeletal and muscle pains among breast cancer survivors who receive hormonal treatment.
The hormonal treatment is given for several years, as a supplementary treatment for breast cancer survivors, who have been diagnosed with a hormone-sensitive cancer, in order to reduce the risk of recurrence, and many survivors report these difficult symptoms.
A research study published in the April 2015 issue of the Breast Cancer Research & Treatment Journal, examined women who had taken Aromatase inhibitors and Tamoxifen. 167 women who took Aromatase inhibitors and Tamoxifen participated in the study, of whom 75 engaged in yoga exercises twice a week, for 4 weeks, and 92 of whom didn't participate in the yoga group and served as a control group. The investigators reported a significant improvement in the yoga group as opposed to the control group, for example: body pains were significantly reduced (88% as opposed to 56.7% in the control group), as well as improvement in specific pain measurements (57.1% as opposed to 37.1%) and improvement in physical functioning (78.9% as opposed to 60% in the control group).
In view of these findings, the researchers recommend yoga exercises as a possible way of reducing pain symptoms and musculoskeletal tightness among breast cancer survivors, which may in turn improve their quality of life and increase their perseverance in receiving hormonal therapy which is so crucial to reducing recurrence of their disease.
In the second study which was published in the January 2015 issue of the Psychooncology Journal, the researchers examined the impact of "Iyengar Yoga" (yoga based on great precision in positions, to improve body movement, strength and stability), on body pains and joint stiffness, among breast cancer survivors treated with hormonal therapy in the form of Aromatase Inhibitors, as they sometimes cause skeletal muscle pains.
The survivors with an average age of 60, participated for 12 weeks, twice a week, in Iyengar Yoga, which lasted 90 minutes a session. The participants reported significance decrease in many measurements of pain, stiffness (43% decrease), and hand pains (18% decrease), decreased knee and pelvic joint pain (38%), a decrease in joint stiffness (45%) and in stiffness and general functioning (34%), as well as a decrease in fatigue level (41%) and a decrease in hot flashes (58%).
70% of the participants rated the yoga lessons as significantly contributing to pain reduction and 100% of the participants would recommend such exercises to other women.
To conclude, the researchers recommend a combination of yoga exercises in the community, to increase accessibility of such exercises for women who have recovered from breast cancer and suffer from such symptoms which are caused by hormonal therapy in the form of Aromatase Inhibitors.
ICA 'Strong Together' Support and Activity Centers for Patients, Survivors and their Families across Israel offer body-mind activities, including yoga, free of charge. To join, please call: +972-3-572.16.78.
Efficacy of Therapy to Protect Ovarian Function during Chemotherapy Treatment for Breast Cancer Patients
Researchers from various universities in the U.S. and Australia, asked to examine the efficacy of the hormonal drug Zoladex®, Goserelin® in protecting the reproductive capacity of breast cancer patients who received chemotherapy to treat their disease, after previous researchers had shown conflicting results.
The ovarian function of young women receiving chemotherapy for breast cancer, is impaired by a significant percentage due to treatment, and symptoms such as menopausal signs, osteoporosis, and decreased fertility, are reported among these women.
218 premenopausal women, aged 18-49, who developed breast cancer that is insensitive to estrogen and progesterone, participated in this study. Among the women who were diagnosed with breast cancer, this cancer is more frequent among young women.
The women were divided into two groups: one group comprised 113 women who underwent chemotherapy only and a second group comprised 105 women who received chemotherapy combined with Zoladex. Both groups were monitored for 4 years.
Based on the research results, it emerges that the percentage of ovarian failure in the group that was treated with Zoladex combined with chemotherapy was only 8%, as opposed to ovarian failure at a rate of 22% in the group treated only with chemotherapy. Among the women in the group that received Zoladex, 21% of them reported pregnancy, as opposed to 11% in the group that received only chemotherapy, and 18 births were reported in the group that received Zoladex as opposed to 12 births in the group of women that was treated with chemotherapy only.
Treatment with Zoladex significantly impacted the recovery of these women: 92% of the women in the group that received Zoladex survived during the years of the research study, as opposed to 82% of the women in the chemotherapy group, however, the investigators emphasize that additional research is necessary to confirm this statistic.
To sum up, the researchers conclude that a combination of Zoladex and chemotherapy for women who developed breast cancer that is insensitive to hormones, reduces the risk of ovarian damage, and also reduces the risk of early menopause and all its symptoms, and in addition, improves fertility and the chances of getting pregnant.
This study was published in the March 2015 issue of the New England Journal of Medicine.
Does Tamoxifen treatment reduce the risk for breast cancer among healthy women at high risk?
In a study published in the January 2015 issue of The Lancet, researchers from universities in Britain, Finland, and Australia, examined the impact of Tamoxifen, a hormone therapy drug, on reducing the risk for breast cancer in healthy women at high risk. In previous research studies, it was proven that a decade of such treatment significantly reduced incidence in these women. Now it turns out that the protective effect lasts up to 16 to 20 years.
7,154 high-risk women aged 35-70, were divided into two groups, consisting of the same number of women: in one group, the women took Tamoxifen and in the other group, which constituted the control group, the women took a placebo. Both groups received treatment for 5 years, and they were still being monitored after they had stopped taking the drug.
A significant difference between the groups was observed during surveillance over a 16-year period; the women in the Tamoxifen group were at a 29% lower risk of developing the disease than women in the placebo group: 350 women in the Tamoxifen group were diagnosed with breast cancer (invasive or Ductal Carcinoma In Situ - DCIS) as opposed to 601 women in the placebo group.
The researchers indicate that a similar difference in risk reduction between the two groups was observed during the first 10 years of surveillance: the women in the Tamoxifen group were at a 28% lower risk than the women in the placebo group, and during the 6 subsequent years, they had a 31% lower risk than the placebo group.
Despite the fact that treatment with Tamoxifen over time increases the risk of ovarian cancer, through meticulous surveillance, this kind of cancer may be detected at an early stage, whereby the woman's risk may be significantly reduced, and the 'advantage vs. disadvantage' ratio of treatment with Tamoxifen as a preventive measure may be improved.
The researchers conclude that treatment with Tamoxifen* provides significant and long lasting protection, many years after treatment, for healthy women at high risk of breast cancer.
* It should be noted that this is an affordable drug treatment.
What is the consensus between pathologists regarding breast tumor biopsies of different kinds?
In a study published in the March 2015 issue of the JAMA medical journal, researchers from universities and various oncology centers in the U.S., sought to examine the consensus between the different pathologists regarding breast biopsies of different kinds.
115 pathologists from 8 different states participated in this study. Each pathologist was requested to independently examine 60 breast biopsies representing different kinds of breast tumors, and each pathologist received one glass slide of tissue. Contemporaneously, a panel of 3 experts examined the biopsies and agreed on the diagnosis, this diagnosis was considered to be a "correct diagnosis".
Upon examining the pathologists' diagnoses, and upon comparing them to the diagnosis of the panel of experts, it emerged that the general consensus among them stood at 75.3%.
The highest consensus was in diagnosed cases of invasive breast cancer, with 96% consensus. Lower consensus rates emerged in different types of breast cancer tumors: 84% for breast cancer that forms in the milk ducts – Ductal Carcinoma In Situ – DCIS – while in 3% of the cases, a tumor was misdiagnosed as being of high malignant potential, and 13% of cases was misdiagnosed as being of low malignant potential.
A non-malignant tumor – Atypical Hyperplasia - was correctly diagnosed only in 48% of cases, while 17% of cases were misdiagnosed as having an accelerated rate of cell division, and 35% were misdiagnosed as having a slow rate of cell division. In benign tumors that are not atypical, 87% of the cases were correctly diagnosed, while 13% of cases were diagnosed as having malignant potential.
The researchers agree that it is recommended to receive a second opinion, particularly in cases of DCIS and atypical tumors. However, the research data and limitations must be reviewed in order to make further recommendations.