Because genetic predisposition and exposure to risk factors do cause breast cancer, and incidence ist not affected by the developmental stage of the respective health care system.

Stress. You would find many articles and studies which would point to stress as an important trigger.

Stress is a very broad concept which involves job stress (not having a job or working too much could both trigger it) but also mental stress and various lifestyle factors incl. obesity, food, medicines, exposure to chemicals (above all household cleaning and beauty care products). I think the latter will be studied in depth in the years to come and I am convinced the link (chemicals exposure - cancer) will be positive, similarly to what is already observed in many allergy cases.

You can read more on chemicals exposure and how industry responds here: http://www.breastcancerfund.org/

http://www.breastcancerfund.org/media/in-the-news/

I interpret "major health problems" to mean "higher incidence rates." Multiple factors most likely contribute to the development of breast cancer, where there may be compounded effects. Environmental, genetic, and stress factors have been suspect and studied for decades. Chemotherapy itself raises the risk, albeit relatively small, of the patient's developing a secondt cancer.

When technology, treatment protocols, and patient education are improved, as would be expected in the best healthcare facilities, early detection and survival rates are also expected to rise. Part of the noted increase may be due to earlier detection, improved survival, and more complete statistics.

Thank you everybody

You have to consider that Western women smoke, use contraceptive drugs and drink alcohol, all recognized risk factors for breast cancer. The lifestyles have changed in a few years eg in mediterranean area, in fact, in some countries (Italy, Greece, Spain, etc..) the expected rates of these cancers are increasing today despite efficient tools of prevention are easy accesible.

You may also want to consider average age of the population (broadly speaking, cancer is a disease of old age, breast cancer is no exception), mammography screening (there is a heated debate whether the aforementioned state of the art health system is actually driving over-diagnosis and over-treatment). Also, the mammary gland is a unique organ in that its normal physiology requires cyclical expansion/proliferation and collapse/involution, making it more susceptible to malignancy compared with non cycling cells. So even taking away smoking, stress, diet and contraceptives that people rightly noted as key factors in increased risk, breast cancer will lead incidence numbers due to its inherent biology.

Although all the factors mentioned above are important one of the main reason that this is a major health problem in these countries is that there is a high level of awareness regarding breast cancer in these populations and so more people go for screening. such as mammography. This results in early detection resulting a high incidence. Also because the cancer is detected in the early stages as well in these countries the survival rates have also improved in the last 20 years.

You should definitely read the interview with Jeanne Rizzo - CEO of the Breast Cancer Fund - published yesterday. She speaks of the various causes of breast cancer (links to studies provided) and how she's been working on prevention policies:

"How looking for cancer’s causes became a political act":

http://grist.org/politics/how-looking-for-cancers-causes-became-a-political-act/

She mentions hormone replacement therapy, toxic chemicals, endocrine-disrupting compounds and environmental factors (e.g. air and water pollution) as major risk factors.

Here are also two articles published by Cancer Research UK:

"Why Are Breast Cancer Rates Increasing?" (2011)

http://scienceblog.cancerresearchuk.org/2011/02/04/why-are-breast-cancer-rates-increasing/

"Breast Cancer in Women Under 50 Tops 10,000 Cases for First Time" (2013)

http://www.cancerresearchuk.org/about-us/cancer-news/press-release/breast-cancer-in-women-under-50-tops-10000-cases-for-first-time

Thank you Aftab, Hristina, Hematram and all others for you valuable answers.

Aftab the reasons you are telling are quiet new for me. I would be grateful if you can share some material with me as i am working on this issue in Pakistan. My study is related to the health communication efforts in Pakistan.

Our own epi data (like those mentioned by Aftab) confirm the well known role of late first childbirth, no breast-feeding experience, never being married and some other anomalities of the reproductional history as breast cancer (BC) risk factors. Add to it alcohol overindulgence, fat-rich food, ionizing radiation and many other environmental risk factors (but evidently not smoking that proved to be important for lung, gastric and colorectral cancers). Some of these factorsmay be present in one locality more than in another thus explaining difference of BC morbidity between townships, regions and perhaps countries too.

If you go to http://www.omfi.hu/cejoem/Volume15/Vol15No1-2/CE09_1-2-03.html

you'll see a paper in which some of the above results are tabulated.

Below are somewhat updated data from the article I feferred to yextersay:

A summary of the main results of the case-control study on individual cancer-risk factors1) in Karpinsk (Sverdlovsk region, Russia)

Lung, gastric and colorectal cancers

A.The most important factors increasing probability of cancer common for all the three sites:

1. SMOKING – especially of cigarettes without filters; more than 20 cigarettes a day; a long history of smoking.

2. OVERINDULGENCE IN ALCOHOL.

3. EMPLOYMENT IN ANY INDUSTRY.

4. “UNCOMFORTABLE” HOUSING (no piped water supply, poor sanitation, use of indoor coal burners for heating, water boiling and especially for cooking).

5. COAL-FIRED KITCHEN OVEN (irrespective of housing type).

6. BEING A PERMANENT RESIDENT (as opposed to immigrant).

For lung cancer only:

CHRONIC BRONCHITIS.

For gastric cancer only:

CHRONIC GASTRITIS AND GASTRIC ULCER.

For colorectal cancer only:

LIVER DISEASES.

B. Factor decreasing probability of gastric and colorectal cances:

PREFERRING MILK-VEGETABLE-FISH DIETS.

Breast cancer

A.Factors increasing probability of cancer:

1. HISTORY OF OTHER (BUT ESPECIALLY OF GYNECOLOGICAL) CANCERS.

2. HISTORY OF SURGERY ON BREASTS and/or OF MASTITIS.

3. OVERINDULGENCE IN ALCOHOL.

4. PREFERRENCE FOR FAT-RICH FOOD.

5. HAVING NEVER BEEN MARRIED.

6. LATE FIRST CHILDBIRTH.

7. HAVING NEVER BREAST- FED.

8. ENDOCRINE DISEASES.

9. LIVING IN A NON-TIMBER HOUSE.

10. COAL-FIRED KITCHEN OVEN.

11. BEING A PERMANENT RESIDENT (as opposed to immigrant).

B. Factors decreasing probability of cancer:

1. Childbirth ever.

2. Moderate alcohol drinking.

3. Liver diseases (negatively correlated with preference for fat-rich food).

1)Only those individual risk factors are given for which the adjusted odds ratio differs from 1.0 statistically significantly (P between

Moderate alcohol drinking? This is insane. According to American, British and European research

(just 3 articles as an example: http://www.independent.co.uk/life-style/health-and-families/health-news/even-light-drinking-increases-cancer-risk-8081431.html;

http://www.cancer.org/cancer/news/expertvoices/post/2013/06/26/does-drinking-alcohol-increase-the-risk-of-cancer.aspx

http://www.medscape.com/viewarticle/761187),

any doses of alcohol for women increase the risk.

Dear Hristina, who taught you to characterize any results of a serious study as insane? Shame on you!

It doesn't matter whether the lives of Russian or other women are at stake. There is not a single self-respecting physician or medical researcher who would confirm that moderate alcohol consumption reduces the risk for breast cancer. The risks for women's health outweigh the benefits for heart disease and depression. What is more striking, now researchers are convinced that there is no threshold, meaning that any doses of alcohol including light alcohol significantly increase the risk for breast cancer along with some other types of cancer. A meta-analysis estimated that light drinking caused 5,000 deaths worldwide in 2004:

http://annonc.oxfordjournals.org/content/24/2/301.long

http://nutritionfacts.org/video/breast-cancer-and-alcohol-what-much-is-safe/

http://www.everydayhealth.com/cancer/alcoholic-cancer-link-study-shows-one-drink-per-day-raises-risk.aspx

Just like the tobacco industry had to cope with losses and many lives were saved thanks to the sanity of American politicians, I hope that the same will happen - although slowly - with the alcohol lobbies. There is some hope that over time people will change their lifestyles (not without public policies being considered) - some terrifying facts are being publicly exposed through research in this direction .

Well, well - so now I am not a self-respecting medical researcher, being an alcohol lobbyist into the bargain. So now, if in a case-control study on breast cancer one finds for moderate drinking an adjusted OR that is statistically significantly less than 1.0 one should rather hide this result unless one wants to be called bad names by an angry teatotaller. As they say, if facts contradict a theory, all the worse for facts!

Still with respect (even if marginal)

Professor Boris A. Katsnelson, MD, DSc

A honored scientist of the RF

Dear Attab, thank you very much indeed for your flattering comments. Having got no upvotes (and a harsh criticism pertaining to the matter that is really important but has virtually nothing to do with the Sahifa/s question) I was ready to believe that nobody was interested in our results and speculations based on them.

Because of low health literacy on Breast Self Examination

Well...there could be several reasons behind. I think the following two facts are most important:

1. There are several life style and environment related risk factors in these societies

2. Breast cancer has no major symptoms, especially in its early stages so that people may not tend to seek for health care.

Attab: I'd add: (a) avoiding unnecessary high-dose x-ray diagnostic

procedures; (b) teaching pregnant women how to prepare nipples for the

breast-feeding as to decrease probabilty of fissures and thus of

mastitis; (c) avoiding fat-rich food; (d) avoiding overindulgence in

alcohol. As to smoking, even if we (like some other researchers)

failed to find an association between it and the breast cancer risk,

there are, above any doubt, many adverse outcomes pertaining to the

course of pregnancy and to infants' and children's health proven too

many times by many epi studies, ours included. So if a woman decides

to bear, deliver and breast-feed babies (as a breast cancer-preventive

strategy or simply because she wants to have children) smoking should be

a taboo for her forever.

About your not voting my answers up - please take it easy.

To add: see in my "Contributions" list

INDIVIDUAL AND ENVIRONMENTAL RISK FACTORS INFLUENCING PREGNANCY COURSE, DELIVERY OUTCOMES, NEWBORN STATUS AND HEALTH OF INFANTS DURING THE FIRST YEAR OF LIFE IN THREE INDUSTRIAL TOWNSHIPS OF THE MIDDLE URALS, RUSSIA

by Boris A Katsnelson, Sergey Kuzmin, Larissa L Privalova, Jouni J K Jaakkola, L Malykh, Anastasia V Porovitsina, Tatyana A 0boskalova, Vladimir B Gurvich

European epi marker. 06/2006; 10(3):1-8.

The answer is simple: a good health facility does not prevent you from developing cancer. Hopefully, it helps you detect a cancer early and correctly and offers effective treatment. But the RISK of developing a cancer depends on risk factors...and risk factors for breast cancer are highly prevalent in the US and UK....

Dear Esther, just which risk factors (mentioned in this discussion or others) are prevalent in the US and UK more than in continental European countries? (Honestly, I believe that nothing is simple in the cancer epidemiology,)

In fact Boris, I just checked the facts, age-standardised incidence rates in UK are ranking 6th in Europe, after Belgium, Denmark, France, the Netherlands and Iceland, so as I said in my previous message, the risks of breast cancer is high in UK and USA but not higher than in similar countries...reasons: risk factors like late age at first child, short breastfeeding, few children, birth controll pill, but also good screening programs and good registries allowing every case to be detected and reported.

Esther, are not " late age at first child, short breastfeeding, few children, birth controll pill " typical for all countries you listed? Is Cancer Register in the UK less reliable as compared with that in Belgium? Still these countries rank differently - why? That is what I meant stating " that nothing is simple in the cancer epidemiology"

On a smaller scale, we tried to understand why one small town in our region (Region) has much higher cancer morbidity rate as compared with many other small, medium and big municipalities, many of them much more industrialized and polluted with known carcinogens (for instance, Asbest town - the name speaks for itself) - I gave some results of that study in one of my previous answers.

Dear Boris,

ACtually it is quite simple, incidence is very similar in Belgium and UK, slightly higher in Belgium, but biology is never 100% the same, neither are populations never 100% the same. Differences in age standardised rates between these countries are minimal. In fact, the cancer registry in the UK is probably MORE reliable than the one in Belgium, but that is a whole methodological discussion. The point I would like to make with regards to the original question, is that the incidence of cancer in a country does not heavily depend on the quality of the healthcare system (there should be enough healthcare system to get diagnosed of course)... but on prevalence risk factors, and those are highly prevalent in US and UK in the case of breast cancer (and several other types of cancer).

Comparing small towns in the regions is very challenging, as you run into the problem of ´small numbers´ and therefore small differences in quality or even random fluctuations (unstable estimates) can seemingly cause differences, or hide existing differences....but I think this is a whole methodological issue that is different from the original question posed here.

Best wishes to all

Esther

Dear Esther:

A. " the incidence of cancer in a country does not heavily depend on the quality of the healthcare system " - above any doubt!

B. "Comparing small towns in the regions is very challenging, as you run into the problem of ´small numbers´ and therefore small differences in quality or even random fluctuations (unstable estimates) can seemingly cause differences" - here you are right in general but wrong in our particular case as the 1st rank of Karpinsk was and is very stable during a long period. By the way, it is not so small indeed (population about 40 000).

Best wishes from this end too.

As rightly mentioned by Esther Vries that good health facility does not prevent you from getting breast cancer. to add to her it is more likely to have more number of people diagnosed with breast cancer or any other disease with better health facility in place.

Better health facility will pick up the disease more efficiently, provide better care thus prolong the life of diseased and both will together result in high prevalence of disease.

As she has already mentioned incidence depends on risk factor, has nothing to do with availability of best health facility.

Dear Smita,

20 days ago I agreed with Esther that "" the incidence of cancer in a country does not HEAVILY depend on the quality of the healthcare system " and I still think that this statement is correct if we are speakin about rather strong associations. But

when stating that " incidence ... has ТЩЕРШИП to do with availability of best health facility", please keep in mind that some rather important individual risk factors for breast cancer are of medical character and thus connected with the healthcare quality (for instance, history of mastitis, badly performed breast surgery, unnecessary frequent chest x-rays, poor health education of female population by doctors and district nurses resulting in women's ignorance regarding concequences of having no children and of not breast-feeding them). I am not sure that all this cannot overbalance the quasi-incidence-decreasing factor of poor diagnostics. Generally speaking, good heathcare system would in the final count lead to a decrease in the incidence of any disease even if can start with seemingly increasing it.