by Graham A. Colditz, MD, DrPH
A reminder on numbers that have been around for some time – more than half of cancer is diagnosed in low and middle income countries, where access to care is often limited.
Data from the World Health Organization for 2012 (1) show that an estimated 14 million new cases of cancer were diagnosed, and the number is rising every year. The most common cancers diagnosed were those of the:
- lung (1.8 million cases, 13.0% of the total)
- breast (1.7 million, 11.9%)
- colorectal cancer (1.4 million, 9.7%)
Of course, breast cancer is the leading cause of cancer diagnosis among women, where it accounts for 25% of all cancer diagnosed. The 11.9% misleads as these cases occur in about half the population (25% is more accurate: 1.7 million breast cancer cases among the total of all new cancer cases diagnosed among women, 6.7 million total new cases = 25%).
We should be outraged that so few resources and little prevention effort is going to this disease. Much is focused on high-risk women and those at older ages, such as after 50 (2). But some 25% of all breast cancers are diagnosed among women under age 50. We must start prevention far earlier in life to reduce the burden of this disease.
Cigarette smoking has declined and lung cancer mortality has decreased by one third in the past 20 years. Mortality from lung cancer peaked at 91.1 per 100000 men in 1990 and has declined to 60.3 per 100,000 men in 2010. This is one third fewer lung cancer deaths (3). Stopping smoking reduces lung cancer but also death from heart disease, stroke, and many other cancers too. It is time we focused the same attention on prevention of breast and other cancers, while maintaining our program of prevention of smoking (4). Alcohol, a known carcinogen and cause of breast cancer, needs more attention. We have shown that intake during adolescent and early adult years is significantly related to increased risk of invasive breast cancer and also premalignant breast lesions (5,6).
The World Health Organization recommends policies to limit alcohol intake and to encourage a healthy diet as “best buys” for prevention of chronic diseases (7). For breast cancer, the leading malignancy in women, we must refine the focus of the recommendations and recognize that prevention messages and action must begin early in life and be sustained. We must help women understand that breast cancer prevention strategies will vary according to their age, and that some prevention (childhood diet and exercise) is under the control of mothers and grandparents. Avoidance of alcohol, for example, may be particularly beneficial for young women (6). Improving the presentation of prevention messages for each stage of a women’s life is a top priority.
Today, we should focus again on cancer prevention and the potential for action with what we know already. For more details, visit our recent post in the Huffington Post -
Additional resources for cancer prevention can be found on our page: Preventing Cancer - Today.
1. International Agency for Research on Cancer. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. 2012; Section on Cancer Information. Available at: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed Jan 26, 2014, 2014.
2. Visvanathan K, Hurley P, Bantug E, et al. Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. Aug 10 2013;31(23):2942-2962.
3. National Center for Health Statistics. Health, United States, 2012: With Special Feature on Emergency Care. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2013.
4. Koh HK, Sebelius KG. Ending the tobacco epidemic. JAMA. Aug 22 2012;308(8):767-768.
5. Liu Y, Tamimi RM, Berkey CS, et al. Intakes of alcohol and folate during adolescence and risk of proliferative benign breast disease. Pediatrics. May 2012;129(5):e1192-1198.
6. Liu Y, Colditz GA, Rosner B, et al. Alcohol intake between menarche and first pregnancy: a prospective study of breast cancer risk. Journal of the National Cancer Institute. Oct 16 2013;105(20):1571-1578.
7. World Health Organization. Global Action Plan for Prevention and Control of Noncommunicable Diseases, 2013-2020. http://www.who.int/cardiovascular_diseases/15March2013UpdatedRevisedDraftActionPlan.pdf: World Health Organization,; March 15, 2013 2013.