Risk factors in breast cancer: can we change something

Abstract

Breast cancer is the commonest cancer in women worldwide with a widely variable incidence between countries and regions. The developed countries with a small proportion of the world population account for almost 50% of breast cancers diagnosed worldwide.1The incidence of breast cancer is low in India, but rising. Breast cancer is the commonest cancer of urban Indian women and the second commonest in the rural women.2 Owing to the lack of awareness of this disease and in absence of a breast cancer screening program, the majority of breast cancers are diagnosed at a relatively advanced stage. India is a sub-continent with wide ethnic, cultural, religious, and economic diversity and variation in the health care infrastructure. The health care facility pattern is heterogeneous, with numerous regions where the benefits of the awareness, early diagnosis, and multidisciplinary treatment programs have not reached. As per the ICMR-PBCR data, breast cancer is the commonest cancer among women in urban registries of Delhi, Mumbai, Ahmedabad, Calcutta, and Trivandrum where it constitutes >30% of all cancers in females.2 In India, breast cancer is the second most common cancer (after cervical cancer) with an estimated 115,251 new diagnoses and the second most common cause of cancer-related deaths with 53,592 breast cancer deaths in 2008.3 The age-standardized incidence rate for breast cancer in India is 22.9 per 100,000, one-third that of Western countries, and the mortality rates are disproportionately higher.3 Breast cancer accounts for 22.2% of all new cancer diagnoses and 17.2% of all cancer deaths among women in India. Breast cancer in urban areas of India is three times higher than in rural parts of the country.4