October 23, 2013 — Rising breast cancer incidence and mortality represent a significant and growing threat for the developing world, according to a new global study commissioned by GE Healthcare.
“Breast cancer is on the rise across developing nations mainly due to the increase in life expectancy and lifestyle changes such as women having fewer children, as well as hormonal intervention such as post-menopausal hormonal therapy,” said Bengt Jönsson, professor in health economics, Stockholm School of Economics and report co-author with Nils Wilking, M.D., Ph.D. “In these regions, mortality rates are compounded by the later stage at which the disease is diagnosed, as well as limited access to treatment, presenting a ‘ticking time bomb,’ which health systems and policymakers in these countries need to work hard to defuse.”?
Need for better consumer education
The report on “the prevention, early detection and economic burden of breast cancer” suggests that consumer understanding about breast cancer and screening methods is putting lives at risk in the developing world. For example, a recent survey in Mexico City indicated many women feel uncomfortable or worried about having a mammogram.
“It is of great concern that women in newly industrialized countries are reluctant to get checked out until it is too late,” said Claire Goodliffe, global oncology director, GE Healthcare. “This is why GE is working with a number of governments and health ministries in these regions to expand access to screening and improve consumer awareness. Some of these initiatives are making excellent progress.”
Years of healthy life lost
The study draws some interesting conclusions about the impact of breast cancer on sufferers’ lives. According to the most recent published data, 15 million years of “healthy life” were lost worldwide in 2008 due to women dying early or being ill with the disease. “Healthy life lost” is defined by years lost due to premature death and being incapacitated by the effects of breast cancer. Women in Africa, China and the United States lost the most years of healthy life. Furthermore, of the 15 million years lost globally, more than three times as many years were lost due to dying than being ill with the disease. For women in Africa, Russia, Mexico, Turkey and Saudi Arabia, the number of healthy years lost due to death were up to seven times greater than elsewhere in the world.
“The report findings suggest that a worryingly high proportion of women are still dying from breast cancer across the world and this seems to correlate strongly with access to breast screening programs and expenditure on healthcare,” said Jönsson.
He went on to highlight the distinct lack of accurate and current data in areas like breast cancer incidence and mortality, the economic burden of the disease and detailed patient-linked data on outcomes in relation to treatment patterns and stage of diagnosis.
“This limits analyses of how changes in clinical practice affect patient outcomes and needs to be addressed,” he said.
As mortality falls, quality of life is an issue
As breast cancer incidence rates have steadily increased in developed countries over the last 50 years, it is no surprise that the main focus of treatment has been survival. However as more women are now living with the disease, the report suggests that quality of life is becoming a growing issue as survival rates improve. As a result, doctors are urged to focus on measuring the impact of diagnosis and treatment on survivors’ quality of life to identify what problems patients may have and how these can be mitigated.
“This report finds a direct link between survival rates in countries and the stage at which breast cancer is diagnosed,” said Goodliffe. “It provides further evidence of the need for early detection and treatment which we welcome given current controversies about the relative harms, benefits and cost effectiveness of breast cancer screening.”
Country/continent breakdown: years of healthy life lost/ratio of healthy life lost due to death versus living with disability
Global: 15,127,050 3.2:1
Africa: 1,751,772 7.0:1
China: 1,739,518 2.8:1
United States: 1,294,414 1.6:1
Russia: 635,497 4.0:1
Germany: 460,066 1.8:1
Brazil: 427,393 2.9:1
Japan: 381,079 2.0:1
France (metropolitan): 352,920 1.5:1
United Kingdom: 340,797 1.8:1
Italy: 329,447 1.6:1
Mexico: 186,906 3.7:1
Spain: 171,311 1.8:1
Canada: 156,963 1.5:1
Turkey: 151,802 4.4:1
Australia, New Zealand: 113,459 1.5:1
Sweden: 43,202 1.6:1
Saudi Arabia: 28,253 4.5:1
For more information: newsroom.gehealthcare.com
 Webb, M. L., Cady, B., Michaelson, J. S., Bush, D. M., Calvillo, K. Z., Kopans, D. B. and Smith, B. L. (2013), A failure analysis of invasive breast cancer. Cancer. doi: 10.1002/cncr.2819, and Perry et al European guidelines for quality assurance in breast cancer screening and diagnosis: Fourth Edition http://www.euref.org/european-guidelines