Ahead of the Breast Cancer Awareness Month observed in Israel and worldwide during the month of October, the Israel Cancer Association in collaboration with the Ministry of Health, published the updated breast cancer statistics in Israel.
The statistics collected by the National Cancer Registry at the Ministry of Health shows that 24,778 women diagnosed with breast cancer during 2014-2018 live in Israel today and have survived or are still coping with the disease. Of those, 21,831 were diagnosed with invasive breast cancer and 2,758 were diagnosed with cancer in situ.
Moshe Bar-Haim, ICA Director General: “Breast cancer is the most prevalent cancer growth amongst women. In the current year reported (2018), over 5,500 women were diagnosed with breast cancer. The on-going increase in the number of new breast cancer cases diagnosed at an early stage and the decrease in mortality rates indicate the increase in early detection of the disease and improved treatment methods. Early detection has been proven to reduce breast cancer mortality, enables to change the course of the disease and increase recovery rates by about 90%. Even during this COVID-19 pandemic period, women of screening age must not forgo taking their screening tests. Simultaneously, women must get checked according to age-based guidelines, know their body and its normal condition, so that if a change occurs, it is important they consult their physician immediately to inquire about it."
Prof. Lital Keinan-Boker, Director of the Israel Center for Disease Control at the Ministry of Health explains that according to 2018 statistics, the majority of morbidity is in women over 50. In Jewish and other women (non-Christian Arabs and those with no religious affiliation), 78% of the new cases in 2018 were diagnosed amongst women of 50 and up, and 45% amongst women ages 65 and up. In Arab women, the percentages were 65% and 24% respectively. According to her, 1.1% of all new cases of invasive breast cancer in 2018, that is 52 women, were diagnosed under 30.
Due to the complexity of data gathering, the newest National Cancer Registry data refers to 2018, and is the most updated as of today.
In 2018, breast cancer comprised about one-third of all newly diagnosed invasive tumors in women (33% amongst Jewish and other women, and 35% amongst Arab women.)
Breast cancer comprises about one-third of all newly diagnosed cancer cases in all women each year. It is the most prevalent malignant disease amongst women in all population sectors in Israel (Jewish and other, Arab). In 2018, 5,539 (87%) new patients were diagnosed with breast cancer; 4,832 (87%) were diagnosed with an invasive tumor and 707 in situ.
The majority of morbidity – both with invasive breast cancer and in situ – is in women over 50. The temporal trend of incidence – the number of newly diagnosed cases of invasive breast cancer during 1996-2018 amongst Jewish women was stable; in Arab women, a significant yearly increase of 1.7% was seen during the entire period, most likely a result of adopting a Western lifestyle, which is attributed to later child bearing, having less children, breastfeeding less, an increase in BMI, a poorer diet, etc.
*It is worth nothing that in 1990, the by the Israel Cancer Association launched a campaign to raise awareness to early detection of breast cancer by means of mammography, and in 1995, the nation-wide screening program was launched.
The rate of women diagnosed with an early stage of breast cancer (in situ or localized) was 69.2% in 2018 vs. 58.3% in 2005; the rate of women diagnosed with locally advanced breast cancer (to nearby tissue and/or lymph glands) was 27.9% in 2018 vs. 38% in 2005. The rate of women diagnosed with metastatic breast cancer was low and similar in 2018 and in 2005 (3.4% vs. 3.6% ). The relative five-year breast cancer survival rate in Israel in women diagnosed during 2008-2013 is relatively high: 89% amongst Jewish and other women and 84% amongst Arab women. The equivalent rates for those diagnosed during 1996-2001 were 84% and 74%, respectively.
Invasive breast cancer morbidity rates: In 2018, 1,042 Israeli women died of invasive breast cancer. It is the most prevalent cause of cancer mortality in women, comprising about one-fifth of all cancer mortality in Israeli women. The majority of mortality is in women of older age groups. About 14% of the deceased (146 women) were less than 50 upon death. The lowest breast cancer mortality rates were seen in women younger than 35. The rates in older age were considerably higher and peaked in the 75+ age group in Jewish and other women.
Amongst Jews and others, invasive breast cancer mortality during 1996-2018 has shown a clear downward trend of 2% each year. Amongst Arab women, the trend was stable throughout the period.
According to the World Health Organization (WHO) statistics for 2020, breast cancer is the most prevalent cancer in women worldwide in terms of incidence (2,261,419 cases in total) and mortality (684,996 cases in total).
Amongst the 186 countries reported to the WHO, Israel is ranked 26 in breast cancer incidence (preceded by Belgium, Holland and Luxemburg), and ranked relatively low at 69 in mortality (preceded by Barbados, Fiji and Jamaica).
According to the statistics collected by the National Cancer Registry at the Ministry of Health, thanks to the national program for early detection of breast cancer initiated by the ICA, the upward trend of early detection is ongoing: the rate of women diagnosed with early stage (localized or in situ) breast cancer was 69.2% in 2018, vs. 66% in 2017, and 58% in 2005. Simultaneously, the downward trend in the rate of women diagnosed with locally advanced breast cancer (to nearby tissue and/or lymph glands) continues, reaching 27.9% in 2018 vs. 31% in 2017 and 38% in 2005.
The rate of women diagnosed with metastatic breast cancer was similar in 2018 and 2005 (3.4% vs. 3.6%, respectively).
*Early detection by means of a screening program has 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 Israel Cancer Association, 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.
Breast cancer can be characterized according to proteins in the tumor cells. Estrogen and progesterone receptors cause the tumor to be sensitive to these hormones. High levels of HER2 protein bind to a fast growth of the lesion. The status of the receptors and HER2 affects the treatment options and the prognosis.
The National Cancer Registry began collecting data on the status of ER and PR receptors and the levels of HER2 for women diagnosed with invasive breast cancer starting in 2016 and on. The source of data is a pathological examination of the women. In 2018, full details about the status of ER/PR/HER2 registered for 67% of the women diagnosed with invasive breast tumor. Of those, 85% were ER+, 70% ER+/PR+, 62% - ER+/PR+/HER, and 9% - ER-/PR-/HER.
The BRCA1/2 genetic mutation test for healthy Jewish women whose parents are both of Ashkenazi background (even without family history) was added to the 2020 technology and drug basket. Click here for the interactive questionnaire on genetic diagnosis and consultation – as part of the Prevention Generation program (in Hebrew) The ICA runs the Breast Cancer Forum and the Forum for Genetic Carriers and Women in High Risk of developing Breast and Ovarian Cancer, mediated voluntarily by top professionals.
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 2019, approx. 19,000 screening tests were performed in social and geographical peripheries, as part of the mobile unit’s activity across the country. The mobile unit is operated by Assuta Medical Services and provides services to insureds of all healthcare funds.
The ICA produces and distributes a complimentary brochure "Choosing Healthily – Breast Health is in Your Hands", which includes recommendations for women on reducing breast cancer risk factors and coping with the disease. Click here to order informational materials.
The ICA has various informational materials on prevention and early detection of breast cancer as well as for women who have been diagnosed and are coping with the disease.
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 72.1% as of 2019.
According to a recommendation by a committee established last year and headed by Prof. Lital Keinan-Boker, women ages 45 can see a physician in order to obtain information regarding the advantages and disadvantages of undergoing screening at this age. Should they decided to undergo the screening, it will be covered by the technology and drug basket.
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.
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.
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. It is recommended for any woman between the ages of 50 and 74 to undergo mammography screening once every two years.
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.
Men rarely develop breast cancer (1% of the total breast cancer patients). According to statistics, about 50 men are diagnosed with breast cancer each year. The cause for breast cancer in men is yet to be determined, but it seems that some men are at an average risk of developing breast cancer. The main risk factors are age 60+ and having close family relations (men or women) that had or are currently coping with breast cancer. Men at high risk should ask their healthcare fund physician for referral to genetic counselling. Currently, there is no recommendation for healthy men at normal risk to undergo early detection. Men who are gene carriers may pass on the mutation to their daughters.
Information campaign – during breast cancer awareness month, the ICA will launch an information campaign on the importance of early detection on the TV, radio, digital platforms, and newspapers.
"Celebrating Life" Webinar – on breast cancer – 20.10.21, with a panel of experts on breast cancer.
Breast cancer webinar in Arabic – 27.10.21
'Stop' signs at Azrieli Mall TLV – as part of a collaboration with Azrieli Mall TLV, pink stop signs have been placed throughout the mall, bearing the caption" 'Stop! At any age and any state, if you feel a lump or a change in your breasts, it is important to consult your physician and inquire about it.'
Activity at the Israeli Parliament (Knesset) in Jerusalem – in marking awareness month and the importance of early detection, the Knesset clinic headed by Dr. Noam Ofek and Dr. Kobi Sher, that Assuta's Mammography Mobile Unit operated with the initiative and support of the CA, will be placed in front or the Knesset building for one day and conduct screening tests for female Knesset members, ministers and other employees who meet the screening age criteria. Other activities are also scheduled for the Knesset women on that day.
As customary each year, the ICA is collaborating with the Estee Lauder Group.
Women who complete their breast cancer chemotherapy and radiotherapy treatments often find themselves at a loss. The expectation that the side effects they experienced will subside, and that they will be able to resume a normal life right away most often doesn't materialize. In addition, the intensive support system of the treatment frameworks is no longer part of their life. Many of them also receive hormonal treatments, which adds to the changes in their life and poses a real challenge in their coping. As a result, many experience a deep personal crisis – physical, emotional and social – at this stage in the treatment.
It is worth noting that a research funded with the help of the ICA and conducted by Dr. Yakir Rothenberg from Hadassah Ein Karen medical center shows that breast cancer patients within working age were employed even 10 years following their diagnosis.
Many studies show and reinforce the fact that physical activity helps significantly in coping with the side effects of treatments, and raises survival chances of cancer patients in general and breast cancer patients in particular (who are more prone to morbidity throughout life than healthy women). Regular, balanced physical activity combined with proper nutrition increases energy, releases tension, encourages appetite, reduces fatigue and pain, reinforces positive self-esteem, improves mood and ability to function, and above all – helps greatly in reducing side effects of treatments and the risk of disease recurrence.
"The Day After" program, which runs in collaboration with the oncology institute at Shaare Zedek Medical Center, the Rothberg Sports Center of Shaare Zedek at Arena Pais Jerusalem and the ICA, was founded in order to help address the needs of women coping with breast cancer during the treatment phase.
According to test and questionnaire results – impressive changes were recorded at the end of the program compared to its onset: considerable improvements were detected in physical fitness measures, including pressing power, walking and percentage of bodily fat. A considerable improvement was also recorded in the patients' quality of life upon completion of the program. For example: improvement in fatigue, pain, mood, self-image and more.
Fertility treatment for BRCA1/2 mutation carriers is not associated with a discernible increase in breast cancer riskHigher levels of leisure-time physical activity in women were associated to a lower breast cancer risk
Exposure to passive smoking in childhood and the risk of breast cancer