Breast Cancer

         Breast Cancer is the most common malignant disease in Israel and the Western world. The Israel Cancer Association statistics demonstrate that the number of women who recover from breast cancer is steadily on the rise, thanks to early detection, enhanced treatment modalities and heightened awareness in Israel

• About 4500 women are diagnosed with breast cancer in Israel each year and about 900 die of the disease. 

• 1 out of 8 women in Israel may develop breast cancer, and the earlier the disease is detected, the higher the chances of a cure - reaching nearly 90%. 
  
  
  
  

• As of November 2019, 23,969 women diagnosed with breast cancer currently live in Israel.
  
  
• Thanks to the ICA's initiatives in the area of early detection, there has been 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.
  
  
• 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.

• ICA Recommendations:

• It is highly imperative that starting from the age of 20 you become acquainted with your breasts and to the changes that take place in them. The better acquainted you are with your body, the better you will discern the changes should they occur; the next step is to consult with your physician to clarify the nature of such changes. 

• A manual breast exam should be performed by your physician who specializes in breast examinations.

• Women who are 50 years and older should regularly undergo a mammography screening once every two years.

• Women who are at high risk, who have a mother or sister affected by breast cancer, should be tested once a year, starting from the age of 40, or according to their physician's recommendation. BRCA 1/2 gene mutation carriers are entitled to a breast MRI scan.

• It is important to keep in mind: the earlier the disease is diagnosed - the better are the chances of recovery!

• The Israel Cancer Association invites the female public to contact the 24HR tele-meida® hotline service for answers to any questions that may have about breast cancer and other cancers, and to receive informative material free of charge.

• ICA, joining the rest of the world, initiates Breast Cancer Awareness Month held in October each year, as part of the national and global breast cancer awareness campaign. The ICA holds many events during this month to increase awareness about this subject.

• Breast Cancer Awareness Month activity:

• In October, the ICA launches an extensive public education and information campaign in all the media channels, focusing on the importance of early detection and ways of treating breast cancer. Diverse events are held during the month to increase public awareness about the disease and the importance of early detection, namely: the Estée Lauder Group's Global Landmark Illumination Initiative in collaboration with the ICA, the "Tree of Bras" Art Installation, a Special 'Pink Flotilla' sail with breast cancer patients and survivors wearing pink T-Shirts, the 'Riding to Victory' motorcycle parade in collaboration with Harley Davidson Israel and more. 
  
  

• On October 31, 2019, 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. At the same time, 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.”

• ICA encourages women to adopt a healthy lifestyle which includes physical exercise, proper diet, and maintaining a healthy weight - strategies that can reduce the risk of developing breast cancer. 

• The National Mammography Screening Program:

More than 20 years ago, the Israel Cancer Association initiated a national program for early detection of breast cancer, which has since been operated with the Ministry of Health and in collaboration with all the health service providers. The program has been funded and monitored for 20 years with the ICA’s help, from population-based diagnostic radiology screening for target groups of women aged 50-75, to surgical procedures and pathological diagnosis and monitoring in oncology institutes for women diagnosed with malignancies.  Until 2013 the program was headed by Prof. Gad Rennert, Director of the Community Medicine and Epidemiology Department at the Carmel Medical Center and consultant to the ICA in the field of cancer control.  The entire national program was initiated and is coordinated on behalf of the ICA by Miri Ziv, ICA Vice Chair and former Director General.

In 2018, the Executive Board approved funding for a further period to the Ministry of Health to operate a system of targeted registries for quality assurance of the National Program for Early Detection of Breast Cancer in Israel.

The ICA-initiated National Mammography Screening Program statistics presented by Prof. Gad Rennert, Head of the National Programs for the Early Detection of Breast Cancer and Colorectal Cancer and Advisor to the ICA, indicate that gaps in mammography compliance rates noted in Arab women have been completely dissipated, and are identical to those of Jewish women, and also demonstrate a narrowing of disparities between different sub-populations in Israel.   
     

• Current compliance rates in new immigrant and ultra-Orthodox female populations are about 5%-10% lower than those observed among native secular Jewish female populations. 
                                                          

• In 2001 the percentage of compliance to undergo mammography screenings among Arab women stood at 49%, and today, the compliance rate is similar to that of Jewish women, and stands at about 70%. 
     

• In 2016, 305,618 women aged 50-74 with no personal history of breast cancer underwent mammography. The result was that 2,822 new cases of breast cancer were detected in this group, comprising 356 cases of non-invasive cancer (DCIS), and 2,466 cases of invasive cancer. 76.7% of the invasive cancers (1,892 cases) did not involve the lymph glands. In other words, 80% of the cases were detected at an early stage.
  
                                                        

• Since the beginning of the program, over seven million breast imaging tests have been performed on over one million women, including 200,000 tests done in the mobile mammography unit.
  
  

• Incidence: 

• Prof. Lital Keinan-Boker, Director of the Israel Center for Disease Control at the Ministry of Health explains: "Breast cancer is the most common type of malignancy among women in Israel (Jewish, Arab, “other”). 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 main incidence is among women aged 50 and over; the highest risk was observed in older women, and it is higher among Jewish women than Arab women.

• 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.)

• Mortality:
  
  

• For the first-time ever, a decrease in mortality rates has also been recorded among Arab women: from 16.0 per 100,000 in 2008 to 11.9 per 100,000 in 2010.  The mortality rates among Jewish females have dropped from 22.6 per 100,000 in 1998 to 17.1 per 100,000 in 2010.  The statistics indicate a downward trend among Jewish women (about 30%) and Arab women alike (about 25%).
  
  
  
• The increase in the incidence of in situ breast cancer and the decline in mortality rates indicate the detection of the disease at its early stages, enhanced treatment and higher chances of a cure. There has been an upward trend in relative breast cancer survival rates, and the current survival rate exceeds 85%.
  
  
  
•  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, there has been a significant downward trend in invasive breast cancer mortality during 1996-2016, by about 2% annually, which is approx. 25% decrease in mortality rate over a decade. 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.
  
  
  

• International Comparison:
  
  
  
  • According to International Agency for Research on Cancer (IARC) statistics which compare between countries with the highest incidence and mortality rates in the world, it emerged that Israel ranks high in incidence (5th highest), whereas, as far as mortality rates are concerned, Israel ranks lower (9th highest) and shows a downward trend.
   
  
  

* Source: EUROCARE-4 European Cancer Registry-based study on survival and care of cancer patients.

• The relative five-year breast cancer survival rate in Israel for women diagnosed in the period from 2005 to 2009 is one of the highest in OECD countries:  87.5% for Jewish women and 84.4% for Arab women.
  
  
• Apart from the encouraging data reported in Israel in recent years through the Israel Cancer Association, a survey by the World Health Organization found that Israel leads the European region in mammography compliance rates, while continually bridging the gaps between different population groups within the country. According to WHO, Israel ranks among the leading countries in cure rates on a global scale. 

• Declining Trend in Breast Cancer Mortality Rates:

The Israel Central Bureau of Statistics (2011) data revealed:

• That breast cancer age-standardized mortality rates, from 1998-2009, decreased from 22.6% in 1998 to 17.4% in 2009.  In other words, a 30% decrease!   

• This proves that thanks to the National Mammography Screening Program initiated by the ICA, and thanks to its information and education efforts, women are diagnosed at an earlier stage, which enables quick and more effective treatment that consequently has live-saving impact.

• Breast Cancer Treatment Coordinators and Patient Navigators:

• The ICA continues to finance special posts for nurses and social workers who work as breast cancer care coordinators and patient navigators during all stages of diagnosis, treatment and follow-up. 

• The ICA project's goal is to accompany the breast cancer patient throughout the treatment process, and to provide her with information, support and assistance, thereby significantly easing the burden of coping with the disease. This service is currently provided in many centers across the country. 

• Other centers have already adopted this service and the ICA continues to update personnel. Thanks to the ICA, there is a national network of professionals who maintain regular contact with breast cancer patients and attend to their well-being.

• 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.

• The National 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.
  
  
• The ICA Mobile Mammography Unit, currently run by Assuta Medical Services, is now in its 18th year of operation across Israel, since 2001.
   
• 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 ICA Mobile Mammography Unit, currently run by Assuta Medical Services, is now in its 18th year of operation across Israel, since 2001. 
  
  

• The aim of the vehicle is to enable women who reside in remote areas, as well as those who are unaware of the importance of the detection test, to undergo a mammography screening close to home.   

• The overall objective is to improve access to and compliance with this potentially life-saving screening test. In 2013, as a result of the great demand for mobile mammography services, an additional Mobile Mammography Vehicle began to operate. 

• The Mobile Mammography Vehicle operates in collaboration with all healthcare funds.  

• A personal invitation letter is sent to women of the appropriate age in anticipation of the arrival of the mobile mammography vehicle to the designated town, and ads are placed in the local newspapers announcing the mobile's scheduled activity in the area. 

• Due to the demand for the mobile unit’s services, a second unit began operating in 2011.  Both units were operated by professional staff from Assuta Medical Center in collaboration with all health service providers.
  
  

• In 2015, about 30,000 tests were carried out in some 140 different venues all over the country.  In 2016, the older unit was retired.  The provision of a mobile unit from 2015 to 2017 was helped by a donation from the Azrieli Foundation (Israel).

• Regional Early Breast Cancer Detection Stations:

• The ICA continues to assist in operating regional early breast cancer detection stations throughout the country.

• The National Breast Health and Early Detection Awareness Program is conducted among the general female population. 

• Countless resources are invested in diverse population segments such as Arab society, kibbutzim (collective settlements), the new immigrant population, the ultra-Orthodox sector, and other populations.
  
  
• Informational material is distributed in hundreds of thousands of copies in Hebrew, Arabic and Russian, and a breast health lecture notes kit has been updated for Breast Health Nurses who lecture throughout Israel on behalf of the ICA.

• Breast Health Nurse Lecture Series on Prevention and Early Detection of Breast Cancer, Healthy Lifestyle, and ICA Activity:

• In coordination with ICA's Health Promoter and Public Information and Education Dept., lectures continue to be delivered by breast health nurses representing the ICA. 

• The nurses deliver lectures to the general population across Israel, to heighten awareness of the importance of breast cancer early detection and the significance of making healthy lifestyle choices which may reduce the overall risk of developing cancer and breast cancer in particular; additionally, these nurses shed light on ICA's noteworthy activity in Israel - for the patients and against the disease.  This program featured lectures in different settings, such as women's clubs, corporate offices, municipalities and local authorities.
  
  

• In 2017, some 40 lectures were delivered, each accompanied by the personal story of a ‘Reach for Recovery’^® volunteer and distribution of informational material.
  
  

• Cancer in the Family - Counselling Program for high risk families 

First degree relatives of cancer patients (colon, breast, ovary, prostate gland and melanoma) are at high risk of contracting the disease, and it may be a hereditary cancer. For 26 years there has been an advisory service on familial cancer at the National Center for Cancer Control. This service is provided in collaboration with the Israel Cancer Association and is managed by Prof. Gad Rennert, Director of the Community Medicine and Epidemiology Department at the Carmel Medical Center and consultant to the ICA in the field of cancer control, forming a national unit of Clalit Health Services on this subject. In that period over 12,958 families have used this service, receiving advice at various levels. This National Counseling Service is an important information resource for the public and for decision makers in the health system dealing with cancer.

The National Breast Health and Early Detection Awareness Month

The National Breast Health and Early Detection Awareness Month is conducted among the general female Israeli population to promote the fight against breast cancer.

• In October the ICA launches an extensive public education and information campaign in all the media channels, focusing on the importance of early detection and ways of treating breast cancer.  Diverse events are held during the awareness month to increase public awareness about the disease and the importance of early detection, namely: the Estée Lauder Group's Global Landmark Illumination Initiative in collaboration with the ICA.
                                                                                                   

• ICA encourages women to adopt a healthy lifestyle which includes physical exercise, proper diet, and maintaining a healthy weight - strategies that can reduce the risk of developing breast cancer.  You may find information about healthy lifestyle choices to maintain good health on the Europa Donna, European Breast Cancer Coalition website.
  
  

• Other ICA's Activities regarding Beast Cancer:

• The ICA continues to assist in operating regional early breast cancer detection stations throughout the country. 

• Countless resources have been invested in diverse sectors such as the Arab society, kibbutzim (collective settlements), the new immigrant population, the ultra-Orthodox sector and others. 

• Informational material on breast cancer is distributed in hundreds of thousands of copies in Hebrew, Arabic and Russian, and Breast Health Nurses lecture across the country on behalf of the ICA.

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.