"Westernizing" Women's Risks? Breast Cancer in Lower-Income Countries (New Eng Jour Med)

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"Westernizing" Women's Risks? Breast Cancer in Lower-Income Countries
Peggy Porter, M.D.

Recent media reports have highlighted the increasing incidence of breast cancer in low- and middle-income countries. Although the disease continues to be most prominent in affluent countries, the risks of both breast cancer and death due to breast cancer are clearly increasing worldwide (see maps). Some 45% of the more than 1 million new cases of breast cancer diagnosed each year, and more than 55% of breast-cancer–related deaths, occur in low- and middle-income countries.1 Such countries now face the challenge of effectively detecting and treating a disease that previously was considered too uncommon to merit the allocation of precious health care dollars.

One hindrance to any discussion of global breast-cancer incidence is the limited data available for many countries. Incidence figures are based on data from small geographic areas that are often pooled and extrapolated to large regions. Reported rates may reflect only the women who are easiest to reach or who have the highest standard of living. Thus, current global figures cannot truly reflect the underlying economic and cultural diversity driving increased incidence and related mortality.

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The causes of increasing breast-cancer incidence and mortality in low-income countries are complex, and solutions will be country-specific. Recognizing that a practical approach is required, the Breast Health Global Initiative is developing guidelines for breast care that are "evidence-based, economically feasible, and culturally appropriate."5 Certainly, early detection must be a primary goal worldwide: given that we cannot effectively treat metastatic breast cancer in the United States, there is little hope that we'll do so in developing countries.

Source Information

Dr. Porter is a cancer biology researcher at the Fred Hutchinson Cancer Research Center and a professor of pathology at the University of Washington School of Medicine — both in Seattle.

An interview with Dr. Porter can be heard at www.nejm.org.

The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.

Full article is here:

http://content.nejm.org/cgi/content/full/358/3/213?query=TOC