Breast cancer: some good news

Doctors involved in treating breast cancer in Ontario say there is significant and positive news in the fight against the disease. While the number of cases is up, the death rate is down. Earlier detection and improved treatments are the reasons, according to a report from Cancer Care Ontario.

Elsewhere in Canada, the picture isn’t as clear-cut. But the Breast Cancer Society of Canada says the odds for a complete recovery are highest (90 per cent) when the disease is detected early. Cancer Care Ontario reports:
· A 9 per cent decline in the mortality rate.
· Increased long-term survival after diagnosis and treatment.

The doctors say improved detection and post surgical treatments are the main reason for the drop in death rates. But the report also says:
· The incidence of breast cancer has increased by eight per cent in the decade leading up to 1996 (the most recent year for full data).

This increase in the number of cases is partly due to an increase in mammograms, and more frequent detection, according to the doctors.

“Mammograms save lives,” said Dr. Verna Mai, the director of screening for Cancer Care Ontario. “We are detecting brea cancers sooner and women are benefitting from earlier and better treatment.”

Mammogram testing
The statistics in the report reinforce the argument for frequent mammograms, even for women younger than age 50. Currently, the recommendations for breast cancer screening for women ages 40 to 49 differ from those for women ages 50 to 69, according to Health Canada.

One group of scientists argues there are no demonstrable benefits to screening women younger than 50 for breast cancer. It’s known that the chances of breast cancer increase after age 50 and especially after age 60. The official recommendation is for annual screening for women aged 50 to 69 years and over.

This year, it’s estimated that 170,000 women will be screened for breast cancer in Ontario-a 600 per cent increase over the first year of a breast-screening program begun a decade ago.

Provincial cancer rankings
Elsewhere in Canada, breast cancer incidence and mortality rates vary from province to province to territory. According to Health Canada’s breast cancer figures, the four western provinces:
· British Columbia, Manitoba, Saskatchewan and Alberta have the highest incidences of breast cancer.
· Nova Scotia, Quebec and Ontario are the top three in mortality rates.
According to a report from Health Canada called Breast Cancer in Canada, “There are many reasons why breast cancer rates may vary between areas of Canada, including differences in the way the disease is reported.” The report does not deal with the issues of access to treatment or policies regarding mammograms.

Post-surgery treatments
The Cancer Care Ontario report says the risk of breast cancer death is reduced when chemotherapy and/or hormone therapy is used after surgery. Surgery remains the primary treatment for breast cancer.

According to the report:
· By the early 1980’s, clinical trials established that therapy after surgery was effective for women whose breast cancer had spread to their lymph nodes.
· Since the early 90’s, this additional treatment is offered, even if lymph nodes do not indicate the presence of cancer cells. 

In addition, the Cancer Care report says doctors have developed increasing sophistication in the use of chemotherapy and hormone therapy for breast cancer treatment. 
· Tamoxifen is one well- known drug shown to lower the risk of breast cancer by 45 per cent among women considered at high risk for the disease.

However, two recent Tamoxifen trials in England and Italy did not find any benefit for healthy women or those from families with a history of breast cancer.
Because of side effects of blood clots and uterine cancer, Tamoxifen is recommended only for women already diagnosed with breast cancer.

· Aromasin, another new drug, was recently approved by Health Canada. It’s used only for post-menopausal women with advanced breast cancer, where Tamoxifen is no longer effective. Aromasin, like Tamoxifen, is an estrogen-suppressing drug. Certain breast cancer cells need estrogen to survive. 

Background on breast cancer:
The National Cancer Institute of Canada says:
· Breast cancer is second to lung cancer in the statistics for cancer deaths for all women
· Breast cancer is the leading cause of cancer death among women aged 40 to 55.
· Women age 60 and older show the highest incidence of breast cancer.

The Breast Cancer Society of Canada, a fundraising organization, says early detection is key in successfully battling breast cancer:
· The odds for a complete recovery are highest (90 per cent) when the disease is detected early.
· The best detection is a monthly self-examination of breasts.
· An annual check-up and assertive questioning are important defences against breast cancer.
· 80 per cent of all breast lumps are non-cancerous, but report all breast changes to a physician.

In the United States, the third Friday in October each year is National Mammography Day.  Since 1993, on this day, or throughout October, radiologists provide discounted or free screening mammograms to American women.

In both the U.S. and Canada, October is Breast Cancer Awareness Month.