Breast cancer cases in the United States could be 50% higher in 2030 than the number in 2011, according to new research from the National Cancer Institute. In the new study, presented at the American Association for Cancer Research’s annual meeting, researchers used cancer surveillance data, census data and mathematical models to arrive at projections. Part of the reason the numbers are so high, they note, is because women are living longer. Another factor is the increase in screening that enables doctors to spot and diagnose more cases of in-situ tumors very early stage growths that may not require treatment, as well as more invasive tumors.
According to abstract published by PubMed, by the year 2030, the United States’ population will increase to approximately 365 million, including 72 million older adults age 65 years or older and 157 million minority individuals. Although cancer incidence varies by age and race, the impact of demographic changes on cancer incidence has not been fully characterized. From 2010 to 2030, the total projected cancer incidence will increase by approximately 45%, from 1.6 million in 2010 to 2.3 million in 2030. This increase is driven by cancer diagnosed in older adults and minorities. A 67% increase in cancer incidence is anticipated for older adults, compared with an 11% increase for younger adults. A 99% increase is anticipated for minorities, compared with a 31% increase for whites. From 2010 to 2030, the percentage of all cancers diagnosed in older adults will increase from 61% to 70%, and the percentage of all cancers diagnosed in minorities will increase from 21% to 28%.
This data comes at a time of real concerns about the over-treatment of breast cancer. Last year, an analysis of women with stage 1 or stage 2 breast cancer in the Journal of the National Cancer Institute found little difference in survival rates 20 years after diagnosis between women who had an unaffected breast removed and those who did not. “There’s certainly concern, especially in the older patients, about over-diagnosis of breast cancer, and that’s one of the reasons that screening mammography can become very controversial in older patients,” says Dr. Sharon Giordano, MPH, department chair of health services research at MD Anderson Cancer Center. (Giordano was not involved in the research.) “We don’t want to end up diagnosing and treating a disease that would never cause a problem during the person’s natural lifetime.”
Not all in-situ breast cancer progresses into a dangerous condition, Giordano explains. “One of the unanswered questions is, how do we identify the in-situ cancers that are the ones that go on and progress to a life-threatening illness, and which are the ones that we should be leaving alone and not subjecting people to invasive surgery and radiation for treatment?”
The researchers also discussed some more hopeful projections: that the number of estrogen-receptor negative (ER-negative) cancers, the kind that don’t need estrogen to grow and don’t typically respond to endocrine therapy, will drop from 17% in 2011 to 9% in 2030. That may be good news, since ER-positive breast cancers tend to grow slower and have better long-term survival rates. The reasons for the expected drop aren’t clear yet, the study authors say, but one contributing factor could be that women are having children later in life, and having a child young is a risk factor for ER-negative tumors.
“In sum, our results suggest that although breast cancer overall is going to increase, different subtypes of breast cancer are moving in different directions and on different trajectories,” said study author Philip S. Rosenberg, PhD, a senior investigator in cancer epidemiology and genetics at the National Cancer Institute, in a statement. “These distinct patterns within the overall breast cancer picture highlight key research opportunities that could inform smarter screening and kinder, gentler, and more effective treatment.”
The American Cancer society recommends that women begin screening for breast cancer in their 20s and 30s, initially by getting to know the shape and feel of their own breasts in order to tell when something changes, and then by a clinical breast exam every three years. Once a woman turns 40, annual mammograms and clinical breast exams should begin. Some women, because of their family history or genetic makeup, should be even more vigilant with screening at an earlier age or with more intensive methods. However the statistics progress remains to be seen, but one thing is clear, taking charge of their breast health should be an essential part of every woman’s regular routine.
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