KING Felipe VI and president Pedro Sánchez were in Paris on Sunday to join the centenary celebrations of the Armistice, which put an end to World War I on the 11 day of the 11 month in 1918. Sánchez and his wife...
World Breast Cancer Day: Survival at all-time high and incidence in Spain among lowest in the western world
CASES of breast cancer may be rising in number, but survival rates are higher than ever thanks to advances in medical technology – not so much in treatment methods, but in detection.
Yesterday (Friday) was World Breast Cancer Awareness Day and October is Breast Cancer Awareness Month, and the planet's media has been replete with statistics and interviews with specialists giving advice and explaining facts.
One of these was Dr Blanca Cantos, oncologist at Madrid's Hospital Puerta de Hierro who specialises in breast cancer, and who revealed that, although the disease is much more likely to be diagnosed these days, it is also far more likely to be cured – when detected early and treated in time, it is almost certain to result in a positive outcome.
Fertility, the pill, HRT and breast cancer
Dr Cantos says newly-diagnosed breast cancer patients tend to be around 60 years old, give or take five years, but that it is more likely to occur after the menopause and, for this reason, screening is routine for all women in Spain from age 45 or 50, depending upon region.
This does not mean breast cancer cannot affect younger women, of course. Dr Cantos says 7% of cases are diagnosed in women aged under 40, the majority of whom have not have children, which means information and procedures aimed at preserving fertility are becoming an important element of breast cancer treatment.
Although scientific evidence shows breast-feeding can reduce the risk of breast cancer, the fact that most of Spain's younger women diagnosed do not have children is not necessarily connected – recent figures have shown that 70% of women aged 35 do not have children, that one in five first-time mums are aged over 40, and 90% of babies in Spain are born to women aged 36-40 inclusive; the other 10% of babies are not necessarily born to women aged 35 or under, but often to those aged 41-plus.
Dr Cantos says there has been no conclusive evidence produced as yet which correlates modern-day contraceptive drugs with a higher risk of breast cancer, although specialist charities in the UK and Ireland counter that a 'slight risk' is present, both with the contraceptive pill and with hormone replacement therapy (HRT) in women going through the menopause.
However, the risk disappears within a couple of years of ceasing either treatment, according to Breast Cancer Now.
Screening and family history
Screening is not automatic in Spain for women under 45; this is largely because breast tissue is too dense for a mammogram to be of any real clinical use.
But women who have a family history, however remote, or who have found from lumps in the past or are very prone to cysts in their breasts will often be referred for ultrasound examinations either on an ad hoc basis or regularly every year or two.
This, however, may change: in the Comunidad Valenciana (eastern Spain), the regional health authority plans to send all women aged 40 or over with a family history of breast cancer for screening automatically every two years, and may even reduce the minimum age to 30, thanks to a petition raised by a survivor which netted over a quarter of a million signatures.
Mum-of-five María José Ferrer, from Jávea, paid for a mammogram at a private clinic as, at 42, she was too young for routine screening, but was concerned as her own mother had died from breast cancer aged 35.
The mammogram revealed she had the disease, and she began the petition on Change.org since she had realised that if she had waited until she was old enough for bi-annual screening, she would 'not be here'.
Her petition called for screening for all women aged 30 or over with a family history, and was presented in person at the regional government headquarters last year, where it is being debated with a view to changing procedures in the three provinces of Valencia, Castellón and Alicante.
Even before this happens, any woman with a family history – going back to the generation of her great-grandmother – should mention this to her GP.
Family history is important, since it increases the likelihood of breast cancer, but it is not the end of the story, says Dr Cantos – at present, between 5% and 7% of all types of cancer suffered are of an hereditary nature, and are typically the result of alterations in the genes BRCA1 and BRCA2 which have been passed down from female relatives.
Scientists across Europe have been working on drugs that inhibit these inherited mutations, although at present this therapy is not in regular clinical use.
Other ways to reduce the risk
Dr Cantos says leading a healthy lifestyle – a balanced diet, physical activity and avoiding alcohol and smoking – can reduce the risk of most types of cancer by up to 30%, although Breast Cancer Now says the main risks of this particular strain of the disease are simply age, being female, and genetics.
Limiting alcohol intake, keeping a healthy weight and being physically active 'isn't a guarantee against breast cancer', says the charity, but 'can help lower the chances of the disease developing'.
And oncologist Dr Teresa Maristany stresses that the 'vast majority' of women diagnosed with breast cancer 'have no identifiable risk factors'.
All charities and medics consulted stressed that one of the key risk-reducers is simply to 'know your own body' – women, and even young girls, should check their breasts regularly and, if they notice any changes in appearance, colour or shape, any unexplained pain, rash or tenderness, or lumps, go straight to their GP.
Nobody should be ashamed about 'being a time-waster' or pass off anything unusual as 'probably overreacting'; GPs will always treat women's concerns seriously and refer them for further tests.
In the overwhelming majority of cases, these 'unusual features' will indeed have a concrete cause, but one that is not serious; however, GPs will never take the chance and urge women not to be embarrassed or fearful.
Incidence of breast cancer in Spain is 'very low' and survival is high
Every year, 1.38 million women will be diagnosed with breast cancer worldwide, although in Spain, the frequency appears to be lower than elsewhere: whilst one in eight women in Britain will suffer breast cancer at some point in her life, the incidence in Spain is one in 10, according to the SESPM Society of medical specialists.
Every year in Spain, out of a population of approximately 46.5 million people, a total of between 16,000 and 26,000 cases of breast cancer are diagnosed, the former cited by the SESPM and the latter by the research and care charity AECC – yet in the UK, the number is closer to 55,000 a year.
Overall, the frequency of breast cancer in Spain is well below that of the USA, Canada, the UK, The Netherlands, Belgium, Germany, France and Switzerland, and is similar to that of other Mediterranean and central European countries, and to Portugal and Ireland.
The reasons for geographical variations in the developed world are not clear, although Dr Cantos says the Mediterranean diet may be a factor.
Men can also get breast cancer, although the incidence is fewer than 1%, generally about 350 cases a year in the UK.
Age is a factor
Dr Teresa Maristany of the SESPM says the higher number of cases detected is partly due to increased risk factors these days, with HRT being taken more frequently than 20 years ago, and partly due to better diagnostics and more regular screening.
Contrary to popular belief, the number of cases in younger women is not rising any faster than in women across the board: the appearance of this being the case is largely because the psychological and social repercussions of breast cancer in pre-menopausal women tend to be greater, especially as – although these cases are rare – the types of tumour found in women under 45 tend to be more aggressive.
Overall, Dr Maristany says, the vast majority of breast cancer diagnoses affect women aged 35 to 80, with about a quarter aged under 50 – the vast majority of these being over 40 – another quarter in women aged 70 or over and around half between women from age 50 to 69. By contrast, Breast Cancer Now says over 80% of UK cases are in women aged over 50.
Survival rates above 85% in Spain; regular screening and early diagnosis are key
Across Europe, survival rates average at between 93% a year post-treatment, and 73% after five years post-treatment, but national rates vary sharply according to the speed of diagnosis and treatment and to screening policies by country.
In the UK, five in six women – 83% - diagnosed this month will still be alive in October 2024, compared with just 50% of women diagnosed in the late 1970s, although current estimates show that 1,000 women a month die from breast cancer in the UK.
In Spain, survival rates at five years are above 85%, and the number of breast cancer sufferers who do not survive is about half that of the UK – just over 500 a month, or about 3.3% of the total number of deaths in women by any cause.
Effectively, 96.7% of deaths of women in Spain will be due to causes other than breast cancer, which helps put the risk into perspective.
Annually, five-year survival rates are going up by 1.4%, says the AECC, even without many great advances in treatment having been introduced at clinical level.
Five years is taken as the benchmark, since it is thought that the cancer will not 'come back' after this time; any cancer which appears more than five years post-treatment would normally be a new tumour, meaning check-ups become less frequent or even limited to routine bi-annual mammograms after this period and post-five year survivial statistics harder to determine.
The AECC says evidence of earlier detection being key is clear: the northern region of Navarra has seen the sharpest drop in breast cancer mortality since 1992, and it was the first of Spain's 17 autonomous communities to set up a regular screening programme, in 1990.
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