The Israel Cancer Association announces Breast Cancer Awareness Month

The Israel Cancer Association launched Breast Cancer Awareness Month held through October 31 2019

23,969 women diagnosed with breast cancer currently live in Israel

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Increase in early detection – 64% of all new patients diagnosed at an early stage in 2016 compared to 58% in 2005

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78% of the new patients in 2016 were over the age of 50

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The five-year breast cancer survival rates are relatively high (number 14, above the OECD average) amongst women diagnosed during 2007 – 2011; 89% amongst Jews and 84% amongst Arabs 

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A significant downward trend of about 2% per year in breast cancer mortality in Jewish women, and in the last decade; approx. 25% decrease in mortality rates

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Israel ranks 26 in the number of new patients per year, and 64 in mortality rates, apparent evidence of early detection and up-to-date, efficient treatments

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The Israel Cancer Association in collaboration with the Ministry of Health, published the updated statistics in Israel ahead of the Breast Cancer Awareness Month observed in Israel and worldwide during the month of October.  The statistics show that 23,969 women diagnosed with breast cancer during 2012-2016 live in Israel today and have survived or are still coping with the disease. Of those, 21,275 were diagnosed with invasive breast cancer and 2,694 were diagnosed with cancer in situ.

Miri Ziv, ICA Vice Chairman: “We are aware of the vital importance of early detection of breast cancer. Israel is amongst the leading countries in women’s breast cancer recovery rates, thanks to the increase in early detection rates as well as in awareness of the disease and improvement in treatments options. It is important that women take responsibility for their health and adopt a healthy lifestyle, which has been scientifically proven significantly to reduce the risk of developing breast cancer. In parallel, women should undergo examination according to age-based guidelines, be familiar with their body and its normal state, and if a change occurs consult their physician and insist on it being checked.”

Prof. Lital Keinan-Boker, Director of the Israel Center for Disease Control at the Ministry of Health explains: “In 2016, invasive breast cancer comprised about one-third of the total invasive tumors in women (32.9%, 34.1% and 33.3% of all new cancer incidence rates in Jewish, Arab and “other” women, respectively). In total, 4,792 women were diagnosed with invasive breast cancer, 4,029 of them Jewish (84%), 490 Arab (10%) and 273 “other” patients (6%). According to the Central Bureau of Statistics, the general population distribution in Israel in 2016 was 75% Jewish, 21% Arab and 4% “others”.

The most updated statistics as of October 2019:

• Breast cancer comprises about one-third of all newly diagnosed cancer cases each year in women overall: this is the most prevalent malignant disease amongst women in all population sectors in Israel (Jewish, Arab and “other”). In 2016, 5,436 new patients were diagnosed with breast cancer; 4,792 were diagnosed with an invasive tumor and 644 in situ.
  
  
• Morbidity rates are mostly amongst women age 50 and over – both invasive breast cancer and in situ: the highest risk in women was seen in older age groups, and is usually higher amongst Jewish and “other” women than in Arab women. In the younger age groups, incidence rates were similar between the various population sectors.
  
  
• The temporal trend of incidence – the number of Jewish women newly diagnosed with invasive breast cancer per year during 1996-2016 has been stable: in Arab women, a significant 2% increase per year was seen in the number of new patients diagnosed during the entire period. In “other” women, the rate since 1996 was very high, most likely as a result of the immigration wave from the former Soviet Union, which included breast cancer prevalence in addition to incidence rates; these rates declined by 2003 and have remained constant ever since.
  
  
• The temporal trend of in situ breast cancer incidence (very early stage) during 1996-2016 showed a significant increase in all population groups: In Jewish women, the increase rate during 1996-1999 was 15% annually, and narrowed down to 2.5% per year in the following years of 1999-2016; in Arab women, the increase rate was close to 4% annually during the entire period; in “other” women, the increase rate was close to 3% annually for the entire period.
  
  
• The percentage of women diagnosed with an early stage of breast cancer (in situ or localized) was 64% in 2016 (58% in 2005); the percentage of women diagnosed with metastasized breast cancer was 3.4% in 2016 (3.6% in 2005).
  
  
• The relative five-year breast cancer survival rate in Israel in women diagnosed during 2007-2011 was relatively high: 89% amongst Jewish women and 84% amongst Arab women (the equivalent rates for those diagnosed during 2001-2006 were 87% and 80% respectively, and in women diagnosed during 1996-2000, 85% and 74% respectively.)
  
  
• In 2016, 1,038 women died of invasive breast cancer in Israel – this is the most common cause of cancer mortality amongst women, constituting about one-fifth of all cancer mortality in Jewish, Arab and “other” women. The majority of mortality occurs primarily in older age groups. About 13% of the total (135 women) were younger than 50 upon death. The average breast cancer death age is 70.3, and the median age is 70.7.
  
  
• Amongst Jewish women, invasive breast cancer mortality during 1996-2016 declined significantly by 2016, to about 2% annually. Amongst Arab and “other” women, mortality trends remained stable throughout the period.
  
  
• According to the World Health Organization (WHO) statistics for 2018, breast cancer is most common cancer amongst women worldwide in terms of incidence and mortality. Compared to countries with the highest rates in the world, Israel is ranked 26 in breast cancer incidence, and 64 in mortality. Early detection and up-to-date treatments have led to an improvement in recovery rates and a decline in mortality rates. 
  
  

An Increase in Early Detection Due to the National Mammography Screening Program Initiated by the Israel Cancer Association

Early detection by means of a screening program has been proven to reduce breast cancer mortality and allow for change in the course of the disease. The program was initiated in Israel in the 1990’s by the ICA, and has been implemented ever since in collaboration with the Ministry of Health and all the health care funds, based on clinical research findings and guidelines by professional bodies. The program includes women 50-74 years of age with an average risk of developing cancer, for whom a mammography screening once every two years is recommended. For women over 40 with an increased risk of developing cancer for various reasons, an annual mammography screening is recommended. Women who have been diagnosed with a genetic mutation are eligible for an annual MRI exam, also included in the health fund basket of services.

According to the Ministry of Health’s National Cancer Registry, the number of women diagnosed with early stage breast cancer (in situ, or with local invasion only) has increased in recent years: in 2016, 64% of all new patients were diagnosed with this stage, versus 58% of patients diagnosed in 2005. About one-third (32%) of the new patients in 2016 were diagnosed with locally spread breast cancer to local tissue and/or lymph nodes (LABC), versus 38% in 2005. The number of patients diagnosed with metastatic breast cancer in 2016 shows a slight decline – 3.4% versus 3.6% in 2005.

The ICA Mobile Mammography Unit

As part of the national screening program, the ICA purchased its first Mobile Mammography Unit, 'Michal', in 2001, with the aim of raising compliance amongst women in geographical and social peripheries with mammography examination.  Since the mobile mammography unit began operating, its importance has been proven in significantly minimizing the gaps in compliance rates between the various population groups, such as ultra-Orthodox and new immigrant women, and completely eliminating the disparities between Jewish and Arab women. At this time, Israel is a global leader in mammography compliance rates, while continually bridging the gaps, and ranks amongst the leading countries in breast cancer recovery rates.

In light of the high demand for the mobile unit services, an additional unit began operating in 2011 staffed by a professional medical team of Assuta Medical Center, in collaboration with all health the care funds. In 2018, some 20,000 mammography screenings were conducted in social and geographical peripheries, as part of the mobile unit’s activity across the country.

The Ministry of Health and the Israel Cancer Association Recommendations for Early Detection of Breast Cancer

Mammography Screening for Women between the ages of 50-74

• As of today, mammography is widely accepted as the best method for detecting a cancerous growth in the breast, at an early stage, even before it can be felt manually.
  
  
• Initiated by the ICA, Israel runs a National Mammography Screening Program for women between the ages of 50-74, in collaboration with the Ministry of Health and all health care funds. As part of the program, an invitation is sent to all women in this age group to undergo screening. Mammography screening compliance rates in Israel are some of the highest out of the OECD countries, reaching 70.5% as of 2017.
  
  

Recommendations for women at normal risk

• Know your breasts. At any age and in any situation (pregnant, breastfeeding ,etc.), if you discover a lump or feel any change, consult your physician and check it out.
  
  
• You can undergo a breast examination once a year by a breast surgery specialist (a manual breast examination has not been proven to reduce the risk of breast cancer mortality).
  
  
• It is recommended for any woman between the ages of 50 and 74 to undergo mammography screening once every two years.

Recommendations for women at high risk with a family history of cancer

• Women with genetic mutations or a family history of breast cancer (a first-degree relative such as a mother or sister who has had breast cancer,), should undergo mammography screening once a year starting at the age of 40 or earlier, according to the physician’s recommendations.
  
  
• If you have been diagnosed as a BRCA 1/2 gene mutation carrier or you belong in other risk groups, you should undergo a breast MRI screening once a year, according to the Ministry of Health recommendations. MRI screening is also recommended for women who have been defined as having more than 20% risk of developing breast cancer during their life time.
  
  
• The details of all the approved indications in the basket of services can be found on the Ministry of Health website.
  
  
• A woman/girl who has undergone chest radiation (usually as part of a Hodgkin Lymphoma treatment), principally during prepubescence, is at a higher risk of developing breast cancer, and should be under medical supervision for early detection according to the physician’s recommendations.
  
  
  

  Recommendations for genetic counselling
  
  

• Despite not having a cancer family history, it is important that a woman whose first-degree relative has developed breast or ovarian cancer seek genetic counselling to determine if she should undergo genetic testing. The result may affect the type of treatment she is offered, if and when she is found to carry the mutation, and she can consider options for reducing her risk.
  
  
• It is important that a woman whose first-degree relative developed breast or ovarian cancer, obtain a referral for genetic counselling. As part of the consultation, a decision will be made as to whether the woman should undergo genetic testing to negate or detect a hereditary risk factor for the disease.
  
  
• A woman diagnosed as a BRCA 1/2 gene mutation carrier can reduce the risk of developing cancer. You may also consult your primary physician regarding drug treatment that reduces the risk of developing breast cancer.
  
  
  

  The Israel Cancer Association recommendations for reducing breast cancer risk
  
  

  • Maintain a healthy, active lifestyle: a third of all breast cancer incidence can be prevented by adopting a healthy, active lifestyle. Studies have shown that there is a link between physical activity and a decline in the risk of developing breast cancer, mainly after menopause. Physical activity reduces the risk of developing breast cancer, independently of the risk factor related to body weight.

   

  • Maintain a healthy body weight: in order to avoid obesity and maintain a healthy body weight, it is recommended to find the proper balance between calorie intake and physical activity – “the energy balance.” Overweight and lack of physical activity increase the risk of breast cancer morbidity.

   

  • Avoid adopting behavioral patterns that may increase the risk of developing breast cancer: refrain from smoking, lack of physical activity, obesity and alcohol consumption, which have been proven to increase the risk of developing breast cancer.

   

  • Breastfeeding: it has been scientifically proven that breastfeeding reduces the mother’s risk of developing breast cancer. Aside from the baby’s health, this is another reason why breastfeeding is recommended.
    
    
    

    New Publications by the Israel Cancer Association
    
    

• New advertisement - the Israel Cancer Association produced a new advertisement entitled, “You are not alone in your fight against breast cancer – the Israel Cancer Association – with you and for you”, courtesy of Bilt Graphic Studio. The advertisement contains information about ICA’s various activities in promoting the fight against breast cancer. Click here to see the ad.
  
  

• A new public service announcement - the ICA produced a new infomercial entitled, “Sometimes, even the slightest sensation or change means something. Get checked”, ahead of Breast Cancer Awareness Month, courtesy of BBDO Gitam agency. The main message the infomercial delivers is the importance of consulting a physician at any age and any condition, should a woman feel a lump or any change in her breasts. The public service announcement goes hand in hand with the advertisement which carries a similar message.
  
  
  
  The Israel Cancer Association Information center presents new research

  
  Long-term use of menopausal hormone therapy (MHT) in menopausal women may increase risk of breast cancer risk
  
  
  

  So far, there are no consistent findings regarding breast cancer risk associated with different types of menopausal hormone therapy (MHT) in menopausal women. An extensive research conducted by researchers from Oxford University in the U.K. examined the risk of developing breast cancer as a result of using different types of MHT after menopause, as well as the duration of usage.

   

  The researchers conducted a statistical analysis of 58 epidemiological studies from 1992-2018 on 143,887 postmenopausal women (median age of 65) with invasive breast cancer and 424,972 healthy women as the control group. 71,217 of the women with breast cancer used MHT at some point during their life. The average duration of current MHT use (treatment that began less than 5 years from the time of breast cancer diagnosis) was 10 years, and the average duration of past MHT use (treatment that began more the 5 years from the time of breast cancer diagnosis) was seven years, whilst the average age for commencing usage was 50.

   

  The findings showed that every MHT type, except vaginal estrogens, was associated with excess breast cancer risks, which increased steadily with the duration of use and were greater for estrogen-progestagen than estrogen-only preparations. Amongst current users, these excess risks were definite even during years 1–4 (60% in combined estrogen-progestagen preparation, and 17% in estrogen-only). Moreover, the risks were twice as great for long-term daily combined use (5-14 years) versus less frequent use of estrogen only. The combined, long-term use entailed a much greater risk for estrogen-receptor-positive tumors than for estrogen-receptor-negative tumors, regardless of the age in which women began the hormonal therapy or excess weight.  After ceasing MHT, some excess risk persisted for more than 10 years, and was higher the longer the duration of usage, with little risk of developing breast cancer following less than 1 year of MHT use.

   

  The researchers calculated the cumulative 20-year absolute breast cancer risk for women starting MHT use at age 50, versus average weight women who never used MHT, whose risk rate was 6.3%.

   

  The researchers concluded that the anticipated cumulative breast cancer risk in women who use estrogen-progestagen preparations consistently for 5 years is 8.3% (one in every 50 users of hormonal therapy is expected to develop breast cancer) whereas consistent use of estrogen only therapy was calculated as a cumulative risk of 6.8% (one in every 200 users). The corresponding excess risks from 10 years of MHT would be about twice as great.  It was further found that even after ceasing MHT, some excess risk persisted for more than 10 years.

   

  To sum up, the research indicates that long-term use of menopausal hormone therapy amongst menopausal women, predominately one containing progestogen, increases breast cancer risk.

   

  The research was published in the 29.8.2019 volume of The Lancet.

   

  Click here for the full article.

  
  
  
  Soy Food Consumption, Exercise, and Body Mass Index and Osteoporotic Fracture Risk amongst Breast Cancer Survivors
  
  

  Many breast cancer treatments are known to accelerate the onset of menopause and reduce bone mineral density, thus increasing the risk of survivors suffering from osteoporosis-related fractures compared with age-matched healthy women. Moreover, the intake of soy and its derivatives is known to have healthy benefits. Research has shown that soy, which is rich in isoflavones, whose activity is similar to the estrogen hormone, may help reduce breast cancer risk as well as fractures in postmenopausal healthy women.

   

  Researchers from Yale University and other universities in the U.S. and China investigated whether soy food consumption, exercise, and body mass index may reduce the risk of bone fractures amongst breast cancer survivors.

   

  The research examined physical and medical data, dietary habits and lifestyle factors (exercise, BMI and more). In the questionnaires filled out by 5,042 Chinese female patients with newly diagnosed breast cancer, aged 20 to 75 years, 52% were postmenopausal and 48% were premenopausal. Follow up was conducted for the development of bone fractures (as a result of falls and osteoporotic fracture) over 10 years. Over these years, bone fractures developed in 3.7% of the total research participants, of whom 2.9% were premenopausal and 4.4% were postmenopausal. As against Low intake or non-intake of soy products, high and consistent daily intake of soy and its derivatives, including tofu, soy milk, fresh soy beans, and other soy products), (≥56.06 mg/d = slightly over 1/4 cup) versus lot intake (<31.38 mg="" day="slightly" less="" than="" 1="" 8="" cup="" was="" associated="" with="" a="" 77="" decline="" in="" teh="" development="" of="" bone="" fractures="" premenopausal="" women="" --31="" 38--="">

   

  In addition, excess weight (BMI of 25 or higher) was associated with an increased risk of developing bone fracture in premenopausal women, and physical exercise (high impact versus low impact) significantly reduced (44%) the risk of fractures in postmenopausal women.

   

  The researchers claim that this is the first study ever to evaluate the association of soy food consumption with osteoporotic bone fracture amongst breast cancer survivors and the largest investigation on other modifiable risk factors in this population group. 

   

  The research was published in JNCI Cancer Spectrum on 21.5.2019.

   

  Click here for the full article.