EUROPA DONNA – The European Breast Cancer Coalition

Breast Health Day Key Messages and Facts

KEY MESSAGES

• Living a healthy, active lifestyle, avoiding weight gain and obesity can help maintain healthy breasts. Studies show that about one-third of breast cancer cases can be attributed to increased weight and physical inactivity.

• Growing evidence supports that there is a protective association between physical activity and breast cancer, preferably over a lifetime, but probably beneficial even if begun after menopause.

• Women should limit their weight gain in adult life and maintain a body mass index (BMI) of 18.5-24.9. They should also try to limit their amount of abdominal fat. In women who have had breast cancer, maintaining a healthy weight may reduce the chances of recurrence.

• Engaging in moderate exercise for at least 30-60 minutes every day may help maintain breast health.

• Eating a well-balanced diet (with fat intake not exceeding 30%), including fresh fruit and vegetables in your daily food choices and limiting intake of red meat, has numerous health benefits.

• Limiting alcohol intake to one glass of wine or beer a day (10 grams of alcohol or less per day) can help keep breasts healthy.

• Having children at a younger age, having several and breast-feeding them also protects against breast cancer.

• Seriously considering the pros and cons of taking hormone replacement therapy and discussing them with your physician can influence future health.

• Mammography is widely accepted as the best method to detect breast cancer early.

• Participating in population-based mammography screening programmes can help detect potential problems early. Studies show that women who attend screening have a greater chance of surviving a breast cancer diagnosis.

FACTS ABOUT LIFESTYLE AND BREAST CANCER

• The increasing number of breast cancer cases may be due to changes in lifestyle habits, increase in sedentary lifestyle, weight gain and obesity and sociological changes such as increasing age at first birth and decreasing number of children born to women.¹

Physical activity and weight

• Excess body weight and physical inactivity account for approximately 25–33% of breast cancer cases.²

• Postmenopausal women who are obese (body mass index > 30) have a 30% greater probability of developing breast cancer than those with a normal weight.³

• Inactivity is estimated to cause 10-16% of all breast cancer cases.²

• The effect of weight loss is independent of physical activity.²

• A large amount of abdominal fat may increase the risk of breast cancer.⁴

• A Western diet (highly caloric food rich in animal fat and protein), often combined with a sedentary lifestyle and hence energy imbalance, increases the risk of breast and other cancers.⁵

• In the EU-27, an average of 60.9% of women aged 55-64 (ranging from 43.1% in Denmark to 78.1% in Czech Republic) and an average of 37.1% of women aged 35-44 (ranging from 21.3% in Italy to 56% in the UK) are overweight or obese.⁶

Alcohol consumption

• The relative risk of breast cancer in women with a high consumption of alcohol is approximately twofold.⁵

• In women, approximately half of the neoplasms attributed to alcohol drinking are breast cancers.⁵

Reproductive factors

• Having children at a younger age, having several and breast-feeding them can protect against breast cancer.⁷

• Having first menstruation at an early age and menopause at a late age increase the probability of developing breast cancer.⁷

Hormonal treatments

• There is a very clear connection between hormone replacement therapy (HRT) and the risk of developing breast cancer.8,9 In the Million Women Study, current users of HRT at recruitment were more likely than never users to develop breast cancer (adjusted relative risk 1.66).¹⁰ Breast cancer risk increases the longer HRT is taken.^8,9

• The International Agency for Research on Cancer (IARC) now considers combined oestrogen–progestogen menopausal therapy to be carcinogenic. Numerous studies have reported an increased risk of breast cancer in women who currently use or have recently used combined oestrogen–progestogen therapy.¹¹

• An IARC evaluation of the cancer risk with oral contraceptive use concluded: “There is sufficient evidence in humans for the carcinogenicity of combined oral oestrogen–progestogen contraceptives. This evaluation was made on the basis of increased risks for cancer of the breast among current and recent users only.”  The risk was particularly noted in women who were under 35 years of age at diagnosis and had begun using contraceptives when young (< 20 years). This risk appears to be no longer present 10 years after stopping treatment.¹¹

FACTS ABOUT MAMMOGRAPHY SCREENING

• Studies show that women who attend mammography screening have a greater chance of surviving a breast cancer diagnosis; it is estimated that deaths from breast cancer to be reduced by about 35% in women aged 50-69 who participate in screening.⁵

• While studies have shown that breast clinical examination and self-examination do not reduce breast cancer mortality, they may help to detect interval cancers (cancers appearing between screening rounds).⁵

• Population-based breast cancer screening programmes should be implemented and conducted according to the recommendations in the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis.

Breast cancer screening in the EU

• Experience in the Europe Against Cancer Programme indicates that that the overall burden of breast cancer and the great disparity in this burden between EU Member States could be substantially reduced by implementation of population-based screening programmes of appropriate high quality.¹²

• In 2007 more than 59 million women in the EU were of the target age for breast cancer mammography (50–69 years). Four out of 10 women in this age group in the EU (41%) were targeted for breast cancer screening by 11 Member States in which nationwide rollout of population-based programmes was complete in 2007. A slightly higher proportion of the women in this age group in the EU (44%) were targeted for breast cancer screening by the seven Member States in which nationwide rollout of population-based breast screening programmes was ongoing in 2007.¹²

• In the Member States which have adopted a population-based approach for breast cancer screening, the smallest target age range is 50–59 years and the largest age range is 40–74 years.¹²

• In 2007, over 64 million women in the EU were targeted for, and approximately 12 million women attended breast cancer mammography screening programmes.¹²

FACTS ABOUT BREAST CANCER

Incidence

• Breast cancer is the most common cancer in women worldwide, with over 1 million new cases reported annually.¹³

• Breast cancer is the most common cancer in European women with an estimated 430,000 new cases every year.¹⁴

• There are twice as many new breast cancer cases annually than new cases of cancer in any other site. ¹⁵

• One in 10 women in the EU-27 will develop breast cancer before she reaches 80 years of age.¹⁶

• An average of 20–30% of breast cancer cases in Europe occur in women when they are younger than 50 years old; 33% occur at age 50–64 and the remaining cases in women above this age.16 Breast cancer therefore affects many women during their years dedicated to working and raising a family.

Mortality and survival

• Breast cancer claims the lives of more European women than any other cancer.¹⁴

• In Europe, almost 132,000 women died from breast cancer in 2006.14

• The average 5-year relative survival of European women diagnosed with breast cancer in 1995-1999 was 79.5%.¹⁷

• If detected early, most breast cancers can be controlled if managed properly. The disparity in breast cancer mortality among different geographical areas suggests that the efficacy of the health care systems may have a greater influence on mortality than background risk of the disease.¹⁸

REFERENCES

1. The International Agency for Research on Cancer, press release no. 182, 4 Feb 2008.
2. The International Agency for Research on Cancer.
3. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Washington DC: AICR 2007.
4. Abrahamson PE, Gammon MD, Lund MJ, Flagg EW, Porter PL, Stevens J et al. General and abdominal obesity and survival among young women with breast cancer. Cancer Epidemiol Biomarkers Prev 2006, 15(10): 1871-7.
5. World Health Organization, World Cancer Report 2003.
6. Eurostat.
7. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 2002, 360: 187-95.
8. Women’s Health Initiative Study (www.whi.org).
9. Million Women Study (www.millionwomenstudy.org).
10. Million Women Study Collaborators. Breast cancer and hormone replacement therapy in the Million Women Study. Lancet 2003, 362: 419-27.
11. Combined Estrogen-Progestogen Contraceptives and Combined Estrogen-Progestogen Menopausal Therapy. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 91, 2007.
12. Cancer Screening in the European Union. Report on the Implementation of the Council Recommendation on Cancer Screening. First report. European Commission, 2008.
13. Ferlay J, Bray F, Parkin DM, Pisani P (eds.). Globocan 2000: Cancer Incidence and Mortality Worldwide. IARC Cancer Bases No. 5. IARCPress: Lyon 2001.
14. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007; 18(3): 581-92.
15. Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide. IARC CancerBase No. 5, version 2.0. IARCPress: Lyon 2004.
16. Curado MP, Edwards B, Shin HR, Storm H, Ferlay J, Heanue M et al. Cancer Incidence in Five Continents, Vol. IX, IARC Scientific Publications No. 160. IARCPress: Lyon: 2007.
17. Berrino F, De Angelis R, Sant M, Rosso S, Bielska-Lasota M, Coebergh JW et al. EUROCARE Working group. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncol 2007, 8(9): 773-83.
18. European Union Public Health Information System (www.euphix.org).

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