Controversies in breast cancer

Just back from two days in Edinburgh at a conference titled “Controversies in breast cancer”. An unusual conference organized by scientists and clinicians and by invitation only. Papers are not reviewed and there is no press coverage: just a forum for experts in the field to discuss and debate a wide range of topics in breast cancer research. The proceedings will be published online before the end of the year.

The conference is now in its fifth year and draws from a diverse group both geographically (international) and in terms of discipline and it is a refreshing experience. I don’t claim to understand the more esoteric science but one is left in no doubt that scientists are continually challenging each other, and themselves, to decide which paths to follow to do the best for breast cancer patients.

One topic which was rather less controversial than it sounded was titled the “Emerging breast cancer epidemic”. We have seen breast cancer incidence rise steadily in the UK and in fact in the developed world and this is predicted to continue through the next decades. More and more are surviving so mortality (death) rates are going down but just because we can sometimes cure a disease does not make it less of an epidemic.

That breast cancer is the most common cancer in women knows no geographic boundaries – it is a global burden that has doubled in the last 30 years. We are used to hearing stories about the disease burden in developing countries of, say, HIV/AIDS, malaria and TB but cancer is not a rare disease in Africa.

What was also interesting is if you take a country such as France the at risk population for breast cancer changed from 19.1 million in 1970 to 21 million in 2010. In Nigeria it went from 24.6 million to 42 million. As infectious diseases are being more successfully treated, the impact of AIDS is reducing and therefore women are living longer. This trend is going to continue and of course it is a good thing. However the single most significant risk factor for breast cancer is age and as these populations live longer the incidence of breast cancer will increase rapidly.

At present the number of young women developing breast cancer in Africa appears high – this is not due in the main to some genetic difference but more to do with the fact that the women who are diagnosed are educated, economically active and more likely to seek help. There are women in rural areas who die from advanced breast cancer without diagnosis or treatment.

The problems they are facing are so different from ours - adulterated drugs, very few trained oncologists. Screening programmes are not an option – lack of access to mammography let alone the resources to deal with any false positives and of course a lack of a consistent supply of electricity!

So as the control of infectious diseases improves and the scourge of AIDS is reduced; as life expectancy increases and with economic growth changing lifestyles – the breast cancer epidemic is a reality.