breast cancer research in the developing world dr. steven narod canada research chair in breast...
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Breast Cancer Research in the Developing World
Dr. Steven NarodCanada Research Chair in Breast CancerBoston – November 2009
Annual numbers of breast cancers Top 10 countries
China 224,000
USA 195,000
India 113,000
Germany 53,000
Russia 52,000
Italy 38,000
Brazil 38,000
France 38,000
United Kingdom 36,000
Indonesia 28,000
Breast Cancer Cases by Continent Asia 508 South America 82 Africa 69 Central America 18 (677)
North America 213 Europe 324 Australia 11
(548)
By Stage of Development
Developing 739
Developed 486 (IMF)
Why do research in developing world?
Major cause of death in those countries
Most breast cancers occur in developing world
Rates may be increasing
Populations aging
Better understanding of variation in patterns, etiology
Might lead to understanding in North America
Different stage at presentation
Might be specific etiology for other ethnic groups
Planning of services
Milestones
Examples Advanced cancers:
Different than North America From stage 4 to death
Metastastic oophorectomy/tamoxifen
New drugs
(Raises ethical issues)
Recessive genes
Different diets
Different environmental exposures
Questions about Etiology
Towards a Standard Set of Descriptors
Population or hospital-based
Private or Public
Prevalent or incident cases
One year of diagnosis, several year of diagnosis
Variables to Collect Age of diagnosis
Means of detection patient, physician, mammography
Size Nodes examined Nodes positive Locally advanced Clinical Stage Grouping (early, locally advanced,
metastatic)
ER PR HER2 Grade
Variables to Collect, cont….
o Treatment
o Radiotherapy (y/n)
o Chemotherapy
o Regimen
o Surgery
o Mastectomy
o Lumpectomy
o Bilateral mastectomy
o Hormonal therapy
o Oophorectomy
o Age of oophorectomy
o Tamoxifen
o Aromatase inhibitors
o Menopausal status at diagnosis
o Age of menopause
o Date of last follow-up
o Date of Death
o Cause of Death
Questions to address
Are people getting appropriate treatment?
Is stage at presentation improving?
Is treatment effective?
Western model applied to developing countries Promotes two-tiered system
May not be best approach for population
Access and affordability
All populations may not respond the same
Possible recessive basis for breast cancer Test of recessive disease, parents related
Test in children of consanguinous parents
Homozygosity mapping
Countries with high rates of consanguinity: Pakistan Bangladesh Yemen Saudi Arabia
Risk Factors May Differ
Vietnam: 300 cases and 300 hospital controls
No effect of family history No effect of parity Very low frequency of BRCA1
and BRCA2
Different risk factors?
Hypothesis
There are no common risk factors for breast cancer.