Breast cancer epidemiology and demographics: Difference between revisions

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{{Breast cancer}}
{{CMG}}; {{AE}}{{Soroush}}{{Rim}}'''; Assistant Editor(s)-In-Chief:''' [[User:Jack Khouri|Jack Khouri]]; {{MGS}}
==Overview==
The prevalence of breast cancer is approximately 124.8 per 100,000 women per year. The number of deaths was 21.9 per 100,000 women per year, based on 2010-2012 data. About 1 out of 8 women in United states will develop invasive [[breast]] cancer. Annually (i . e in 2019) around 268,600 and 62,930 new cases of invasive and non-invasive (in situ) breast cancer are expected to be diagnosed respectively. In men, life time likelihood of developing breast cancer is about 1 in 883. Annually 2,670 new cases of invasive breast cancer are expected to be diagnosed in males. Breast cancer increasing pattern of [[incidence]] rates began decreasing after year 2000 in US.
==Epidemiology and demographics==
*About 1 out of  8  women in United states will develop invasive [[breast]] cancer.
*Annually (i . e in 2019) around 268,600 and 62,930 new cases of invasive and non-invasive (in situ) breast cancer are expected to be diagnosed respectively.
*In men, life time likelihood of developing breast cancer is about 1 in 883.
*Annually 2,670 new cases of invasive breast cancer are expected to be diagnosed in males.
*Breast cancer increasing pattern of [[incidence]] rates began decreasing after year 2000 in US.
*According to the results of the Women’s Health Initiative study ,published in 2002, reduced use of [[hormone replacement therapy]] (HRT) by US women might explain the observed decreasing pattern of incidence.
*Around 42000 women in the U.S. are expected to die annually from breast cancer.
*Women under 50 have experienced larger decreases.
*A decreasing pattern of death rates has been observed since 1989 which might be explained by treatment advances, earlier cancer detection courtesy of [[Screening (medicine)|screening]] programs, and increased awareness.<ref name="urlCancer Statistics Review, 1975-2015 - SEER Statistics">{{cite web |url=https://seer.cancer.gov/csr/1975_2015/ |title=Cancer Statistics Review, 1975-2015 - SEER Statistics |format= |work= |accessdate=}}</ref>
**
**
**In the subgroup of women under 45, African-American women breast incidence of breast cancer is higher compared to the  white women, and they are more likely to die of breast cancer.
**Asian, Hispanic, and Native-American women, have a lower risk of developing and dying from breast cancer.
*
===Incidence===
*[https://seer.cancer.gov/csr/1975_2015/ The following tables represent age-adjusted SEER incidence rates, 2011-2015.]
 
=== Age-Adjusted SEER Incidence<sup>a</sup> Rates, 2011-2015 ===
{| class="wikitable"
! colspan="1" |Age at Diagnosis
! colspan="1" |All Races, Females
! colspan="1" |White Females
! colspan="1" |Black Females
|-
!All ages
|31.1
|30.8
|32.1
|-
!Under 65
|23.1
|22.9
|21.9
|-
!65 and over
|86.7
|85.3
|102.9
|-
!All ages (WHO world std)<sup>b</sup>
|25.3
|25.0
|25.
|}
 
=== Age-Specific SEER Incidence Rates, 2011-2015 ===
{| class="wikitable"
! colspan="1" |Age at Diagnosis
! colspan="1" |All Races, Females
! colspan="1" |White Females
! colspan="1" |Black Females
|-
!<1
| -
| -
| -
|-
!1-4
| -
| -
| -
|-
!5-9
| -
| -
| -
|-
!10-14
| -
| -
| -
|-
!15-19
| -
| -
| -
|-
!20-24
|0.2
|0.2
| -
|-
!25-29
|0.7
|0.6
|0.8
|-
!30-34
|2.7
|2.4
|3.1
|-
!35-39
|9.6
|9.7
|8.6
|-
!40-44
|40.7
|40.5
|34.5
|-
!45-49
|62.5
|62.9
|49.4
|-
!50-54
|70.5
|70.6
|62.9
|-
!55-59
|73.1
|71.4
|79.2
|-
!60-64
|86.6
|84.0
|101.7
|-
!65-69
|108.4
|105.9
|122.0
|-
!70-74
|103.4
|101.1
|123.2
|-
!75-79
|88.0
|87.0
|112.8
|-
!80-84
|64.3
|64.2
|74.9
|-
!85+
|28.4
|28.2
|34.4
|}
 
'''Footnotes:''' ''<sup>a</sup> SEER 18 areas. Rates are per 100,000 and are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1130), unless noted.''
 
''<sup>b</sup> Rates are per 100,000 and are age-adjusted to the world (WHO 2000-2025) standard million.''
 
''- Statistic not shown. Rate based on less than 16 cases for the time interval.''


*Estimated new breast cancer cases in 2018 was 266,120 which made 15% of all new caner cases.
*The incidence of breast cancer varies greatly around the world: it is lowest in less-developed countries and greatest in the more-developed countries.
*In the twelve world regions, the annual age-standardized [[incidence rate]]s per 100,000 women are as follows:
::* in Eastern Asia,18;
::* South Central Asia, 22;
::* Sub-Saharan Africa, 22;
::* South-Eastern Asia, 26;
::*North Africa and Western Asia, 28;
::*South and Central America, 42;
::*Eastern Europe, 49;
::* Southern Europe, 56;
::*Northern Europe, 73;
::*Oceania, 74;
::*Western Europe, 78;
::*and in North America, 90.<ref>[http://www.scribd.com/doc/2350813/World-Cancer-Report-2003-Stuart-e-Kleihues-WHO-e-IARC Stewart B. W. and Kleihues P. (Eds): World Cancer Report. IARCPress. Lyon 2003] {{wayback|url=http://www.scribd.com/doc/2350813/World-Cancer-Report-2003-Stuart-e-Kleihues-WHO-e-IARC |date=20081020000016 |df=y }}</ref>


==Epidemiology and etiology==
===Prevalence===
{{main|Epidemiology and etiology of Breast cancer}}
*In 2019, around 3.1 million women are living with breast cancer in the United States.
[[Epidemiological]] risk factors for a disease can provide important clues as to the [[etiology]] of a disease. The first work on breast cancer epidemiology was done by [[Janet Lane-Claypon]], who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health.{{Fact|date=June 2007}}
*Approximately 12.3 percent of women will be diagnosed with female breast cancer at some point during their lifetime.


Today, breast cancer, like other forms of cancer, is considered to be the final outcome of multiple environmental and hereditary factors.
* Worldwide, [[breast cancer]] is the most common invasive cancer in women.  (The most common form of cancer is non-invasive [[Skin neoplasm|non-melanoma skin cancer]]; non-invasive cancers are generally easily cured, cause very few deaths, and are routinely excluded from cancer statistics.) Breast cancer comprises 22.9% of invasive cancers in women and 16% of all female cancers.<ref>{{Cite web|url=http://www.who.int/cancer/detection/breastcancer/en/index1.html|title=Breast cancer: prevention and control |work=World Health Organization |accessdate=}}</ref>
# Lesions to [[DNA]] such as [[genetic mutations]].  Exposure to estrogen has been experimentally linked to the mutations that cause breast cancer.<ref name="pmid16675129">{{cite journal |author=Cavalieri E, Chakravarti D, Guttenplan J, ''et al'' |title=Catechol estrogen quinones as initiators of breast and other human cancers: implications for biomarkers of susceptibility and cancer prevention |journal=Biochim. Biophys. Acta |volume=1766 |issue=1 |pages=63-78 |year=2006 |pmid=16675129 |doi=10.1016/j.bbcan.2006.03.001}}</ref> Beyond the contribution of estrogen, research has implicated viral oncogenesis and the contribution of [[ionizing radiation]].
# Failure of immune surveillance, which usually removes malignancies at early phases of their natural history.
# Abnormal [[growth factor]] signaling in the interaction between [[stromal cells]] and [[epithelial cells]], for example in the [[angiogenesis]] necessary to promote new blood vessel growth near new cancers.
# Inherited defects in [[DNA repair genes]], such as ''BRCA1'', ''BRCA2'' and ''p53''.


Although many epidemiological risk factors have been identified, the cause of any individual breast cancer is often unknowable. In other words, epidemiological research informs the patterns of breast cancer incidence across certain populations, but not in a given individual. Approximately 5% of new breast cancers are attributable to hereditary syndromes, while no [[etiology]] is known for the other 95% of cases.<ref name=Madigan_1995>{{cite journal | author = Madigan MP, Ziegler RG, Benichou J, Byrne C, Hoover RN | title = Proportion of breast cancer cases in the United States explained by well-established risk factors | journal = J. Natl. Cancer Inst. | volume = 87 | issue = 22 | pages = 1681-5 | year = 1995 | pmid = 7473816 | doi = | accessdate = 2007-05-26}}</ref>
* In the United States, breast cancer is the third most common cause of cancer death (after lung cancer and colon cancer). In 2007, breast cancer caused approximately 40,910 deaths (7% of cancer deaths; almost 2% of all deaths) in the U.S.<ref name="acs cancer facts 2007">{{cite web |author=[[American Cancer Society]] |year=2007 |title=Cancer Facts & Figures 2007 |url=http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf |accessdate=2007-04-26}}</ref>
* Among women in the U.S., breast cancer is the most common cancer and the second- most common cause of cancer death (after lung cancer). Women in the U.S. have a 1 in 8 lifetime chance of developing invasive breast cancer and a 1 in 33 chance of breast cancer causing their death.<ref name="acs bc key stats">{{cite web |author=[[American Cancer Society]] |month=September 18, |year=2006 |title=What Are the Key Statistics for Breast Cancer? |url=http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_breast_cancer_5.asp |accessdate=2007-04-26}}</ref> A U.S. study conducted in 2005 by the Society for Women's Health Research indicated that breast cancer remains the most feared disease,<ref>{{cite press release |title=Women's Fear of Heart Disease Has Almost Doubled in Three Years, But Breast Cancer Remains Most Feared Disease | publisher=Society for Women's Health Research | date=2005-07-07 | url=http://www.womenshealthresearch.org/site/News2?page=NewsArticle&id=5459&news_iv_ctrl=0&abbr=press_ |accessdate=2007-10-15 }}
</ref> even though [[heart disease]] is a much more common cause of death among women.<ref>{{cite web |url=http://www.nhlbi.nih.gov/health/hearttruth/press/infograph_dressgraph.pdf |title=Leading Causes of Death for American Women 2004 |accessdate=2007-10-15 |format=PDF |work=National Heart Lung and Blood Institute }}</ref>


The primary risk factors that have been identified are sex,<ref name="Giordano">{{cite journal | last = Giordano | first = Sharon H | authorlink = | coauthors = Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN | title = Breast carcinoma in men | journal = Cancer | volume = 101 | issue = 1 | pages = 51-57 | publisher =American Cancer Society | date = May 2004 | url= http://www3.interscience.wiley.com/cgi-bin/fulltext/108565241/HTMLSTART | doi = | id = | accessdate = }}</ref> age,<ref>{{cite web | title = Individual Risk Factors| publisher = BreastCancer.org | url = http://www.breastcancer.org/cmn_who_indrisk.html | accessdate = 2007-03-11}}</ref> childbearing, hormones,<ref>{{cite journal |author=Yager JD |coauthors=Davidson NE |title=Estrogen carcinogenesis in breast cancer |journal=New Engl J Med |volume=354 |issue=3 |year=2006 |pages=270-82 |id=PMID 16421368}}</ref> a high-fat diet,<ref>{{cite journal | author = Chlebowski RT, Blackburn GL, Thomson CA, Nixon DW, Shapiro A, Hoy MK, et al. | title = Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study (WINS). | journal =J Natl Cancer Inst | volume =98 | issue =24 | pages =1767-1776 | pmid = 17179478 | url =}}</ref> alcohol intake,<ref name=Boffetta_2006>{{cite journal | last = Boffetta | first = Paolo | coauthors = Hashibe, Mia; La Vecchia, Carlo; Zatonski, Witold; Rehm, Jürgen | title = The burden of cancer attributable to alcohol drinking | journal = International Journal of Cancer | volume = 119 | issue = 4 | pages = 884–887 | publisher = Wiley-Liss, Inc | date = 2006-03-23 | url = http://www3.interscience.wiley.com/cgi-bin/abstract/112550783/ABSTRACT | doi = 10.1002/ijc.21903 | accessdate = 2006-10-09 | pmid=16557583 }}</ref> obesity,<ref>BBC report [http://news.bbc.co.uk/1/hi/health/5171838.stm Weight link to breast cancer risk]</ref> and environmental factors such as tobacco use and radiation.<ref name="acs bc facts 2005-6">{{cite web |author=[[American Cancer Society|ACS]] |year=2005 |title=Breast Cancer Facts & Figures 2005-2006 |url=http://www.cancer.org/downloads/STT/CAFF2005BrFacspdf2005.pdf |accessdate=2007-04-26}}</ref>
* Since the 1970s, The number of cases has significantly increased, a phenomenon partly blamed on modern lifestyles in the Western world.<ref name="indy">{{cite news
  | last = Laurance
  | first = Jeremy
  | title = Breast cancer cases rise 80% since Seventies
  | work = [[The Independent]]
  | date = 2006-09-29
  | url = http://news.independent.co.uk/uk/health_medical/article1771835.ece
  | accessdate = 2006-10-09 }}</ref><ref>{{cite web
  | title = Breast Cancer: Statistics on Incidence, Survival, and Screening
  | work = [http://imaginis.com Imaginis Corporation]
  | date = 2006
  | url = http://imaginis.com/breasthealth/statistics.asp
  | accessdate = 2006-10-09 }}</ref>  
* According to the results of the Women’s Health Initiative study ,published in 2002, reduced use of hormone replacement therapy (HRT) by US women might explain the observed decreasing pattern of incidence.
* Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males, although it is less common.<ref name="Dave">{{cite web
  | title = Male Breast Cancer Treatment - National Cancer Institute
  | work = [http://www.cancer.gov/ National Cancer Institute]
  | date = 2006
  | url = http://www.cancer.gov/cancertopics/pdq/treatment/malebreast/healthprofessional
  | accessdate = 2006-10-16 }}</ref>
:


===Age===
===Case Fatality Rate===
The risk of getting breast cancer increases with age. A woman who lives to age 90 has a lifetime risk of about 14.3%, or one in seven.<ref>{{cite web | title = Individual Risk Factors| publisher = BreastCander.org | url = http://www.breastcancer.org/cmn_who_indrisk.html | accessdate = 2007-03-11}}</ref> The probability of breast cancer rises with age, but breast cancer tends to be more aggressive when it occurs in younger people. One type of breast cancer that is especially aggressive and that occurs disproportionately in younger people is [[inflammatory breast cancer]]. It is initially [[cancer staging|staged]] as Stage IIIb or Stage IV. It also is unique because it often does not present with a lump, so it is often undetected by [[mammography]] or [[medical ultrasonography|ultrasound]]. It presents with the signs and symptoms of a breast infection like [[mastitis]], and the treatment is usually a combination of surgery, radiation, and chemotherapy.
*Estimated death due to breast cancer in 2018 was 40,920 which made 6.7% of all caner induced death.
*The number of deaths was 21.9 per 100,000 women per year, based on 2010-2012 data.
*A decreasing pattern of death rates has been observed since 1989 which might be explained by treatment advances, earlier cancer detection courtesy of screening programs, and increased awareness.


===Sex===
Men have a lower risk of developing breast cancer (approximately 1.08 per 100,000 men per year), but this risk appears to be rising.<ref name="Giordano">{{cite journal | last = Giordano | first = Sharon H | authorlink = | coauthors = Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN | title = Breast carcinoma in men | journal = Cancer | volume = 101 | issue = 1 | pages = 51-57 | publisher =American Cancer Society | date = May 2004 | url= http://www3.interscience.wiley.com/cgi-bin/fulltext/108565241/HTMLSTART | doi = | id = | accessdate = }}</ref>


===Heredity===
In 5% of breast cancer cases, there is a strong inherited familial risk.<ref name="pmid9544766">{{cite journal |author=Malone KE, Daling JR, Thompson JD, O'Brien CA, Francisco LV, Ostrander EA |title=BRCA1 mutations and breast cancer in the general population: analyses in women before age 35 years and in women before age 45 years with first-degree family history |journal=JAMA |volume=279 |issue=12 |pages=922-9 |year=1998 |pmid=9544766 |doi=}}</ref>
Two autosomal dominant [[gene]]s, ''[[BRCA1]]'' and ''[[BRCA2]]'', account for most of the cases of familial breast cancer. Family members who harbor mutations in these genes have a 60% to 80% risk of developing breast cancer in their lifetimes.<ref name="pmid9544766"/>  Other associated malignancies include [[ovarian cancer]] and [[pancreatic cancer]]. If a mother or a sister was diagnosed breast cancer, the risk of a hereditary ‘’’[[BRCA1]]’’’ or ‘’’[[BRCA2]]’’’ gene mutation is about 2-fold higher than those women without a familial history.  In addition to the BRCA genes associated with breast cancer, the presence of ''[[NBR2]]'', near breast cancer gene 1, has been discovered, and research into its contribution to breast cancer pathogenesis is ongoing.<ref name=Beth Elton_2007>{{cite journal |author=Emilie Auriol, Lise-Marie Billard, Frederique Magdinier, Robert Dante |title=Specific binding of the methyl binding domain protein 2 at the ''BRCA1-NBR2'' locus |journal=Nucleic Acids Research |volume=33 |issue=13 |pages=4243-4254 |year=2005}}</ref>
Commercial testing for ‘’’[[BRCA1]]’’’ and ‘’’[[BRCA2]]’’’ gene mutations has been available since at least 2004.  Genetic testing for BRCA gene mutations is conducted exclusively by [[Myriad Genetics]], located in Salt Lake City.


===Diet===
[[image:Bcid.png|thumb|center|700px|Breast cancer incidence and death rates (1992-2015). [https://seer.cancer.gov/statfacts/html/breast.html Courtesy of SEER data base website. https://seer.cancer.gov/statfacts/html/breast.html]]]
Dietary influences have been proposed and examined, and recent research suggests that low-fat diets may significantly decrease the risk of breast cancer as well as the recurrence of breast cancer.<ref>{{cite journal
===Age===
  | author = Chlebowski RT, Blackburn GL, Thomson CA, Nixon DW, Shapiro A, Hoy MK, et al.
====Invasive Breast Cancer====
  | title = Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study (WINS).  
* While the overall age-adjusted [[incidence]] of invasive breast cancer among males and females in the United States between 2007 and 2011 is 67.1 per 100,000, the age-adjusted [[incidence]] of invasive breast cancer by age category is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
  | journal =J Natl Cancer Inst
** Under 65 years: 41.9 per 100,000
  | volume =98
** 65 and over: 241.6 per 100,000
  | issue =24
  | pages =1767-1776
  | pmid = 17179478
  | url =
}}</ref>
Another study showed no contribution of dietary fat intake on the incidence of breast cancer in over 300,000 women.<ref name="pmid8538706">{{cite journal |author=Hunter DJ, Spiegelman D, Adami HO, ''et al'' |title=Cohort studies of fat intake and the risk of breast cancer--a pooled analysis |journal=N. Engl. J. Med. |volume=334 |issue=6 |pages=356-61 |year=1996 |pmid=8538706 |doi=}}</ref>  A randomized controlled study of the consequences of a low-fat diet, the Women's Health Initiative, failed to show a [[statistical significance|statistically significant]] reduction in breast cancer incidence in the group assigned to a low-fat diet, although the authors did find evidence of a benefit in the subgoup of women who followed the low-fat diet in a strict manner.<ref name="pmid16467232">{{cite journal |author=Prentice RL, Caan B, Chlebowski RT, ''et al'' |title=Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial |journal=JAMA |volume=295 |issue=6 |pages=629-42 |year=2006 |pmid=16467232 |doi=10.1001/jama.295.6.629}}</ref> Another randomized trial, the Nurses' Health Study II, found increased breast cancer incidence in premenopausal women only, with higher intake of animal fat, but not vegetable fat. Taken as a whole, these results point to a possible association between dietary fat intake and breast cancer incidence, though these interactions are hard to measure in large groups of women.


In a study published in the ''Journal of the American Medical Association'', biomedical investigators found that Brassica vegetable intake (broccoli, cauliflower, cabbage, kale and Brussels sprouts) was inversely related to breast cancer development. The relative risk among women in the highest decile of Brassica vegetable consumption (median, 1.5 servings per day) compared to the lowest decile (virtually no consumption) was 58%. That is, women who consumed the most Brassica vegetables were 58% less likely to develop breast cancer.<ref>{{cite journal |author=Terry P, Wolk A, Persson I, Magnusson C title = Brassica Vegetables and Breast Cancer Risk |journal=JAMA |volume=285 |issue=23 |pages=2975-2976 |year=2001}}</ref>
* Among females, only, the overall age-adjusted [[incidence]] of invasive breast cancer in the United States between 2007 and 2011 is 124.5 per 100,000, whereas the age-adjusted [[incidence]] of invasive breast cancer by age category is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
** Under 65 years: 81.7 per 100,000
** 65 and over: 420.3 per 100,000


A significant environmental effect is likely responsible for the different rates of breast cancer incidence between countries with different dietary customs.  Researchers have long measured that breast cancer rates in an immigrant population soon come to resemble the rates of the host country after a few generations.  The reason for this is speculated to be immigrant uptake of the host country diet.  The prototypical example of this phenomenon is the changing rate of breast cancer after the arrival of Japanese immigrants to America.<ref>{{cite journal |author= Nelson N title = Migrant Studies Aid Search for Factors Linked to Breast Cancer Risk |journal=JAMA |volume=8 |issue=7 |pages=436-438 |year=2006}}</ref>
* Shown below is an image depicting the incidence of breast cancer by age and race in the United States between 1975 and 2011.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>


===Alcohol===
[[Image:Incidence of breast cancer by age and race.PNG|Incidence of breast cancer by age and race]]
Alcohol appears to increase the risk of breast cancer, though meaningful increases are limited to higher alcohol intake levels. Breast cancer constitutes about 7.3% of all cancers.<ref name=ACS_2007>{{cite web | title = Statistics for 2007 | publisher = American Cancer Society | url = http://www.cancer.org/docroot/stt/stt_0.asp | accessdate = 2007-03-11}}</ref> Among women, breast cancer comprises 60% of alcohol-attributable cancers.<ref name=Boffetta_2006>{{cite journal
  | last = Boffetta
  | first = Paolo
  | coauthors = Hashibe, Mia; La Vecchia, Carlo; Zatonski, Witold; Rehm, Jürgen
  | title = The burden of cancer attributable to alcohol drinking
  | journal = International Journal of Cancer
  | volume = 119
  | issue = 4
  | pages = 884–887
  | publisher = Wiley-Liss, Inc
  | date = 2006-03-23
  | url = http://www3.interscience.wiley.com/cgi-bin/abstract/112550783/ABSTRACT
  | doi = 10.1002/ijc.21903
  | accessdate = 2006-10-09
  | pmid=16557583 }}</ref> The UK's ''Review of Alcohol: Association with Breast Cancer'' concludes that "studies confirm previous observations that there appears to be an association between alcohol intake and increased risk of breast cancer in women. On balance, there was a weak association between the amount of alcohol consumed and the relative risk."<ref name=UKDOH_Alcohol>{{cite web | title = Review of Alcohol: Association with Breast Cancer | publisher = U.K. Dept. of Health | url = http://www.advisorybodies.doh.gov.uk/pdfs/alcbrrev.pdf | accessdate = 2007-03-11}}</ref>


The National Institute on Alcohol Abuse and Alcoholism (NIAAA) concludes that "Chronic alcohol consumption has been associated with a small (averaging 10 percent) increase in a woman's risk of breast cancer."<ref name=Friedenreich_1993>{{cite journal |author=Friedenreich C, Howe G, Miller A, Jain M |title=A cohort study of alcohol consumption and risk of breast cancer |journal=Am J Epidemiol |volume=137 |issue=5 |pages=512-20 |year=1993 |pmid=8465803}}</ref><ref name=Longnecker_1988>{{cite journal |author=Longnecker M, Berlin J, Orza M, Chalmers T |title=A meta-analysis of alcohol consumption in relation to risk of breast cancer |journal=JAMA |volume=260 |issue=5 |pages=652-6 |year=1988 |pmid=3392790}}</ref><ref name=Longnecker_1992>{{cite journal | author=Longnecker MP | title = Alcohol consumption in relation to risk of cancers of the breast and large bowel | journal = Alcohol Health & Research World | year = 1992 | volume = 16 | issue = 3 | pages = 223-229 | url= }}</ref><ref name=Nasca_1990>{{cite journal |author=Nasca P, Baptiste M, Field N, Metzger B, Black M, Kwon C, Jacobson H |title=An epidemiological case-control study of breast cancer and alcohol consumption |journal=Int J Epidemiol |volume=19 |issue=3 |pages=532-8 |year=1990 |pmid=2262245}}</ref> According to these studies, the risk appears to increase as the quantity and duration of alcohol consumption increases. Other studies, however, have found no evidence of such a link.<ref name=Chu_1989>{{cite journal |author=Chu S, Lee N, Wingo P, Webster L |title=Alcohol consumption and the risk of breast cancer |journal=Am J Epidemiol |volume=130 |issue=5 |pages=867-77 |year=1989 |pmid=2683749}}</ref><ref name=Schatzkin_1989>{{cite journal |author=Schatzkin A, Piantadosi S, Miccozzi M, Bartee D |title=Alcohol consumption and breast cancer: a cross-national correlation study |journal=Int J Epidemiol |volume=18 |issue=1 |pages=28-31 |year=1989 |pmid=2722377}}</ref><ref name=Webster_1983>{{cite journal |author=Webster L, Layde P, Wingo P, Ory H |title=Alcohol consumption and risk of breast cancer |journal=Lancet |volume=2 |issue=8352 |pages=724-6 |year=1983 |pmid=6136850}}</ref>
====In-Situ Breast Cancer====
* Among females only, the overall age-adjusted [[incidence]] of in-situ breast cancer in the United States between 2007 and 2011 is 31.7 per 100,000, whereas the age-adjusted [[incidence]] of invasive breast cancer by age category is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
** Under 65 years: 23.6 per 100,000
** 65 and over: 87.7 per 100,000


The ''Committee on Carcinogenicity of Chemicals in Food, Consumer Products Non-Technical Summary'' concludes, "the new research estimates that a woman drinking an average of two units of alcohol per day has a lifetime risk of developing breast cancer 8% higher than a woman who drinks an average of one unit of alcohol per day.<ref name=UKDOH_Chemicals>{{cite web | title = CONSUMPTION OF ALCOHOLIC BEVERAGES AND RISK OF BREAST CANCER IN WOMEN | publisher = U.K. Dept. of Health | url = http://www.advisorybodies.doh.gov.uk/pdfs/alco04nontech.pdf | accessdate = 2007-03-11}}</ref> The risk of breast cancer further increases with each additional drink consumed per day. The research also concludes that approximately 6% (between 3.2% and 8.8%) of breast cancers reported in the UK each year could be prevented if drinking was reduced to a very low level (i.e. less than 1 unit/week)." A review article from JAMA also found that breast cancer incidence seems to increase with increasing alcohol consumption.<ref name="pmid11694156">{{cite journal |author=Singletary KW, Gapstur SM |title=Alcohol and breast cancer: review of epidemiologic and experimental evidence and potential mechanisms |journal=JAMA |volume=286 |issue=17 |pages=2143-51 |year=2001 |pmid=11694156 |doi=}}</ref> It has been reported that "two drinks daily increase the risk of getting breast cancer by about 25 percent" (NCI), but the evidence is inconsistent. The Framingham study has carefully tracked individuals since the 1940s. Data from that research found that drinking alcohol moderately did not increase breast cancer risk (Wellness Facts). Similarly, research by the Danish National Institute for Public Health found that moderate drinking had virtually no effect on breast cancer risk.<ref name=Petri_2004>{{cite journal |author=Petri A, Tjønneland A, Gamborg M, Johansen D, Høidrup S, Sørensen T, Grønbaek M |title=Alcohol intake, type of beverage, and risk of breast cancer in pre- and postmenopausal women |journal=Alcohol Clin Exp Res |volume=28 |issue=7 |pages=1084-90 |year=2004 |pmid=15252295}}</ref>
* Shown below is an image depicting the [[incidence]] of in-situ versus invasive breast cancer in females in the United States between 1975 and 2011.
 
One study suggests that women who frequently drink red wine may have an increased risk of developing breast cancer.<ref name=Maggiolini_2005>{{cite journal |author=Maggiolini M, Recchia A, Bonofiglio D, Catalano S, Vivacqua A, Carpino A, Rago V, Rossi R, Andò S |title=The red wine phenolics piceatannol and myricetin act as agonists for estrogen receptor alpha in human breast cancer cells |journal=J Mol Endocrinol |volume=35 |issue=2 |pages=269-81 |year=2005 |pmid=16216908}}</ref>


"Folate intake counteracts breast cancer risk associated with alcohol consumption"<ref>Mayo Clinic news release [[June 26]] 2001 [http://www.mayoclinic.org/news2001-rst/857.html "Folate Intake Counteracts Breast Cancer Risk Associated with Alcohol Consumption"]</ref> and "women who drink alcohol and have a high folate intake are not at increased risk of cancer."<ref>Boston University [http://www.bu.edu/act/alcoholandhealth/issues/issue_may04/html/04-0506-ellison_baily.html ''Folate, Alcohol, and Cancer Risk'']</ref> Those who have a high (200 micrograms or more per day) level of [[folate]] (folic acid or Vitamin B9) in their diet are not at increased risk of breast cancer compared to those who abstain from alcohol.<ref name=Zhang_1999>{{cite journal |author=Zhang S, Hunter D, Hankinson S, Giovannucci E, Rosner B, Colditz G, Speizer F, Willett W |title=A prospective study of folate intake and the risk of breast cancer |journal=JAMA |volume=281 |issue=17 |pages=1632-7 |year=1999 |pmid=10235158}}</ref> Foods rich in folate include citrus fruits, citrus juices, dark green leafy vegetables (such as spinach), dried beans, and peas. Vitamin B9 can also be taken in a multivitamin pill.
[[Image:Incidence of in-situ vs invasive breast cancer by age.PNG|Incidence of in-situ versus invasive breast cancer by age]]


===Obesity===
===Gender===
Gaining weight after menopause can increase a woman's risk. A recent study found that putting on 9.9kg (22lbs) after menopause increased the risk of developing breast cancer by 18%.<ref>BBC report [http://news.bbc.co.uk/1/hi/health/5171838.stm Weight link to breast cancer risk]</ref>


===Hormones===
* In the United States, the age-adjusted [[prevalence]] of invasive breast cancer by gender in 2011 is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
Persistently increased blood levels of [[estrogen]] are associated with an increased risk of breast cancer, as are increased levels of the [[androgens]] [[androstenedione]] and [[testosterone]] (which can be directly converted by [[aromatase]] to the estrogens [[estrone]] and [[estradiol]], respectively). Increased blood levels of [[progesterone]] are associated with a decreased risk of breast cancer in premenopausal women.<ref>{{cite journal |author=Yager JD |coauthors=Davidson NE |title=Estrogen carcinogenesis in breast cancer |journal=New Engl J Med |volume=354 |issue=3 |year=2006 |pages=270-82 |id=PMID 16421368}}</ref> A number of circumstances which increase exposure to endogenous estrogens including not having children, delaying first childbirth, not breastfeeding, early [[menarche]] (the first menstrual period) and late [[menopause]] are suspected of increasing lifetime risk for developing breast cancer.<ref>American Cancer Society. ([[2006-10-03]]). [http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_breast_cancer_5.asp What Are the Risk Factors for Breast Cancer?] Retrieved [[2006-03-30]].</ref>
** In males: 8.3 per 100,000
** In females: 1222.3 per 100,000


[[Hormonal contraception|Hormonal contraceptives]] may produce a slight increase in the risk of breast cancer diagnosis among current and recent users, but this appears to be a short-term effect. In 1996 the largest collaborative reanalysis of individual data on over 150,000 women in 54 studies of breast cancer found a [[relative risk]] (RR) of 1.24 of breast cancer diagnosis among current [[combined oral contraceptive pill]] users; 10 or more years after stopping, no difference was seen. Further, the cancers diagnosed in women who had ever used hormonal contraceptives were less advanced than those in nonusers, raising the possibility that the small excess among users was due to increased detection.<!--
===Sex===
--><ref name="oxford 1996a">{{cite journal |author=Collaborative Group on Hormonal Factors in Breast Cancer |year=1996 |title=Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies |journal=[[The Lancet|Lancet]] |volume=347 |issue=9017 |pages=1713-27 |id=PMID 8656904}}</ref><!--
Men have a lower risk of developing breast cancer (approximately 1.08 per 100,000 men per year), however, this risk appears to be rising.<ref name="Giordano">{{cite journal | last = Giordano | first = Sharon H | authorlink = | coauthors = Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN | title = Breast carcinoma in men | journal = Cancer | volume = 101 | issue = 1 | pages = 51-57 | publisher =American Cancer Society | date = May 2004 | url= http://www3.interscience.wiley.com/cgi-bin/fulltext/108565241/HTMLSTART | doi = | id = | accessdate = }}</ref>
--><ref name="oxford 1996b">{{cite journal |author=Collaborative Group on Hormonal Factors in Breast Cancer |year=1996 |title=Breast cancer and hormonal contraceptives: further results |journal=Contraception |volume=54 |issue=3 Suppl |pages=1S-106S |id=PMID 8899264}}</ref> The relative risk of breast cancer diagnosis associated with current and recent use of hormonal contraceptives did not appear to vary with family history of breast cancer.<ref name=hormone>{{cite web |url=http://www.cancer.gov/cancertopics/pdq/genetics/breast-and-ovarian/healthprofessional#Section_340 |title=Hormone Therapy |accessdate=2006-08-12 |author=National Cancer Institute |date=2006-08-03 |work=Genetics of Breast and Ovarian Cancer}}</ref>


Data exist from both observational and [[randomized clinical trial]]s regarding the association between postmenopausal [[hormone replacement therapy]] (HRT) and breast cancer. The largest meta-analysis (1997) of data from 51 observational studies, indicated a relative risk of breast cancer of 1.35 for women who had used HRT for 5 or more years after menopause. The estrogen-plus-[[progestin]] arm of the [[Women's Health Initiative]] (WHI), a randomized controlled trial, which randomized more than 16,000 postmenopausal women to receive combined hormone therapy or placebo, was halted early (2002) because health risks exceeded benefits. One of the adverse outcomes prompting closure was a significant increase in both total and invasive breast cancers (RR = 1.24) in women randomized to receive estrogen and progestin for an average of 5 years. HRT-related breast cancers had adverse prognostic characteristics (more advanced stages and larger tumors) compared with cancers occurring in the placebo group, and HRT was also associated with a substantial increase in abnormal mammograms. Short-term use of hormones for treatment of menopausal symptoms appears to confer little or no breast cancer risk.<ref name=hormone>{{cite web |url=http://www.cancer.gov/cancertopics/pdq/genetics/breast-and-ovarian/healthprofessional#Section_340 |title=Hormone Therapy |accessdate=2006-08-12 |author=National Cancer Institute |date=2006-08-03 |work=Genetics of Breast and Ovarian Cancer}}</ref>
===Race===
According to the American Cancer Society, between the years of 2008 and 2012, breast cancer incidence rates '''increased''' among black women and Asian/Pacific Islanders. Conversely, incidence rates remained stable amongst white women, Hispanic and American Indian/Alaska Natives, for the same years.


===Environmental causes===
White women have traditionally had the '''highest''' incident rate for breast cancer. However, in '''2012''', the incidence rates for white women and black women converged.<ref name="pmid26513636">DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A (2016) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=26513636 Breast cancer statistics, 2015: Convergence of incidence rates between black and white women.] ''CA Cancer J Clin'' 66 (1):31-42. [http://dx.doi.org/10.3322/caac.21320 DOI:10.3322/caac.21320] PMID: [https://pubmed.gov/26513636 26513636]</ref>
====Tobacco====
Most studies have not found an increased risk of breast cancer from active [[tobacco smoking]], although a number of studies suggest an increased risk of breast cancer in both active smokers and those exposed to [[passive smoking|secondhand smoke]] compared to women who reported no exposure to secondhand smoke.<ref name="acs bc facts 2005-6"/>


====Radiation====
In the 2013 statistics, the incidence rate remains quite close. White women have an incidence rate of '''124.4''' per 100,000 and black women, just a little less at '''122.9''' per 100,000.
Women who have received high-dose [[ionizing radiation]] to the chest (for example, as treatments for other cancers) have a relative risk of breast cancer between 2.1 to 4.0.<!--
  --><ref name="acs bc facts 2005-6">{{cite web |author=[[American Cancer Society|ACS]] |year=2005 |title=Breast Cancer Facts & Figures 2005-2006 |url=http://www.cancer.org/downloads/STT/CAFF2005BrFacspdf2005.pdf |accessdate=2007-04-26}}</ref>


====Impact of environmental estrogenic mimics====
Although incidence rates are similar now among black and white women, there remain differences based on [[Ageing|age]] and stage at diagnosis.
Although environmental exposures are not generally cited as risk factors for the disease (except for diet, pharmaceuticals and radiation), a substantial and growing body of evidence indicates that exposures to certain toxic chemicals and hormone-mimicking compounds including chemicals used in pesticides, cosmetics and cleaning products contribute to the development of breast cancer.
A recent Canadian study concluded that female farm workers are three times more likely to have breast cancer.<ref>{{cite news | author = Ctv.Ca News Staff | title= Breast cancer more likely in farm workers: study |url= http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20061012/breastcancer_farming_061012/20061012?hub=Health| publisher= Ctv.Ca |date=2006-10-12 |accessdate=2007-03-11 }}</ref>
The increasing prevalence of these substances in the environment may explain the increasing incidence of breast cancer, though direct evidence is sparse.


====Dioxins====
[[Image:Breast cancer Incidence by race.png|thumb|center|500px|Breast Cancer incidence rates by race and age group, Courtesy of SEER database]]
Although not well-quantified, there has long been a concern about risk associated with environmental estrogenic compounds, such as [[dioxins]]. {{Fact|date=June 2007}}


====Light levels====
* Shown below is a table depicting the age-adjusted [[prevalence]] of invasive breast cancer by race in females and males in 2011 in the United States.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
Researchers at the [[National Cancer Institute]] and [[National Institute of Environmental Health Sciences]] have concluded a study that suggests that artificial light during the night can be a factor for breast cancer.<ref>''The Independent'' [http://news.independent.co.uk/uk/health_medical/article1090208.ece Avoid breast cancer. Sleep in the dark...]</ref>


===Viral breast cancer pathogenesis research===
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
Humans are not the only mammals susceptible to breast cancer. Some strains of mice, namely the house mouse (Mus domesticus) are prone to breast cancer which is caused by infection with the [[mouse mammary tumour virus]] (MMTV or "Bittner virus" for its discoverer Hans Bittner), by random insertional mutagenesis. This finding is taken to mean that a viral [[etiology]] of human breast cancer is at least possible, though there is no definitive evidence to support the claim that MMTV causes human breast cancer. For example, there may be critical differences between cancer pathogenesis in mice and people.  The understanding of the role of MMTV or other viruses in human breast cancer is preliminary as of May 2007.
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''All Races''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''White''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Black''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Asian/Pacific Islander'''  || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Hispanic'''
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Age-adjusted prevalence'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |666.3 per 100,000 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |700.1 per 100,000|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |592.9 per 100,000|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |510.9 per 100,000 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |460.5 per 100,000
|}


===Factors with minimal or no impact on breast cancer risk===
* Shown below is a table depicting the age-adjusted [[prevalence]] of invasive breast cancer by race in females in in 2011 in the United States.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
====Abortion====
Studies in rats<ref name="RUSSO3">{{cite journal |author=Russo J, Russo I |title=Biological and molecular bases of mammary carcinogenesis |journal=Lab Invest |volume=57 |issue=2 |pages=112-37 |year=1987 |pmid=3302534}}</ref> led to speculation that [[abortion]] may increase the risk of breast cancer because of hormones initiating breast tissue growth in early pregnancy. Some early interview<ref name="DALING">Daling J.R. ''et al.'' (1994) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7932822 PubMed] ''Risk of breast cancer among young women: relationship to induced abortion.'' J Natl Cancer Inst. 1994 Nov 2;86(21):1584-92.</ref> and record<ref name="HOWE">{{cite journal | author = Howe H, Senie R, Bzduch H, Herzfeld P | title = Early abortion and breast cancer risk among women under age 40. | journal = Int J Epidemiol | volume = 18 | issue = 2 | pages = 300-4 | year = 1989 | id = PMID 2767842}}</ref> based [[case-control]] studies indicated a possible correlation, but more recent record based studies<ref name="MELBYE">{{cite journal |author=Melbye M, Wohlfahrt J, Olsen J, Frisch M, Westergaard T, Helweg-Larsen K, Andersen P |title=Induced abortion and the risk of breast cancer |journal=N Engl J Med |volume=336 |issue=2 |pages=81-5 |year=1997 |pmid=8988884}}</ref><ref name="epic">{{cite journal |author=Reeves G, Kan S, Key T, Tjønneland A, Olsen A, Overvad K, Peeters P, Clavel-Chapelon F, Paoletti X, Berrino F, Krogh V, Palli D, Tumino R, Panico S, Vineis P, Gonzalez C, Ardanaz E, Martinez C, Amiano P, Quiros J, Tormo M, Khaw K, Trichopoulou A, Psaltopoulou T, Kalapothaki V, Nagel G, Chang-Claude J, Boeing H, Lahmann P, Wirfält E, Kaaks R, Riboli E |title=Breast cancer risk in relation to abortion: Results from the EPIC study |journal=Int. J. Cancer |volume=119 |issue=7 |pages=1741-5 |year=2006 |pmid=16646050}}</ref><ref name="harvard">Karin B. Michels, ScD, PhD; Fei Xue, MD; Graham A. Colditz, MD, DrPH; Walter C. Willett, MD, DrPH. "Induced and Spontaneous Abortion and Incidence of Breast Cancer Among Young Women." ''Arch Intern Med.'' 2007;167:814-820. [http://archinte.ama-assn.org/cgi/content/short/167/8/814 Abstract].</ref> and a large [[meta-analysis]]<ref>Beral V, Bull D et al, "Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 16 countries." ''Lancet,'' 2004 Mar 27;363(9414):1007-16 [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15051280 PMID 15051280]</ref> study do not support this association. The subject was examined by a [[National Cancer Institute]] (NCI) workshop in 2003, in response to the Bush Administration's alteration of the NCI's website to emphasize studies indicating a potential link.<ref>[http://oversight.house.gov/features/politics_and_science/example_breast_cancer.htm Politics and Science: Breast Cancer Risk]. Accessed [[July 23]] [[2007]].</ref> The NCI expert panel concluded, with the strongest level of evidence, that induced abortion is not associated with an increased breast cancer risk.<ref>[http://www.cancer.gov/cancerinfo/ere-workshop-report Summary Report: Early Reproductive Events and Breast Cancer Workshop], from the U.S. [[National Cancer Institute]]. Posted [[March 4]] [[2003]]; accessed [[July 23]] [[2007]].</ref>


====Deodorants====
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
Much has been made of the possible contribution of aluminum-containing underarm antiperspirants to the incidence of breast cancer, since the most common location of a breast cancer is the upper outer quadrant of the breast.  [[Aluminum]] salts, such as those used in anti-perspirants, have recently been classified as metalloestrogens. In research published in the ''Journal of Applied Toxicology'', Dr. Philippa D. Darbre of the University of Reading has shown that aluminum salts increase estrogen-related gene expression in human breast cancer cells grown in the laboratory.<ref>Harding, Anne. (2006) [http://www.cancerpage.com/news/article.asp?id=9466 Aluminum Salts Could Increase Breast Cancer Risk]. Reuters Health.</ref><ref>{{cite journal
|-
  | last =Darbre
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''All Races''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''White''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Black''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Asian/Pacific Islander''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Hispanic'''
  | first =PD
|-
  | title =Metalloestrogens: an emerging class of inorganic xenoestrogens with potential to add to the oestrogenic burden of the human breast.
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Age-adjusted prevalence'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1222.3 per 100,000 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1300.2 per 100,000|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1026.1 per 100,000|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |916 per 100,000 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |835.9 per 100,000
  | journal =Journal of Applied Toxicology
|}
  | volume =26
  | issue =3
  | pages =191-7
  | publisher =John Wiley And Sons
  | date =2006  
  | pmid = 16489580
  | url =
}}</ref><ref>{{cite journal
  | last =Darbre
  | first =PD
  | title =Aluminium, antiperspirants and breast cancer.
  | journal =Journal of Inorganic Biochemistry
  | volume =99
  | issue =9
  | pages =1912-9
  | publisher =Elsevier
  | date = 2005
  | pmid=16045991mmmmmmiii
  | url =
}}</ref>
Fortunately, this ''in-vitro'' association between aluminum salts and estrogen activity does not translate into an increased risk of breast cancer in humans. The lack of association between underarm deodorants and breast cancer has been the subject of a number of research articles.<ref name="pmid14991030">{{cite journal |author=Surendran A |title=Studies linking breast cancer to deodorants smell rotten, experts say |journal=Nat. Med. |volume=10 |issue=3 |pages=216 |year=2004 |pmid=14991030 |doi=10.1038/nm0304-216b}}</ref><ref name="pmid12543590">{{cite journal |author= |title=Antiperspirants don't cause breast cancer |journal=Harvard women's health watch |volume=10 |issue=5 |pages=7 |year=2003 |pmid=12543590 |doi=}}</ref>


====Fertility treatments====
* Shown below is an image depicting the [[incidence]] of breast cancer by race in the United States between 1975 and 2011.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
There is no persuasive connection between fertility medications and breast cancer.<ref>{{cite journal |author=Potashnik G, Lerner-Geva L, Genkin L, Chetrit A, Lunenfeld E, Porath A |title=Fertility drugs and the risk of breast and ovarian cancers: results of a long-term follow-up study |journal=Fertil. Steril. |volume=71 |issue=5 |pages=853-9 |year=1999 |pmid=10231045 |doi=}}</ref>


==References==
[[Image:Incidence of breast cancer per race.PNG|The incidence of breast cancer by race in the United States between 1975 and 2011]]
<!-- ---------------------------------------------------------------
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discussion of different citation methods and how to generate
footnotes using the <ref> & </ref> tags and the {{Reflist}} template
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{{Reflist|2}}
<small> API: Asian/Pacific Islander; AI/AN: American Indian/ Alaska Native</small>


==External links== <!-- Before adding links, make sure they meet the requirements as noted in [[WP:EL]] or they may be removed. -->
===Developing Countries===
*Breast cancer is a major public health issue in less developed countries, such as those in South America.
*Breast cancer is the leading cause of cancer-related deaths in women in countries such as  Uruguay, Argentina, and Brazil.
*For example, the expected numbers of new cases and deaths due to breast cancer in South America for the year 2001 were approximately 70,000 and 30,000, respectively.<ref>(Schwartzmann, 2001, p 118)</ref>
*Unfortunately, due to lack of funding and resources, treatment is not always available to those suffering with breast cancer.


* {{dmoz|/Health/Conditions_and_Diseases/Cancer/Breast/|Breast cancer}}
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]Rim Halaby, M.D. [3]; Assistant Editor(s)-In-Chief: Jack Khouri; Mirdula Sharma, MBBS [4]

Overview

The prevalence of breast cancer is approximately 124.8 per 100,000 women per year. The number of deaths was 21.9 per 100,000 women per year, based on 2010-2012 data. About 1 out of 8 women in United states will develop invasive breast cancer. Annually (i . e in 2019) around 268,600 and 62,930 new cases of invasive and non-invasive (in situ) breast cancer are expected to be diagnosed respectively. In men, life time likelihood of developing breast cancer is about 1 in 883. Annually 2,670 new cases of invasive breast cancer are expected to be diagnosed in males. Breast cancer increasing pattern of incidence rates began decreasing after year 2000 in US.

Epidemiology and demographics

  • About 1 out of 8 women in United states will develop invasive breast cancer.
  • Annually (i . e in 2019) around 268,600 and 62,930 new cases of invasive and non-invasive (in situ) breast cancer are expected to be diagnosed respectively.
  • In men, life time likelihood of developing breast cancer is about 1 in 883.
  • Annually 2,670 new cases of invasive breast cancer are expected to be diagnosed in males.
  • Breast cancer increasing pattern of incidence rates began decreasing after year 2000 in US.
  • According to the results of the Women’s Health Initiative study ,published in 2002, reduced use of hormone replacement therapy (HRT) by US women might explain the observed decreasing pattern of incidence.
  • Around 42000 women in the U.S. are expected to die annually from breast cancer.
  • Women under 50 have experienced larger decreases.
  • A decreasing pattern of death rates has been observed since 1989 which might be explained by treatment advances, earlier cancer detection courtesy of screening programs, and increased awareness.[1]
    • In the subgroup of women under 45, African-American women breast incidence of breast cancer is higher compared to the white women, and they are more likely to die of breast cancer.
    • Asian, Hispanic, and Native-American women, have a lower risk of developing and dying from breast cancer.

Incidence

Age-Adjusted SEER Incidencea Rates, 2011-2015

Age at Diagnosis All Races, Females White Females Black Females
All ages 31.1 30.8 32.1
Under 65 23.1 22.9 21.9
65 and over 86.7 85.3 102.9
All ages (WHO world std)b 25.3 25.0 25.

Age-Specific SEER Incidence Rates, 2011-2015

Age at Diagnosis All Races, Females White Females Black Females
<1 - - -
1-4 - - -
5-9 - - -
10-14 - - -
15-19 - - -
20-24 0.2 0.2 -
25-29 0.7 0.6 0.8
30-34 2.7 2.4 3.1
35-39 9.6 9.7 8.6
40-44 40.7 40.5 34.5
45-49 62.5 62.9 49.4
50-54 70.5 70.6 62.9
55-59 73.1 71.4 79.2
60-64 86.6 84.0 101.7
65-69 108.4 105.9 122.0
70-74 103.4 101.1 123.2
75-79 88.0 87.0 112.8
80-84 64.3 64.2 74.9
85+ 28.4 28.2 34.4

Footnotes: a SEER 18 areas. Rates are per 100,000 and are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1130), unless noted.

b Rates are per 100,000 and are age-adjusted to the world (WHO 2000-2025) standard million.

- Statistic not shown. Rate based on less than 16 cases for the time interval.

  • Estimated new breast cancer cases in 2018 was 266,120 which made 15% of all new caner cases.
  • The incidence of breast cancer varies greatly around the world: it is lowest in less-developed countries and greatest in the more-developed countries.
  • In the twelve world regions, the annual age-standardized incidence rates per 100,000 women are as follows:
  • in Eastern Asia,18;
  • South Central Asia, 22;
  • Sub-Saharan Africa, 22;
  • South-Eastern Asia, 26;
  • North Africa and Western Asia, 28;
  • South and Central America, 42;
  • Eastern Europe, 49;
  • Southern Europe, 56;
  • Northern Europe, 73;
  • Oceania, 74;
  • Western Europe, 78;
  • and in North America, 90.[2]

Prevalence

  • In 2019, around 3.1 million women are living with breast cancer in the United States.
  • Approximately 12.3 percent of women will be diagnosed with female breast cancer at some point during their lifetime.
  • Worldwide, breast cancer is the most common invasive cancer in women. (The most common form of cancer is non-invasive non-melanoma skin cancer; non-invasive cancers are generally easily cured, cause very few deaths, and are routinely excluded from cancer statistics.) Breast cancer comprises 22.9% of invasive cancers in women and 16% of all female cancers.[3]
  • In the United States, breast cancer is the third most common cause of cancer death (after lung cancer and colon cancer). In 2007, breast cancer caused approximately 40,910 deaths (7% of cancer deaths; almost 2% of all deaths) in the U.S.[4]
  • Among women in the U.S., breast cancer is the most common cancer and the second- most common cause of cancer death (after lung cancer). Women in the U.S. have a 1 in 8 lifetime chance of developing invasive breast cancer and a 1 in 33 chance of breast cancer causing their death.[5] A U.S. study conducted in 2005 by the Society for Women's Health Research indicated that breast cancer remains the most feared disease,[6] even though heart disease is a much more common cause of death among women.[7]
  • Since the 1970s, The number of cases has significantly increased, a phenomenon partly blamed on modern lifestyles in the Western world.[8][9]
  • According to the results of the Women’s Health Initiative study ,published in 2002, reduced use of hormone replacement therapy (HRT) by US women might explain the observed decreasing pattern of incidence.
  • Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males, although it is less common.[10]

Case Fatality Rate

  • Estimated death due to breast cancer in 2018 was 40,920 which made 6.7% of all caner induced death.
  • The number of deaths was 21.9 per 100,000 women per year, based on 2010-2012 data.
  • A decreasing pattern of death rates has been observed since 1989 which might be explained by treatment advances, earlier cancer detection courtesy of screening programs, and increased awareness.


Breast cancer incidence and death rates (1992-2015). Courtesy of SEER data base website. https://seer.cancer.gov/statfacts/html/breast.html

Age

Invasive Breast Cancer

  • While the overall age-adjusted incidence of invasive breast cancer among males and females in the United States between 2007 and 2011 is 67.1 per 100,000, the age-adjusted incidence of invasive breast cancer by age category is:[11]
    • Under 65 years: 41.9 per 100,000
    • 65 and over: 241.6 per 100,000
  • Among females, only, the overall age-adjusted incidence of invasive breast cancer in the United States between 2007 and 2011 is 124.5 per 100,000, whereas the age-adjusted incidence of invasive breast cancer by age category is:[11]
    • Under 65 years: 81.7 per 100,000
    • 65 and over: 420.3 per 100,000
  • Shown below is an image depicting the incidence of breast cancer by age and race in the United States between 1975 and 2011.[11]

Incidence of breast cancer by age and race

In-Situ Breast Cancer

  • Among females only, the overall age-adjusted incidence of in-situ breast cancer in the United States between 2007 and 2011 is 31.7 per 100,000, whereas the age-adjusted incidence of invasive breast cancer by age category is:[11]
    • Under 65 years: 23.6 per 100,000
    • 65 and over: 87.7 per 100,000
  • Shown below is an image depicting the incidence of in-situ versus invasive breast cancer in females in the United States between 1975 and 2011.

Incidence of in-situ versus invasive breast cancer by age

Gender

  • In the United States, the age-adjusted prevalence of invasive breast cancer by gender in 2011 is:[11]
    • In males: 8.3 per 100,000
    • In females: 1222.3 per 100,000

Sex

Men have a lower risk of developing breast cancer (approximately 1.08 per 100,000 men per year), however, this risk appears to be rising.[12]

Race

According to the American Cancer Society, between the years of 2008 and 2012, breast cancer incidence rates increased among black women and Asian/Pacific Islanders. Conversely, incidence rates remained stable amongst white women, Hispanic and American Indian/Alaska Natives, for the same years.

White women have traditionally had the highest incident rate for breast cancer. However, in 2012, the incidence rates for white women and black women converged.[13]

In the 2013 statistics, the incidence rate remains quite close. White women have an incidence rate of 124.4 per 100,000 and black women, just a little less at 122.9 per 100,000.

Although incidence rates are similar now among black and white women, there remain differences based on age and stage at diagnosis.

Breast Cancer incidence rates by race and age group, Courtesy of SEER database
  • Shown below is a table depicting the age-adjusted prevalence of invasive breast cancer by race in females and males in 2011 in the United States.[11]
All Races White Black Asian/Pacific Islander Hispanic
Age-adjusted prevalence 666.3 per 100,000 700.1 per 100,000 592.9 per 100,000 510.9 per 100,000 460.5 per 100,000
  • Shown below is a table depicting the age-adjusted prevalence of invasive breast cancer by race in females in in 2011 in the United States.[11]
All Races White Black Asian/Pacific Islander Hispanic
Age-adjusted prevalence 1222.3 per 100,000 1300.2 per 100,000 1026.1 per 100,000 916 per 100,000 835.9 per 100,000
  • Shown below is an image depicting the incidence of breast cancer by race in the United States between 1975 and 2011.[11]

The incidence of breast cancer by race in the United States between 1975 and 2011

API: Asian/Pacific Islander; AI/AN: American Indian/ Alaska Native

Developing Countries

  • Breast cancer is a major public health issue in less developed countries, such as those in South America.
  • Breast cancer is the leading cause of cancer-related deaths in women in countries such as Uruguay, Argentina, and Brazil.
  • For example, the expected numbers of new cases and deaths due to breast cancer in South America for the year 2001 were approximately 70,000 and 30,000, respectively.[14]
  • Unfortunately, due to lack of funding and resources, treatment is not always available to those suffering with breast cancer.

References

  1. ↑ "Cancer Statistics Review, 1975-2015 - SEER Statistics".
  2. ↑ Stewart B. W. and Kleihues P. (Eds): World Cancer Report. IARCPress. Lyon 2003 Template:Wayback
  3. ↑ "Breast cancer: prevention and control". World Health Organization.
  4. ↑ American Cancer Society (2007). "Cancer Facts & Figures 2007" (PDF). Retrieved 2007-04-26.
  5. ↑ American Cancer Society (2006). "What Are the Key Statistics for Breast Cancer?". Retrieved 2007-04-26. Unknown parameter |month= ignored (help)
  6. ↑ "Women's Fear of Heart Disease Has Almost Doubled in Three Years, But Breast Cancer Remains Most Feared Disease" (Press release). Society for Women's Health Research. 2005-07-07. Retrieved 2007-10-15.
  7. ↑ "Leading Causes of Death for American Women 2004" (PDF). National Heart Lung and Blood Institute. Retrieved 2007-10-15.
  8. ↑ Laurance, Jeremy (2006-09-29). "Breast cancer cases rise 80% since Seventies". The Independent. Retrieved 2006-10-09.
  9. ↑ "Breast Cancer: Statistics on Incidence, Survival, and Screening". Imaginis Corporation. 2006. Retrieved 2006-10-09. External link in |work= (help)
  10. ↑ "Male Breast Cancer Treatment - National Cancer Institute". National Cancer Institute. 2006. Retrieved 2006-10-16. External link in |work= (help)
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.
  12. ↑ Giordano, Sharon H (May 2004). "Breast carcinoma in men". Cancer. American Cancer Society. 101 (1): 51–57. Unknown parameter |coauthors= ignored (help)
  13. ↑ DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A (2016) Breast cancer statistics, 2015: Convergence of incidence rates between black and white women. CA Cancer J Clin 66 (1):31-42. DOI:10.3322/caac.21320 PMID: 26513636
  14. ↑ (Schwartzmann, 2001, p 118)


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