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Breast cancer in the menopause

Breast cancer in the menopause. Anne Gompel, Geneviève Plu-Bureau and Jean-Michel Foidart. Breast c ancer. 1 , 151,298 million newly diagnosed cases annually in the world ASR* = 37.4/100,000/year 410,712 death s from breast cancer ASR* = 13.2/100,000/year

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Breast cancer in the menopause

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  1. Breast cancerin the menopause Anne Gompel, Geneviève Plu-Bureau and Jean-Michel Foidart

  2. Breast cancer • 1,151,298 million newly diagnosed cases annually in the world • ASR* = 37.4/100,000/year • 410,712 deaths from breast cancer • ASR* = 13.2/100,000/year • 20–30% ofall cancers in women *ASR = age-standardized rate or age-adjusted http://www-dep.iarc.fr/

  3. Globally, breast cancer is the most prevalent cancer in women ASR (incidence): 37.7 ASR (deaths): 13.2 New cancer cases (all ages), females 5,060,657 1151289 (22.7%) 493243 (9.7%) 472687 (9.3%) 386891 (7.6%) 330518 (6.5%) 204499 (4.0%) 198783 (3.9%) 184043 (3.6%) 146723 (2.9%) 1491972 (29.5%) http://www-dep.iarc.fr/ Globocan 2002, IARC

  4. Risk factors, RR 1–2 High risk Low risk Socioeconomic status High Low Oophorectomy < 40 years No Yes Nulliparity Yes No Age at first full-term pregnancy (years) ≥ 30 < 30 Age at menarche (years) ≤ 11 ≥ 15 Age at menopause (years) ≥ 55 < 45 Personal history of endometrial Yes Noor ovarian cancer Obesity: postmenopausal breast cancer Obese Lean Obesity: premenopausal breast cancer Lean Obese Breast feeding (premenopausal cancer) > 12 months Exercise > 2 hours/week

  5. Randomized, controlled trials: results HERS II WHI E + P E + P E Follow-up (years) 6.8 6.2 7.1 RR of BC (ITT) 1.27 1.26 0.80 95% CI 0.8–1.9 1.0–1.6 0.62–1.04 RR of BC (adherent) 1.49 0.67 95% CI 1.13–1.96 0.47–0.97 Hulley JAMA 1998; Chlebowski JAMA 2002, JAMA 2003; Stefanick, JAMA 2006

  6. HT may promote pre-existing tumors but does not induce new breast cancer • In all recent studies, former HT users have no increased risk • Breast cancer risk related to HT decreases rapidly after cessation of treatment • HT increases the incidence of preinvasive (in situ) lesions in the Million Women Study in current users

  7. Density • Spontaneous increased density: RR increased 3–6 times • Density during HT • Edema • Stroma (androgens?) • No increase in proliferation • Breasts with increased density : RR increased by a low sensitivity • Increase the frequency of mammograms in US

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